Introduction

Recently, monkeypox has become a public health concern, especially after outbreaks were reported outside of its usual endemic regions. Although it is not as well-known as other infectious diseases, monkeypox has gained the attention of health authorities because of its potential for widespread transmission and its similarities to smallpox. This article explores the details of monkeypox disease, including its causes, symptoms, treatment options, and preventive measures.

What is Monkeypox (Mpox)?

Monkeypox is a rare viral zoonosis (a virus transmitted to humans from animals) caused by the monkeypox virus, a member of the Orthopoxvirus genus in the family Poxviridae. The disease was first identified in 1958 when two outbreaks occurred in colonies of monkeys kept for research, which define the name “monkeypox.” The first human case of monkeypox was reported in 1970 in the Democratic Republic of the Congo (DRC), during a period when intensified efforts were being made to eliminate smallpox.

Although monkeypox is less severe than smallpox, it can cause significant health concerns, especially in areas with limited access to healthcare. The disease primarily occurs in Central and West African countries, particularly rainforest regions. Still, in recent years, cases have been reported in other parts of the world, raising global awareness of the disease.

The Causes and Transmission of Disease

Monkeypox is caused by the monkeypox virus, like the smallpox virus but less severe. The virus is transmitted to humans through direct contact with the blood, bodily fluids, or lesions on the skin or mucous membranes of infected animals. In Africa, evidence of monkeypox virus infection has been found in many animals, including rope squirrels, tree squirrels, Gambian pouched rats, dormice, and various species of monkeys. The disease can also spread from human to human, although this occurs less frequently.

Human-to-human transmission mostly happens through respiratory droplets during prolonged face-to-face contact, direct contact with infected bodily fluids or lesion material, and indirect contact with lesion material (like through contaminated clothing or linens). The virus can enter the body through broken skin, the respiratory tract, or the mucous membranes of the eyes, nose, or mouth.

One of the major concerns with monkeypox is its potential to spread in healthcare settings and among close contacts, particularly in areas with limited infection control measures. However, it is important to note that monkeypox is not as easily transmitted between people as some other viral infections, such as COVID-19 or influenza.

Symptoms of Monkeypox

The incubation period (the interval from infection to the onset of symptoms) for monkeypox is typically 6 to 13 days but can range from 5 to 21 days. The infection can be categorized into two periods:

1. The Invasion Period (lasts 0–5 days): During this phase, the patient may experience:
– Fever
– Intense headache
– Swelling of the lymph nodes (lymphadenopathy)
– Back pain
– Muscle aches (myalgia)
– Lack of energy (asthenia)

Lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may initially appear similar, such as chickenpox, measles, and smallpox.

2. The Rash Period (occurs within 1–3 days after the appearance of fever): The rash typically appears more on the face and extremities than the trunk. It affects the face in 95% of cases and the palms of the hands and soles of the feet in 75%. The rash progresses from flat lesions (macules) to slightly raised firm lesions (papules), lesions filled with clear fluid (vesicles), lesions filled with yellowish fluid (pustules), and finally crusts which dry up and fall off.

The number of lesions can vary from a few to several thousand. In severe cases, lesions can merge until large sections of skin slough off. The illness typically lasts for 2 to 4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease, a mortality rate higher than that of smallpox.

Process of Diagnosis and Testing Mpox

Diagnosing monkeypox can be difficult, especially in areas where the disease is not common. Because the symptoms of monkeypox are like those of many other diseases, healthcare providers must consider the patient’s travel history, contact with potential animal reservoirs, and exposure to infected individuals.

It is important to confirm the diagnosis of monkeypox through laboratory tests. The most common method for confirmation is polymerase chain reaction (PCR) testing, which can detect viral DNA from samples taken from skin lesions or scabs. Other diagnostic methods include virus isolation, electron microscopy, and immunohistochemistry, although these are less commonly used.

Options to Treatment Monkeypox

Currently, there is no specific treatment for monkeypox. However, since monkeypox and smallpox are genetically similar, antiviral drugs developed for smallpox, known as Tecovirimat (brand name TPOXX), may be effective against monkeypox. Tecovirimat has been approved for smallpox treatment and has shown promise in treating monkeypox in animal studies.

The main treatment for monkeypox is supportive care, which includes managing symptoms, preventing, and treating secondary bacterial infections, and maintaining hydration and nutrition. In severe cases, hospitalization may be necessary, especially if complications arise.

Vaccination can also help prevent monkeypox or reduce the severity of the disease. The smallpox vaccine provides some protection against monkeypox and newer vaccines like the MVA-BN (Modified Vaccinia Ankara-Bavarian Nordic) vaccine have been specifically developed for monkeypox and other Orthopoxvirus infections.

The Strategies and Prevention Remedies

Preventing monkeypox involves several strategies, particularly in endemic regions:

1. Reducing the risk of animal-to-human transmission:

This can be achieved by avoiding contact with animals that may harbour the virus, particularly in areas where monkeypox is known to be present. People should avoid consuming or handling bushmeat and should take precautions when caring for sick animals.

2. Reducing the risk of human-to-human transmission:

Infected individuals should be isolated from others to prevent the spread of the virus. Healthcare workers caring for patients with suspected or confirmed monkeypox should use standard infection control precautions, including wearing personal protective equipment (PPE) such as gloves, masks, and gowns.

3. Vaccination:

While the smallpox vaccine is no longer widely available, it is about 85% effective in preventing monkeypox. In the wake of recent outbreaks, vaccination campaigns using newer vaccines have been launched in some countries to protect high-risk populations.

4. Public health education:

Educating the public about the risks of monkeypox and how to prevent infection is crucial, especially in areas where the disease is endemic. Public health campaigns should focus on promoting safe practices when handling animals, recognizing the symptoms of monkeypox, and seeking medical attention if symptoms develop.

The Recent Outbreaks and Global Impact

In recent years, monkeypox has gained international attention due to outbreaks occurring outside of its traditional endemic regions. In 2022, an outbreak of monkeypox occurred in several countries across Europe, North America, and Asia, making it one of the largest and most widespread outbreaks of the disease in history.

The global response to these outbreaks highlighted the need for enhanced surveillance, rapid diagnostic capabilities, and coordinated public health efforts to control the spread of the virus. While most cases in these outbreaks were mild, the rapid spread of the virus emphasized the potential for monkeypox to become a more significant public health challenge, particularly as the world becomes increasingly interconnected.

Conclusion

Monkeypox is a complex and evolving public health issue that requires ongoing attention from healthcare professionals, researchers, and policymakers. Although the disease is relatively rare, its potential for spread and the severity of its symptoms make it a concern in both endemic and non-endemic regions.

Understanding the causes, symptoms, and transmission of monkeypox is crucial for preventing and controlling outbreaks. With appropriate measures, including vaccination, public health education, and robust infection control practices, the spread of monkeypox can be effectively managed. However, continued research and global cooperation will be essential to address the challenges posed by this disease and to protect public health worldwide.