Overview

Monkeypox is a viral zoonotic disease belonging to the Orthopoxvirus genus, the same family as the viruses that cause smallpox, horsepox, camelpox and cowpox. It was first identified in lab monkeys in Copenhagen, Denmark in 1958. It is thought by some that its natural reservoirs are likely to be small rodents in Central and West Africa. The first human cases were reported in 1970 in the Congo.

Transmission

The virus enters the body via broken skin or mucosal surfaces (mouth, lungs, genitals). Transmission from animals to humans occurs through direct contact with the blood, bodily fluids or skin lesions of infected animals. Transmission among humans occurs through respiratory droplets, direct contact with skin lesions, and contaminated materials like beddings. During the 2022/2023 outbreak transmission was primarily by way of sexual contact.

Symptoms

Fever, muscle pains, headache and exhaustion at first. A few days after the onset of fever, a rash appears which is mostly in the facial area but spreads to other areas of the body. First it is macules, then papules, vesicles, pustules, and finally scabs. The illness typically lasts 2 to 4 weeks.

Severity

Monkeypox is usually not as serious as smallpox. That said, the case fatality rate is in the 1% to 10% range depending on the strain and quality of medical care. People with weak immune systems are at higher risk.

Recent Outbreaks

Historically, outbreaks have been confined to Central and West Africa. More recently however, it has been reported in Europe and North America. The recent outbreaks have generateed concern because the spread of the disease in non-endemic areas is unusual.

Prevention and Treatment

Avoidance of animals that might be infected.
Personal hygiene and the use of personal protective equipment (PPE) in healthcare settings.
The smallpox vaccine offers cross-protection with monkeypox although the vaccination programme was discontinued in 1980.
As of August 2024 there are 4 specific monkeypox vaccines but in limited supply.

Public Health Response

The World Health Organization plays a role in trying to prevent and control outbreaks through monitoring in relevant countries. This includes educational programs, and also by supporting vaccination programmes. Travel advisories, contact tracing and isolating cases are important measures.

Conclusion

Monkeypox is a potential global public health issue not least due to it being translocated from the regions where it has mostly been observed. Educating the public about its transmission, symptoms, and preventive measures is an important way to mitigate against the negative effect of the spread of the disease.