Just when the cases of COVID-19 are gradually declining around the world, a new threat – monkeypox – has garnered the limelight. According to the World Health Organization, a total of 257 confirmed cases and around 120 suspected cases of monkeypox have been reported in 23 countries[1] so far but no deaths have been reported to date. India has been safeguarded from monkeypox as no cases have been reported as of now.
If all the news about the monkeypox has got you worried or if you feel threatened by it, hold on! There is no need to press the panic button as we have got you all covered with everything you need to know about this infection. Read on to get all your queries answered.
What is monkeypox disease?
Monkeypox is a viral zoonotic disease, meaning a viral infection that spreads from animals to humans. The disease is caused by the virus named monkeypox.
Does monkeypox come from monkeys?
The monkeypox virus was first isolated and identified in 1958 when monkeys that were shipped from Singapore to a Denmark research facility fell ill. As the disease was first discovered in monkeys, hence the name monkeypox.
Also, the first confirmed human case of this disease was isolated from a child in the Democratic Republic of Congo suspected to have smallpox disease in 1970[1]. In addition to monkeys, the virus has been found in many more animals such as rope squirrels, tree squirrels, Gambian pouched rats, and dormice to name a few.
Is monkeypox the same as smallpox and chickenpox?
Like the smallpox virus, the monkeypox virus belongs to the Poxviridae family. The disease symptoms are similar to smallpox but monkeypox causes lymphadenopathy (swelling of the lymph nodes) while smallpox does not. Moreover, unlike smallpox, this infection is associated with a low risk of mortality.
On the other hand, chickenpox is caused by the varicella-zoster virus. However, both monkeypox and chickenpox can spread through close contact with respiratory secretions and direct skin contact.
How does a person get monkeypox?
The monkeypox virus mainly causes animal-to-human transmission but in rare cases, human-to-human transmission is also possible. The spread of the virus from one infected individual to another can occur through prolonged close contact and mainly through large respiratory droplets.
Animal-to-human transmission may occur through:
– A close contact with an animal infected by monkeypox
– A bite or scratch of infected animals like rats or squirrels
– Eating the meat of an infected animal that has not been cooked thoroughly
Human-to-human transmission may occur through:
– Being in close physical contact with a person infected by monkeypox
– Touching things contaminated with the virus-like clothes, bedding, or towels
– Through saliva or respiratory droplets (by coughing or sneezing)
– Via the placenta from mother to fetus
– During and after childbirth from mother to baby
Note: Monkeypox can spread through direct skin-to-skin contact with lesions during sexual activities but there is no clarity on whether it can spread through sexual intercourse via semen or vaginal fluids.
What are the symptoms of monkeypox?
In humans, the symptoms of monkeypox are similar to smallpox but milder in nature. The typical symptoms include fever, an acute skin rash with blisters either on the face, hands, feet, eyes, mouth, or genitals, and lymphadenopathy (swollen lymph nodes).
Patients may develop a rash within 1 to 3 days (sometimes longer) after the appearance of fever. The lesions first appear on the tongue and mouth. The rash begins on the face and then spreads to other parts of the body like the arms, palms, legs, and soles within 24 hours. By the 4th to 5th day, the lesions become raised and filled with pus. By the end of the 2nd week, they dry up and crust. The scabs usually remain for a week before they start to fall off. A person infected with this disease can spread the infection around 1-2 days before the appearance of the rash until all the scabs fall off or get subsided.
Other mild associated symptoms include:
– Asthenia (profound weakness)
– Headache
– Myalgia (muscle and body aches)
– Backache
– Sore throat and cough
– Chills and/or sweats
The incubation period (time from infection to symptoms) for monkeypox is usually 7−14 days but can range from 5−21 days.
When to get tested for monkeypox?
The provisional diagnosis of monkeypox is based on the symptoms. People with symptoms such as the new onset of fever, swollen lymph nodes, and rash should be evaluated for this infection.
A person with a history of travel to any of the affected countries within the last 21 days and presenting with an unexplained acute rash along with any signs and symptoms of monkeypox, is considered to be a suspected case. If suspected, he/she should be monitored for the onset of signs/symptoms on a daily basis for a period of 21 days post-contact with a patient or their contaminated materials during the infectious period. In case of occurrence of fever, lab testing is a must.
As per the ICMR guidelines [3], if a patient is suspected of this infection then:
– A PCR test to detect the Orthopoxvirus genus (Cowpox, Buffalopox, Camelpox, Monkeypox) will be done.
– If tested positive, then a confirmatory test for this infection will be done with Monkeypox specific conventional PCR or real-time PCR for Monkeypox DNA
To test or confirm the diagnosis, the clinical testing procedure includes:
– Nasopharyngeal and oropharyngeal swab
– Blood sample
– Urine sample
– Scrapping of the lesion roof or base
– Fluid and crust/scab sample
How is monkeypox treated?
Monkeypox is usually a mild and self-limiting disease. However, it can be severe in some individuals such as children, pregnant women, and people with low immunity due to low immunity
Currently, there is no definite treatment approved for this infection. The treatment plan mainly involves supportive care to ease the patient’s symptoms. Most patients who have mild diseases recover without medical intervention.
According to the MOHFW guidelines [3], the supportive treatment of monkeypox includes:
Skin rash: Cleaning the area with an antiseptic ointment such as mupirocin acid or fucidin and covering the lesion with a light dressing is recommended. In case of secondary infection, antibiotics might be advised. Do not touch or scratch the lesions as it can worsen the rash and increase the risk of infections.
Ulcers: For genital ulcers, sitz bath works best whereas, for oral ulcers, warm salt gargling and use of topical oral anti-inflammatory gel are advised.
Dehydration: This may require the use of fluid therapy such as ORC, oral fluids, or intravenous drip. Additionally, eating a balanced, nutrient-rich diet is recommended.
Symptom relief: For fever, the use of tepid sponging and paracetamol can help. Medications such as antiemetics for nausea and vomiting and antihistamines for itching are also known to aid in improving the condition.
Note: Some antiviral medicines may be useful for the treatment of the disease. Antivirals such as tecovirimat, brincidofovir, and cidofovir were approved for the treatment of smallpox based on animal models and are expected to have the activity against human monkeypox as well.
Home-care for monkeypox patients
For patients who do not require hospitalization, the home-care approach involves:
– Self-isolation and limited contact with family members and no visitors allowed.
– If you have respiratory symptoms, wear a surgical mask
– Wear long sleeves and long pants to reduce the risk of contact with others
– Use disposable gloves when handling lesions and dispose them post-use
– Dispose contaminated waste such as dressings and bandages in separate containers/bags
– Wash your hands with soap and water after touching lesion material, clothes, bedding, etc that may have had contact with the lesion on the patient.
– Wash laundry with warm water and detergent and handle soiled laundry with care.
– Do not share dishes or any other eating utensils with family members
– Clean and sanitize the contaminated surfaces daily.
– Do not allow pets or any other domestic animals near the patient’s room.
How do you prevent monkeypox?
There are multiple ways through which this infection can be prevented. Here are some of the ways to protect yourself and others from monkeypox.
– Isolate yourself or any family member if you have symptoms and talk to a doctor
– Avoid close & direct contact (skin to skin or face to face contact) with an infected or suspected person
– Avoid contact with any material such as bedding, utensils, etc that have been in contact with the patient
– Practice proper hand hygiene post getting in touch with infected animals or patients
– Always clean the objects and surfaces which are touched regularly with detergents
– Avoid touching any rash or blister of an infected person or animal
– Wear a mask if you have to be in close contact with a sick person
– Use proper personal protective equipment (PPE) if taking care of a patient
Is Monkeypox deadly?
In most cases, the symptoms of monkeypox go away on their own within a few weeks. But in some individuals, they can lead to medical complications such as secondary infections, pneumonia, confusion, sepsis, encephalitis, eye infections (which can lead to vision loss), and even death.
Severe cases are seen among children and the severity varies depending upon the extent of the exposure to the virus exposure, overall health of the kid, and the type of complications reported. The risk of death is seen to be around 0 to 11% in the general population with young children having a greater risk. In recent times, the risk of death due to this disease is seen to be around 3–6% [2].
Is there a vaccine against monkeypox?
Vaccines used during the smallpox eradication program can be used for protection against this disease. However, post-1980, when WHO declared that smallpox was eradicated globally, no vaccine has been manufactured in India. One vaccine named JYNNEOSTM (also known as Imvamune or Imvanex) has been licensed in the United States to prevent monkeypox and smallpox.
Are there any guidelines for international travelers?
Currently, the surge in cases of monkeypox is seen in endemic countries like Cameroon, Central African Republic, Nigeria, Republic of the Congo, and also in non-endemic areas like Canada, the US, Netherlands, Portugal, Span, UK, Germany, Italy, etc. According to the WHO, the cases reported in the non-endemic area have no established travel links to endemic areas so far[1].
The MOHFW has laid an advisory for international passengers which states that the travelers should avoid:
– Close contact with a suspected person and/or sick people with skin lesions
– Contact with dead or live animals such as rodents (rats, squirrels) and non-human primates (monkeys, apes)
– Eating or preparing bush meat
– Use of any African products derived from wild animals such as lotions, creams, etc
– Clothing, bedding, or materials that have had been in contact with a sick person or infected animals
Note: If you develop symptoms that suggest monkeypox like fever with a rash and you have been to an area where the disease is reported or have had come in close contact with a person infected with the virus, then consult a doctor immediately.
(The article is reviewed by Dr. Saurabh Bhatia, Director, Medical Affairs)
References:
1. Multi-country monkeypox outbreak in non-endemic countries: Update. Disease outbreak news dated 29th May 2022. World Health Organization. https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON388
2. What is monkeypox? Monkeypox. World Health Organization. May 2022. https://www.who.int/news-room/questions-and-answers/item/monkeypox
3. Guidelines For Management Of Monkeypox Disease. Ministry Of Health And Family Welfare. Government Of India. https://main.mohfw.gov.in/sites/default/files/Guidelines%20for%20Management%20of%20Monkeypox%20Disease.pdf
4. Moore M, Zahra F. Monkeypox. [Updated 2022 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. https://www.ncbi.nlm.nih.gov/books/NBK574519/
5. Signs and Symptoms. Monkeypox. Center For Disease Control And Prevention. July 2021. https://www.cdc.gov/poxvirus/monkeypox/symptoms.html
6. Harris E. What to Know About Monkeypox. JAMA. Published online May 27, 2022. https://jamanetwork.com/journals/jama/fullarticle/2793012