Monkeypox Virus

Things Every Doctor Should Know About Monkeypox Virus

Some may have flu-like symptoms early on
According to the Centers for Disease Control and Prevention (CDC), monkeypox symptoms are similar to those of smallpox—including fever, headache, back ache, muscle aches, swollen lymph nodes, chills and fatigue—but they tend to be milder.

The rash can be nonspecific
In fact, it can look a lot like herpes, chickenpox and shingles. Still, there are subtle differences to look for. For example, rashes caused by chickenpox (varicella virus) rapidly progress from macular to papular to vesicular lesions before crusting. Lesions are usually most concentrated on the chest and back.

There have been accounts of patients co-infected with Monkeypox and other infectious agents—such as varicella zoster, syphilis—so patients with a characteristic rash should be considered for monkeypox testing, even if other tests are positive.

Personal contact is key
Monkeypox spreads through close, often skin-to-skin contact. This includes intimate activities, such as kissing, hugging, massage and sexual intercourse, as well as touching objects, fabrics or surfaces—for example, clothes, bedding and towels— contaminated with the monkeypox virus. It can also spread through contact with respiratory secretions.

While monkeypox seems to be spreading largely among men who have sex with men, it can infect anyone, no matter their sexual orientation.

There are two vaccines available
The Food and Drug Administration (FDA) has licensed JYNNEOS for the prevention of smallpox and monkey pox and ACAM2000 to prevent smallpox. ACAM2000 has been made available under an expanded access investigational new drug protocol. The FDA has authorized the emergency use of JYNNEOS vaccine to be given intradermally to people 18 or older at high risk for infection—to increase the number of doses available.

The CDC currently recommends vaccination for people who have had a sexual partner in the past two weeks who has been diagnosed with monkeypox; have had multiple sexual partners in the past two weeks in an area with known monkeypox cases;” have been identified by public health officials as a contact of someone with monkeypox and “are at occupational risk of monkeypox,” such as laboratory workers who perform monkeypox testing.

Is The Monkeypox Virus Severe?

The severity of the monkeypox virus (mpox) can vary significantly based on several factors, including the strain of the virus, the individual's health status, and access to medical care. Generally, mpox can lead to a range of symptoms, from mild to severe.

Severe cases may involve larger and more widespread lesions, particularly affecting sensitive areas such as the mouth, eyes, and genitals. Complications can arise, including secondary bacterial infections of the skin or blood, pneumonia, and even encephalitis (inflammation of the brain).

According to available data, the mortality rate for mpox ranges from 0.1% to 10%, depending on various factors like healthcare access and underlying health conditions—individuals with compromised immune systems, such as those with advanced HIV, are at a higher risk for severe disease and death. Young children and pregnant individuals are also more vulnerable to severe outcomes.

Most people recover from mpox within 2 to 4 weeks with supportive care; however, severe cases may require hospitalisation and antiviral treatments to manage symptoms and reduce recovery time. The differences in severity are also tied to the clade of the virus: clade I strains tend to be more virulent than clade II strains.

What You Need To Know About The History Of Monkeypox Virus

Since it was first identified in a colony of monkeys in Copenhagen in 1958, monkeypox has been largely overlooked by the Western world. An infectious poxvirus that causes fever, chills and rashes, the disease is endemic, or consistently regionally present, in ten African countries. Until recently, however, it was rarely found in Europe and the Americas—a trend that has, historically, led Western public health officials to disregard its spread elsewhere.

This May, as news broke of a multicountry monkeypox outbreak, sensationalized headlines and public hysteria (much of it tinged with racism and homophobia) suggested that the disease was poised to kick-start another pandemic. But while there’s cause for concern—at least 2,103 cases have been recorded in 42 countries, and the disease appears to be spreading more rapidly than before—monkeypox is not a novel threat. Western countries that previously paid little attention to the disease can learn much from African scientists who have studied it for decades.

Believed to have been circulating for thousands of years, monkeypox is mired in misconception. Even its name is something of a misnomer: Monkeys (and humans) are just incidental hosts of the disease, which is thought to be found primarily in rodents. While monkeypox is more common in central and western Africa, it’s misleading to describe the virus as “being African,” wrote more than 20 scientists in a recent paper detailing the need for a nondiscriminatory, nonstigmatizing name for the disease.

The current outbreak appears to be spreading mainly among men who have sex with other men (MSM)—a trend that has drawn parallels with the HIV/AIDS epidemic, which disproportionately affected the LGBTQ community at its height in the late 1980s and early ’90s. Scientists are not entirely sure why the disease is spreading this way, but early findings suggest it “may have made its way into highly interconnected sexual networks within the MSM community, where it can spread in ways that it cannot in the general population,” per Science magazine.

The story of monkeypox and poxviruses more generally is part of a larger narrative about global health inequities and scientific progressivism, which refers to how science is often portrayed in an irrevocably linear, victorious way that elides the incremental nature of most discoveries. Amid the current outbreak, monkeypox’s long-neglected history renders the disease simultaneously obscure and subject to heightened scrutiny—both to the detriment of public health.

Monkeypox’s past is inextricable from that of smallpox, which is believed to have first appeared around 10,000 B.C.E. One of humanity’s deadliest diseases, smallpox killed more than 300 million people worldwide in the 20th century alone. From sniffing up dried smallpox scabs to puncturing people with iron needles dipped in smallpox pustules, communities in Africa, India, China, Turkey and other non-Western nations have long sought to prevent the virus’ spread. (These measures, known as inoculation or variolation, involve immunizing a patient by infecting them with a mild form of a virus.) But inoculation only arrived in Europe in the early 18th century, when Lady Mary Wortley Montagu, wife of the British ambassador to the Ottoman Empire, brought the practice back to England after learning about it from Turkish women.

Around that same time, in 1721, a smallpox epidemic in the colony of Massachusetts led Reverend Cotton Mather and physician Zabdiel Boylston to similarly experiment with the procedure. Today, celebrations of the pair’s tenacious efforts tend to erase the contributions of Onesimus, the enslaved man who introduced Mather to inoculation—a practice Onesimus learned in his native West Africa. Otherwise, much about him remains unknown, including his original name and place of birth.