The following article was released by the Ministry of Health after the World Health Organization (WHO) declared the growing monkeypox outbreak a global health emergency, its highest level of alert.
By Dr Tariq Jagnarine
Family Medicine, Endocrinology / Diabetes
Monkeypox is a rare disease similar to smallpox caused by the monkeypox virus which is a member of a family called orthopoxvirus. While it is found mostly in areas of Africa, it has made its way to other areas of the world in recent years. Monkeypox was discovered in 1958 when two outbreaks of a pox-like disease occurred in groups of monkeys being used for research. There are two known types (clades) of monkeypox virus — one that originated in Central Africa and one that originated in West Africa.
In the spring of 2003, the first outbreak of monkeypox outside of Africa occurred in the United States. A shipment of infected animals from Ghana was imported into Texas. The infected rodents spread the virus to pet prairie dogs, which then infected 47 people in the Midwest.
As international travel becomes more common, viruses that were once fairly confined to certain locations can more easily spread around the world. In the summer of 2021, a case of monkeypox was found in a U.S. resident who had travelled from Nigeria to the United States. Then, 2022 brought outbreaks to regions outside of Africa, including Europe, the Americas, and Australia.
The current world outbreak (2022) is caused by the less severe West African clade. Monkeypox is rare but the number of cases is increasing in Africa, as well as in regions that haven’t seen these infections before. On July 19 of this year, a total of 1882 cases of monkeypox were reported.
Symptoms
Monkeypox causes pus-filled blisters that crust over and fall off. After exposure, it may be several days to a few weeks before developing symptoms. Early signs of monkeypox include flu-like symptoms like:
• Fever
• Chills
• Headache
• Muscle aches
• Fatigue
• Swollen lymph nodes
After a few days, a rash often develops. The rash starts as flat, red bumps, which can be painful. Those bumps turn into blisters, which fill with pus. Eventually, the blisters crust over and fall off — the whole process can last two to four weeks. Persons can also get sores in their mouth, vagina, or anus.
Not everyone with monkeypox develops all of the symptoms. In fact, in the current (2022) outbreak, many cases aren’t following the usual pattern of symptoms. This atypical presentation includes only a few lesions, no swollen lymph nodes, less fever, and other signs of illness. Persons can have it and not know it. But even if they don’t show any signs of infection, it can spread still spread to others through prolonged close contact.
How is monkeypox spread
Monkeypox is spread by coming into contact with an animal or a person infected with the virus. Animal-to-person transmission occurs through broken skin, like from bites or scratches, or through direct contact with an infected animal’s blood, bodily fluids, or pox lesions (sores).
Monkeypox can spread from person to person, but it’s less common. Person-to-person spread (transmission) occurs when persons come in contact with the sores, scabs, respiratory droplets or oral fluids of an infected person usually through close, intimate situations like cuddling, kissing, or sex. Researchers aren’t sure if the virus is transmitted through semen or vaginal fluids.
It can also be spread by coming into contact with recently contaminated materials like clothing, bedding, and other linens used by an infected person or animal.
Who is at risk?
Anyone can get monkeypox. In Africa, most cases are among children under 15 years old. Outside of Africa, the disease appears to be more common in men who have sex with men, but there are numerous cases in people who don’t fall into that category.
Diagnosis and tests
Healthcare providers may first suspect other rash illnesses, such as measles or chickenpox. But swollen lymph nodes usually distinguish monkeypox from other poxes.
To diagnose monkeypox, a healthcare provider takes a tissue sample from an open sore (lesion). Then they send it to a lab for polymerase chain reaction (PCR) testing (genetic fingerprinting). A blood sample can be taken for the monkeypox virus or antibodies the immune system makes to it.
Management and treatment
Monkeypox is usually a self-limited disease with symptoms lasting from two to four weeks. Most people with monkeypox get better on their own without treatment. Following diagnosis, a healthcare provider will monitor a person’s condition and try to relieve their symptoms, prevent dehydration and give them antibiotics to treat secondary bacterial infections if they develop.
There’s currently not an approved antiviral treatment for monkeypox. Antiviral drugs may help, but they haven’t been studied as a treatment for monkeypox. Several investigational antivirals with activity against monkeypox are available, but only as part of a research study.
Monkeypox normally takes about two to four weeks to run its course. If exposed to monkeypox, health care providers will monitor persons until the rash resolves.
Prevention
A smallpox vaccine protects against monkeypox, but its use is currently limited to clinical trials. Prevention depends on decreasing human contact with infected animals and limiting person-to-person spread. The best way to help the prevent spread of the monkeypox virus is to:
• Avoid contact with infected animals (especially sick or dead animals).
• Avoid contact with bedding and other materials contaminated with the virus.
• Thoroughly cook all foods that contain animal meat or parts.
• Wash your hands frequently with soap and water.
• Avoid contact with people who may be infected with the virus.
• Practice safe sex, including the use of condoms and dental dams.
• Wear a mask that covers your mouth and nose when around others.
• Clean and disinfect frequently touched surfaces.
• Use personal protective equipment (PPE) when caring for people infected with the virus.
Is monkeypox deadly?
The less severe West African clade is causing the current world outbreak (2022) with no deaths thus far. But, monkeypox can lead to other problems (complications), like pneumonia and infections in your brain (encephalitis) or eyes, which can be fatal.
Self-care
If you have monkeypox symptoms, inform a health care worker immediately. There are over-the-counter medications that can help persons feel better, including:
• Pain relievers and fever reducers. Medicines like ibuprofen (Advil®, Motrin®) and acetaminophen (Tylenol®).
• Oatmeal baths. Soaking in a warm bath with colloidal oatmeal can relieve the dry, itchy feeling that comes with skin rashes.
• Isolation if infected. Avoid contact with others until all lesions have scabbed.
• Cover single or local lesions. Use gauze or bandages to limit the spread to others and the environment.
• Take good care. It’s important to stay home and rest when sick, wear a mask around others and drink plenty of fluids.
• Avoid contact with pets (especially rodents).
The best way to protect yourself is to avoid contact with people who are infected, wash your hands frequently and wear a face mask in crowded, indoor spaces. See your healthcare provider if you develop symptoms.
