INTRODUCTION
Although less severe than smallpox, monkeypox is a viral zoonotic disease that can spread from animals to people. It has symptoms that are very similar to those of smallpox.
After smallpox was eradicated in 1980 and smallpox vaccinations were discontinued, monkeypox emerged as the most significant orthopoxvirus infection for public health.
Because it was first discovered in 1958 in colonies of monkeys housed for research in a Danish laboratory, the illness is also known as monkeypox.
A human monkeypox outbreak
The first human case of monkeypox was discovered in 1970 in a kid in the Democratic Republic of the Congo. Since that time, cases of monkeypox in humans have been reported in Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Cote d’Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan, among other central and western African nations.
The first monkeypox outbreak documented outside of Africa occurred in the United States in 2003, and contact with pet prairie dogs that had the disease was to blame.
Travelers from Nigeria to Israel in September 2018, the UK in September 2018, December 2019, May 2021, and May 2022, Singapore in May 2019, and the United States of America in July and November 2021 have also been reported to have monkeypox.
Monkeypox cases were found in a number of non-endemic nations in May 2022. To understand the epidemiology, sources of infection, and patterns of transmission, investigations are now being conducted.
Symptoms
Monkeypox has a clinical appearance similar to smallpox, which was proclaimed eradicated globally in 1980. Compared to smallpox, monkeypox is less contagious and has milder symptoms. Monkeypox typically has an incubation period of 5 to 21 days (from infection to beginning of symptoms).
There are two phases of the infection.
- Typically lasting one to three days, the febrile stage of sickness is characterised by fever, severe headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle ache), and severe asthenia (lack of energy).
- The skin eruption stage, which lasts for 2 to 4 weeks, comes after the feverish stage. The progression of lesions is as follows: macules (flat lesions), papules (raised, painful lesions), vesicles (filled with clear fluid), pustules (filled with pus), then scabs or crusts that eventually dry out and flake off. The face, hands, and feet are the areas of the body where the rash appears most frequently. Additionally, the lips, genitalia, and eyeballs all exhibit them.
Typically, monkeypox is a self-limiting illness with symptoms that last between two and four weeks.
CAUSES
The monkeypox virus is what causes the sickness. The Orthopoxvirus genus is part of the Poxviridae family, which includes the monkeypox virus. The variola virus, which causes smallpox, the vaccinia virus, which is used in the smallpox vaccine, and the cowpox virus are all members of the orthopoxvirus genus.
A double-stranded DNA virus with an envelope is the monkeypox virus. The central African (Congo Basin) clade and the West African clade are two separate genetic clades of the monkeypox virus.
The virus that causes monkeypox’s natural host:
The monkeypox virus can infect many different animal species. Rodents and primates such as dormice, rope squirrels, tree squirrels, Gambian pouched rats, non-human primates, and other animals can serve as hosts.
Transmission:
Direct contact with the blood, body fluids, or cutaneous or mucosal lesions of infected animals can cause the monkeypox virus to transfer from animal to person. Near tropical rainforests where the virus is carried by animals, human cases are frequently discovered.
Close contact with the saliva, lesions, or respiratory secretions of an infected person, as well as recently contaminated things such dining utensils or dishes, clothing, bedding, or towels, can cause human-to-human transmission.
Those who have the monkey pox are contagious while they are ill (two to four weeks). The risk of contracting the illness is higher for household members, sexual partners, and health care workers.
Congenital monkeypox is another way the virus can transfer from mother to foetus through the placenta, or from an infected parent to child during or after birth through intimate contact.
However, direct skin-to-skin contact with lesions during sexual activity can spread the virus. It is still unknown if monkeypox can be transmitted by sexual transmission channels (for example, through semen or vaginal fluids).
How to Diagnose Monkeypox?
Chickenpox, measles, bacterial skin infections, scabies, syphilis, herpes simplex virus, molluscum contagiosum virus, enterovirus, parapoxviruses (producing orf and related disorders), chancroid, and medication-associated allergies must all be clinically distinguished from monkeypox.
The prodromal stage of monkeypox can be distinguished from chickenpox or smallpox by lymphadenopathy (swollen lymph nodes).
Any person who fits the criteria for a suspected monkeypox case has to be tested. Skin lesion material, such as swabs of lesion exudate, roofing from many lesions, or lesion crusts, are the suggested specimen type. The recommended laboratory test for monkeypox is polymerase chain reaction (PCR), which detects virus DNA.
Monkeypox cannot be confirmed using antigen or antibody detection techniques because orthopoxviruses are serologically cross-reactive. A recent or distant immunisation with a vaccinia-based vaccine (for example, anyone immunised prior to the eradication of smallpox, or more recently immunised due to heightened risk, such as laboratory staff who work with orthopoxvirus) may provide false-positive findings.
In India, the Integrated Disease Surveillance Programme (IDSP) network of the relevant district/state is used to route all clinical specimens to the Apex Laboratory of the ICMR-NIV (Pune) for testing.
Management
Monkeypox symptoms frequently go away on their own without any special care. Clinical management of monkeypox primarily entails steps to lessen symptoms, handle problems, and avoid long-term aftereffects.
Fluids and food should be provided to patients to ensure proper nutritional status.
For severe situations, vaccine immune globulin (VIG) may be advised.
In January 2022, tecovirimat, an antiviral medication originally created to treat smallpox, received approval for the treatment of monkeypox.
COMPLICATIONS
Skin infections, bronchopneumonia, sepsis, encephalitis, and eye infections that can result in blindness are complications from severe instances of monkeypox.
In previous years, between 3 and 6 percent of reported cases in endemic nations resulted in death. Monkeypox can cause significant illness and even death in newborns, children, pregnant women, persons with underlying immune weaknesses, and other groups of people.
PREVENTION
Lowering the risk of zoonotic transmission:
- Avoiding unprotected contact with wild animals, especially those that are ill or dead, can lower the risk of contracting monkeypox from animals (including their meat and blood).
- Any items containing animal meat or components should be fully prepared before consumption in endemic nations where animals transmit monkeypox. Animals that may have interacted with an infected animal need to be confined, handled with regular safety measures, and monitored for signs of monkeypox for 30 days.
Lowering the potential for transfer from person to person:
- Minimize your risk by avoiding contact with those who have known or suspected cases of monkeypox.
- Encourage the affected person to isolate themselves and, if they are able to, hide any skin lesions (by wearing clothing over the rash).
- A medical mask should be worn by both the patient and the caregiver, especially if the patient is coughing or has lesions in their mouth.
- Wash your hands frequently with soap and water or an alcohol-based hand rub, particularly after coming into contact with an infected person, their clothes, bed sheets, towels, and other items or surfaces they may have touched or that may have come into contact with their rash or respiratory secretions (e.g., utensils, dishes).
- When caring for the ill, whether in a hospital or at home, wear gloves and other personal protective clothes and equipment.
- Use warm water and detergent to wash the person’s clothes, towels, bedsheets, and dining utensils.
- Dispose of contaminated waste (such as dressings) properly and clean up any contaminated surfaces.
- There are a number of smallpox vaccines on the market that also offer some protection against monkeypox. 2019 saw the approval of a more recent monkeypox vaccine that was created as a smallpox vaccination, albeit it is not yet readily accessible.
In the current situation, contact identification and contact tracing should start as soon as a suspected case is discovered. During the infectious period, contacts should be watched at least daily for the emergence of any signs or symptoms for 21 days after their last encounter with a patient or their contaminated items.
REFERENCES
https://www.who.int/health-topics/monkeypox#tab=tab_1
https://www.who.int/publications/i/item/WHO-MPX-laboratory-2022.1
https://www.who.int/health-topics/monkeypox#tab=tab_2
https://www.who.int/news-room/fact-sheets/detail/monkeypox
https://www.who.int/news-room/questions-and-answers/item/monkeypox
https://www.who.int/publications/i/item/WHO-MPX-surveillance-2022.1
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385