What you need to know about monkeypox

This article is brought to you thanks to the collaboration of The European Sting with the World Economic Forum.

Author: Kelly McCain, Head, Healthcare Initiatives, World Economic Forum

• More than 90 monkeypox cases have been identified in 18+ countries in which the virus is not endemic, though most have been mild.
• Monkeypox is in the same family of virus that causes smallpox, and while symptoms are similar, monkeypox is less severe.
• While there is currently no medication for monkeypox, certain antiviral drugs can be used and public health authorities are exploring vaccination.

From 13-21 May, there were at least 92 laboratory-confirmed cases and 28 suspected monkeypox cases, according to the WHO. Cases have been reported in more than 18 countries in which the monkeypox virus is not endemic.

Eleven countries have been reporting cases regularly since the virus was discovered in 1970, all in Africa. Cases outside of Africa have historically been rare, traced back to infected travelers or imported animals.

Here’s what you need to know about monkeypox and how public health authorities worldwide are responding.

What is monkeypox?

The monkeypox virus is a type of orthopoxvirus, in the same family of virus that causes smallpox. The symptoms of monkeypox are similar – though less severe and less contagious – than smallpox.

There are two identified genetic clades – or groups – of the virus: the Congo Basinclade and the West African clade. The Congo Basin clade typically causes a more severe version of the disease and was thought to be more transmissible. Cases recently identified have been in the West African clade.

How does monkeypox spread?

Monkeypox is classified as a zoonosis, which means a disease that is transmitted between humans and animals. Cases often appear in tropical climates and rainforests where there are animals carrying the virus, including types of squirrels, dormice and certain types of monkeys and rats. The disease is transmitted through bites, scratches or bush meat preparation.

Human-to-human transmission is limited and the virus is transmitted through direct contact with bodily fluids or skin lesions as well as indirect contact with lesion materials through items such as contaminated bedding or clothing. It can also spread through respiratory droplets, but does not travel easily by air and requires direct, prolonged contact with someone who has an active rash.

What are the symptoms?

Monkeypox usually presents with a fever, rash and swollen lymph nodes. Early stages (1-3 days) involve headache and backache, sore muscles and lack of energy. Individuals with the infection will also often develop a rash 1-5 days from the onset of symptoms, starting as raised spots before turning into fluid-filled blisters, which ultimately turn into scabs and fall off.

What is the prognosis?

Monkeypox symptoms usually clear within 2-4 weeks without treatment. In recent times, the mortality rate has been between 3-6%, mostly among young children and immunocompromised individuals.

The cases diagnosed to date have been mild.

How is monkeypox being diagnosed?

All individuals who have tested positive have had the infection confirmed by a PCR test. Genomic sequencing was also used to confirm a case in Portugal.

How is it treated?

There is currently no medication for the monkeypox virus itself. However, the antiviral drugs cidofovir, brincidofovir and tecovirimat may be used.

The WHO is currently convening experts to discuss recommendations on vaccination.

How are public health authorities responding?

According to the WHO, health authorities are responding through the following measures:

• Ongoing public health investigations in non-endemic countries that have identified cases, including contact tracing, lab investigation, clinical management and isolation with supportive care.
• Genomic sequencing, where available, has determined the monkeypox virus clade(s) infecting individuals. Scientists are working to determine if the recent infections in Europe are related to strains in Africa.
• Vaccination for monkeypox, where available, is being deployed to manage close contacts, such as health workers.