Monkeypox, an emerging pandemic

This article was written for The European Sting by one of our passionate readers, Ms. Maryam Omar Alamodi, a 4th year medical student at Alfaisal University, college of Medicine in Riyadh, Saudi Arabia. The opinions expressed within reflect only the writer’s views and not necessarily The European Sting’s position on the issue.

While the world is still challenged by the infamous pandemic Corona Virus (Covid-19), another breakout seems to emerge by another virus causing rising concerns among public health authorities of whether it is considered as a new threat. Monkeypox is a new emerging disease caused by the DNA double-stranded monkeypox virus which’s a zoonotic orthopoxvirus that was initially reported in Africa in 1970 and affected some of the most marginalized and poorest communities in the world. Recently, On May 17, 2022, the Massachusetts Department of Public Health (MDPH) confirmed the presence of orthopoxvirus DNA through real-time polymerase chain reaction (PCR) from lesion swabs obtained from a resident in Massachusetts. Monkeypox virus was originally isolated from monkeys, however the natural host of this virus also includes tree squirrels, rope squirrels, Gambian, dormice, and pouched rats.

The clinical presentation is similar but less severe than smallpox and is characterized by rash, fever, and lymphadenopathy. However, In the current outbreak, cases are atypical with the characteristic rash starting in the perianal and genital areas with or without spreading to other parts of the body. Monkeypox is incidentally transmitted to humans when there’s a contact with an infected animal. Also, reports showed that it can be transmitted through direct contact whether skin-to-skin or sexual, respiratory droplets, and via fomites such as bedding or towels. Patients are considered infectious once the rash begins, until lesions scab fall off and a new layer of healthy skin has formed under the crust. The ideal strategy for diagnosing active monkeypox cases is viral DNA identification in a swab taken from ulcers or vesicles crusts.

Some data suggest that smallpox vaccine prior immunization might have a protective effect against monkeypox virus and might improve the clinical presentation of the infection. Currently, two vaccines are available against monkeypox which are ACAM2 (live, replication vaccinia virus) and JYNEOS (live, replication incompetent vaccinia virus). Even though most cases of monkeypox are mild and self-limited with the presence of sufficient supportive care, antivirals ((e.g. cidofovir, brincidofovir, tecovirimat) and vaccinia immune globulin intravenous (VIGIV) are available as treatment. Antivirals can be considered in immunocompromised patients, severe diseases patients, pregnant and breastfeeding women, pediatrics, complicated lesions, and lesions that appear near the eyes, mouth, and genitals. Some of its complications can include encephalitis, pneumonitis, secondary bacterial infection, and sight-threatening keratitis. The prognosis for monkeypox depends on multiple factors such as initial health status, previous vaccination status, and concurrent comorbidities or illnesses. Therefore, developing personalized and individualized treatments appears to be the most reasonable strategy.

There are measures that can be taken by the public to prevent the spread of infection with monkeypox: 1) isolating ill individuals from uninfected ones; 2) practicing good hand hygiene and using appropriate personal protective equipment to protect household members if ill person at home (e.g., a surgical mask, disposable gloves, and long sleeves and pants); 3) using an Environmental Protection Agency. Patients should also avoid any contact with pets and other animals while being infectious because some animals might be susceptible to monkeypox. Patients with symptoms of monkeypox, including unexplained lesions, should avoid contact with others, including intimate or sexual contact, until they are evaluated or receive testing by their health care provider.

References:

• Guarner, J., del Rio, C. and Malani, P.N. (2022) “Monkeypox in 2022—what clinicians need to know,” JAMA, 328(2), p. 139. Available at: https://doi.org/10.1001/jama.2022.10802.

•   Adler, H. et al. (2022) “Clinical features and management of human Monkeypox: A retrospective observational study in the UK,” The Lancet Infectious Diseases, 22(8), pp. 1153–1162. Available at: https://doi.org/10.1016/s1473-3099(22)00228-6. 

•   Minhaj, F.S. et al. (2022) “Monkeypox outbreak — nine states, May 2022,” MMWR. Morbidity and Mortality Weekly Report, 71(23), pp. 764–769. Available at: https://doi.org/10.15585/mmwr.mm7123e1. 

About the author

Maryam Omar Alamodi, a 4th year medical student at Alfaisal University, college of Medicine in Riyadh, Saudi Arabia. A member of Walter E. Dandy club for Neurosurgery in Yemen