Monkeypox, now known as mpox is causing a multi-country outbreak of disease in several regions of the world. As of 13 April 2023, there were 86,956 cases worldwide as per CDC data[1]. Interestingly 98 percent of these cases are present in locations that have not historically recorded Mpox. According to the WHO global risk assessment, it is of Moderate global risk[5].
Table of Contents
What is Monkeypox (Mpox)
Mpox is a DNA virus belonging to the genus Orthopoxvirus. Orthopoxvirus consist12 species causing various diseases like cowpox, smallpox and monkeypox. That is why Mpox has many similarities with the smallpox.
How does Monkeypox spread
Since mpox is a Zoonotic disease, means it is naturally transmissible from vertebrate animals ( squirrels, Gambian pouched rats, dormice and different species of Monkeys) to humans. The disease is of concern because it can transmit from human to human also[2].
humans to humans
- Direct contact with Mpox rash and scabs
- Through contact with bodily fluids or upper respiratory secretions (snot, mucus)
- Respiratory droplets and contaminated objects- clothing, bedding, and towels used by the patient
- Intimate contact- contact with internal mucosal surfaces of the patient ( mouth, anus, rectum, or vagina)
People with mpox are infectious and can pass the disease on to others until all sores have healed and a new layer of skin has formed
animals to humans
- People can get infected with the virus through direct contact with infected animals, often while hunting, trapping, and processing infected animals or the infected body parts and fluids of animals
- bites or scratches of infected animals
domestic and farm animals (cows camels goat sheep pigs) and dogs & cats are not known to be infected with Mpox (though can be infected with other orthopoxviruses)
The incubation period of Monkeypox
Though the incubation period range is 3 to 17 days[4], the Mean incubation period is ranging from 6 to 10 days as observed in studies during 2022[3]. during this time (incubation period), a person does not have symptoms and may feel fine.
what are the symptoms of Monkeypox
Common symptoms:
(pic credit: UK Health Security Agency)
- rash: itchy/ painful
- typically:
- The rash is preceded by fever, muscle pains and sore throat.
- The rash begins on the face and spreads over the body, including palms and soles.
- The rash goes through various stages – macules, papules, vesicles and pustules and finally crust is formed and Scabs fall off.
- Lymphadenopathy (swollen lymph nodes) is a classic feature of mpox
- What is observed during the global outbreak in 2022:
- rash may appear before, after or simultaneously with other symptoms. sometimes the only feature is Rash (no other symptoms)
- The rash does not always progress over the body.
- The first lesion of rash can be in the groin, anus, or in or around the mouth.
- typically:
- fever
- sore throat
- headache
- backache
- muscle aches
- generalized weakness
- swollen lymph nodes
How long do Mpox symptoms last
symptoms of mpox including skin rash may last 2–4 weeks[2].
Complications of Monkeypox
people with mpox can become very sick. complications include:
- secondary bacterial skin infection leading to skin damage or abscess formation
- pneumonia
- corneal infection with loss of vision
- severe dehydration or malnutrition (due to pain or difficulty swallowing, vomiting and diarrhoea)
- sepsis (infection of the blood with a widespread inflammatory response in the body)
- inflammations of various organs: Encephalitis (brain), myocarditis (heart), proctitis (rectum), urethritis (urethra)
- death
Who is at Risk of Monkeypox
- Children,
- pregnant people and
- people with weak immune systems
- People living with HIV more often develop severe disease
Diagnosis of Monkeypox
- polymerase chain reaction (PCR)- for Detection of viral DNA. it is the preferred laboratory test for mpox.
- recommended specimens: Use swabs directly from the rash -fluid, crust or skin.
- other specimens: oropharyngeal, anal or rectal swabs if rash samples are not available.
- Antibody detection methods:- don’t distinguish other orthopoxviruses therefore may not be useful.
Monkeypox treatment
Early supportive care with the aim to manage rash, pain and complication is the mainstay treatment option since:
- specific treatment is not available as of now
- alternatively, Tecovirimat (TPOXX) is given to patients with severe diseases and people with higher risk. Tecovirimat is an FDA-approved drug for Smallpox and not for mpox. Research is going on to test the safety and effectiveness of this drug in all mpox cases.
Prevention of Monkey Pox
Do
- stay home and in your own room if possible
- wash hands often with soap and water or hand sanitiser, especially before or after touching sores
- wear a mask ( the medical mask is sufficient) and cover lesions when around other people until your rash heals
- keep skin dry and uncovered (unless in a room with someone else)
- avoid touching items in shared spaces and disinfect shared spaces frequently
- use saltwater rinses for sores in the mouth
- take sitz baths or warm baths with baking soda or Epsom salts (magnesium sulfate) for body sores
- take over-the-counter medications for pain like paracetamol or ibuprofen.
Do not:
- do not pop blisters or scratch sores, it can slow healing, spread the rash to other parts of the body, and cause sores to become infected.
- do not shave areas with sores until the scabs have healed and you have new skin underneath (this can spread the rash to other parts of the body)[2].
Monkey Pox Vaccination
- Two vaccines may be used for the prevention of mpox disease:
- JYNNEOS vaccine is approved for the prevention of mpox and smallpox. JYNNEOS is the main vaccine being used in the United States. whatever limited data obtained has shown that un-vaccinated are 14 times more prone to disease.
- standard dosing is 0.5 ml sub-cutaneously but alternatively, an intra-dermal regimen with 0.1ml dose has been given EUA (emergency use authorisation)
- Whether you get the vaccine subcutaneously or intradermally, you should still get two doses. The second dose should be given 4 weeks (28 days) after the first dose
- ACAM2000 vaccine is approved for immunization against smallpox and made available for use against mpox under an Expanded Access Investigational New Drug (EA-IND) protocol. it is available in large quantities but its use is limed due to more side effects and contraindications.
- JYNNEOS vaccine is approved for the prevention of mpox and smallpox. JYNNEOS is the main vaccine being used in the United States. whatever limited data obtained has shown that un-vaccinated are 14 times more prone to disease.
the vaccine can be given as pre-exposure prophylaxis to those who are high-risk individuals and given as post-exposure prophylaxis who came in contact with lab-confirmed cases.
it is administered for free to eligible candidates in the US.
Monkeypox now known as mpox, had never been reported historically in India until 14 July 2022, when the first case was reported in Kerala. Since then 22 cases of mpox and 1 death have been reported in India, as of 13th April 2023.
Monkeypox outbreak in India
India is facing its first outbreak of monkeypox. India is not alone as it is a multi-nation outbreak of mpox in a total of 110 locations so far.
Note: I have explained in detail- what is monkeypox virus, what are the symptoms, how it spreads, and how to diagnose it. how to prevent it and what are treatment options available, in my separate article: Monkeypox: unlock all valuable information.
Monkeypox Case Definitions in India
According to NCDC (National Centre for Disease Control), Ministry of Health and Family Welfare, Govt. of India, case definitions of- suspected, probable and confirmed cases are given below:
Suspected case: (For screening):
A person of any age presenting with An unexplained acute rash anywhere over the body.
AND
One or more of the following signs or symptoms:
- Swollen lymph nodes
- Fever
- Headache
- Body aches
- Profound weakness
Probable cause: (For sample collection, testing & isolation)
A person meeting the suspected case definition and has an epidemiological link with a confirmed case
- (Direct physical contact with skin or skin lesions or
- body fluids or sexual contact;
- Face-to-face exposure,
- Healthcare workers without appropriate PPE;
- Contact with contaminated materials such as clothing, bedding or utensils
OR
A clinically compatible case.
Confirmed case: (For management)
A case that is laboratory confirmed for monkeypox virus (by detection of unique sequences of viral DNA either by polymerase chain reaction (PCR) and/or sequencing).
FAQ
Why named Monkey Pox
Monkeypox was first discovered in 1958 in colonies of monkeys kept for research, hence the name
‘monkeypox.’
The First Case of Monkeypox in Humans
Monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo in a 9-
year-old boy in a region where smallpox had been eliminated in 1968.
Who should get mpox vaccine
pre-exposure vaccine: People at high risk, especially during an outbreak. they include:
- health workers
- men who have sex with men (MSM)
- people with multiple sex partners
- sex workers.
Post-exposure prophylaxis:
- For post-exposure prophylaxis, the vaccine should be given within 4 days of contact with someone who has mpox (or within up to 14 days if there are no symptoms).
for more information on vaccination-related queries visit:https://www.cdc.gov/poxvirus/mpox/vaccines/index.html#:~:text=JYNNEOS%20is%20a%202%2Ddose,stopping%20the%20spread%20of%20mpox.
Side Effects of Monkey Pox Vaccine
- one may have pain, redness, and itching at the site of injection
- might also experience fever, headache, tiredness, nausea, chills, and muscle aches
How long a patient of mpox can spread infection
A patient with mpox can spread the infection to others from the time symptoms start until the rash has completely healed and a fresh layer of skin is formed.
Differential Diagnosis of Monkeypox
laboratory confirmation of mpox is necessary because mpox may look like a number of other diseases:
- chickenpox
- measles
- bacterial skin infections
- scabies
- herpes
- syphilis
- other sexually transmissible infections and
- medication-associated allergies
The case fatality rate of Monkeypox
according to External Situation Report 18, published by WHO on 16 March 2023: ‘Since the beginning of the outbreak, 111 mpox deaths have been reported to WHO, with a case fatality ratio (CFR) of 0.13% (n=86 496).
Strain of mpox responsible for 2022-2023 outbreak
clad IIb strain of mpox is responsible for the outbreak of mpox In 2022–2023. Two different clades of mpox exist: clade I and clade II [2]
references
1] https://www.cdc.gov/poxvirus/mpox/response/2022/world-map.html
2]WHO- world health organization
3]https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1139801/Mpox__monkeypox__transmission_and_mpox_infectious_and_incubation_periods_A_rapid_review.pdf
4]https://www.cdc.gov/poxvirus/mpox/symptoms/index.html
5]https://www.who.int/docs/default-source/coronaviruse/situation-reports/20230316_mpox_external-sitrep—18.pdf?sfvrsn=faae6a92_3&download=true
6]https://www.cdc.gov/poxvirus/mpox/vaccines/index.html#:~:text=JYNNEOS%20is%20a%202%2Ddose,stopping%20the%20spread%20of%20mpox.
7] https://ncdc.mohfw.gov.in/
