Context
There have been 14,533 probable and laboratory-confirmed monkeypox cases reported from 72 countries this year, according to the WHO, increasing from 3,040 cases across 47 countries recorded in the beginning of May.
- The World Health Organization declared the outbreak a public health emergency of international concern (PHEIC), its highest level of alarm.
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A PHEC is declared for “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”.
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Where has monkeypox occurred before?
- Monkeypox is not a new disease like Covid-19, which emerged in 2019.
- The first monkeypox infection in was identified in 1970 in the Democratic Republic of Congo in a nine-month-old boy.
- Most infections initially were caused by interaction of humans and animals in rural, rainforest regions of the Congo basin.
- Before the 2022 outbreak, rising cases were being reported from Central and West Africa.
- The first outbreak outside Africa happened in 2003, when the United States saw over 70 cases.
What do we know about the disease?
- Monkeypox is a self-limiting viral infection, with symptoms lasting 2–4 weeks.
- The case fatality ratio ranges between 0 and 11%.
- The most common symptoms include fever, headache, muscle ache, back pain, low energy, and swollen lymph nodes, along with rashes that last for 2–3 weeks.
- Although mostly mild, it can lead to complications and deaths in children and those with a weak immune system.
- Complications include pneumonia, secondary skin infections, sepsis, encephalitis, and infection in the cornea leading to blindness.
Can vaccines work against it?
- The monkeypox virus belongs to the same family of orthopoxviruses as smallpox, now eradicated.
- Orthopoxviruses are cross-reactive, meaning that existing smallpox vaccines and therapeutics can be used for monkeypox.
- Although most monkeypox cases are treated symptomatically, an antiviral agent known as tecovirimat developed for smallpox may be used.
- The US, which has recorded over 2,800 cases, is using two vaccines meant for smallpox.
- Jynneos with two doses is allowed for use in adults, while ACAM2000 uses a live, attenuated form of a different orthopoxvirus and is meant for protection of high-risk individuals for smallpox such as lab workers.
- Vaccination against smallpox was demonstrated through several observational studies to be about 85% effective in preventing monkeypox.
Is monkeypox sexually transmitted?
- Although the WHO says it is unclear if the infection is transmitted sexually, it is under investigation with almost all cases in the current outbreak being reported in gay or bisexual men.
- A recent analysis of 528 persons from London, published in the New England Journal of Medicine, shows 98% of those infected were gay or bisexual men and suggests transmission in 95% cases happened through sexual activity.
- In 29 of 32 persons whose semen was analysed, monkeypox DNA was found.
- It is unclear whether it is sexually transmitted, but the infection might be transmitted more while having sex due to increased skin contact.
