Krishna: WHO considers declaring monkeypox a global health emergency means an extraordianry event and that the disease is at risk of spreading across even more borders.(1).

It is not a pandemic.

Monkeypox, as the name suggests, was first found in laboratory monkeys in the late 1950s. However, scientists aren’t sure if monkeys are the main animal reservoirs (carriers of the virus), so the name may be a bit of a misnomer. The latest thinking is that the main reservoir is probably smaller animals, such as rodents.

Unlike COVID, monkeypox can but does not spread easily from human to human. It typically requires interaction with animals that carry the virus, or being in very close contact with infected people, or having contact with “fomites” (such as contaminated clothes, towels or furniture). Also unlike COVID, monkeypox is not known to spread asymptomatically. However, the evidence on monkeypox is thin, and the current outbreaks will provide new knowledge around its impact and transmission.

Monkeypox belongs to the same family of viruses as smallpox, but is less transmissible. People who catch it typically develop a fever and a distinctive rash and blisters. The disease is usually self-limiting, with symptoms disappearing after a few weeks. However, monkeypox can cause severe illness, with outbreaks typically showing a case-fatality rate (the proportion of people with the disease who die from it) of between 1% and 15%, with severe disease and death more likely among children.

The UKHSA says that some cases in the May 2022 outbreak cannot be explained by recent international travel, suggesting that there has probably been some “community transmission”. Four of the seven cases are in people who identify as gay, bisexual or other men who have sex with men. A UKHSA epidemiologist tweeted that this is “highly suggestive of spread in sexual networks”. The cases in Spain may also fall under similar consideration.

So the transmission here may be a little unusual compared with previous outbreaks. While there is a lot we don’t know about monkeypox, we do know the virus can be transmitted via close contact, for example, including prolonged skin-to-skin contact.

There is no evidence that it is a sexually transmitted infection in the manner of HIV or chlamydia. It’s more that, in the UK outbreak, the close contact during sexual or intimate activity may have been a key factor during transmission.

This may be the first time transmission of monkeypox via sexual contact or intimate activity has been documented. But the implications are not so significant in that we know close contact is required for transmission. The social dynamics around the transmission of infectious diseases means this finding may be most useful for the public health teams involved in “contact tracing” – finding other people who may have been exposed to the virus. (3)

Very low risks for the general public

The monkeypox risks to the wider public are extremely low. And, thankfully, there are ways of bringing the virus to heel.

The US Centers for Disease Control and Prevention highlights how the smallpox vaccine, cidofovir (an anti-viral drug), and vaccinia immune globulin can be used to control a monkeypox outbreak.

However, beyond the smallpox vaccine, there is no specific vaccine to protect against monkeypox. Some experts have suggested that stopping widespread vaccination against smallpox might have lowered population immunity against monkeypox, thus making cases and outbreaks more likely.

A 2019 meeting at Chatham House in London suggested that an unintended consequence of smallpox eradication could be that “emergent or re-emergent human monkeypox might fill the epidemiological niche vacated by smallpox”.

However, these imported monkeypox cases and other tropical infections (such as Ebola, malaria and Lassa fever) indicate a wider burden of disease elsewhere in the world, typically in low-income countries with limited access to healthcare. It may be that in a post-pandemic environment, we should give more consideration to understanding the local and global implications of Lassa, monkeypox, Ebola and other rare but serious pathogens.

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Monkeypox goes global: why scientists are on alert (2)

Scientists are trying to understand why the virus, a less lethal relative of smallpox, has cropped up in so many populations around the world.

Called monkeypox because researchers first detected it in laboratory monkeys in 1958, the virus is thought instead to transmit from wild animals such as rodents to people — or from infected people. In an average year, a few thousand cases occur in Africa, typically in the western and central parts of the continent. But cases outside Africa have been limited to a handful that are associated with travel to Africa or with the importation of infected animals. The number of cases detected outside of Africa in the past week alone — which is all but certain to increase — has already surpassed the number detected outside the continent since 1970, when the virus was first identified as causing disease in humans. This rapid spread is what has scientists on high alert.

For monkeypox to be detected in people with no apparent connection to one another suggests that the virus might have been spreading silently.

Unlike SARS-CoV-2, which can spread asymptomatically, monkeypox does not usually go unnoticed when it infects a person, in part because of the skin lesions it causes.

It doesn’t transmit from person to person as readily, and because it is related to the smallpox virus, there are already treatments and vaccines on hand for curbing its spread.

You can reduce your risk by limiting contact with people who have suspected or confirmed monkeypox. (4). If you do need to have physical contact with someone who has monkeypox because you are a health worker or live together, encourage the infected person to self-isolate and cover any skin lesion if they can (e.g., by wearing clothing over the rash). When you are physically close to them, they should wear a medical mask, especially if they are coughing or have lesions in their mouth. You should wear one also. Avoid skin-to-skin contact whenever possible and use disposable gloves if you have any direct contact with lesions. Wear a mask when handling any clothes or bedding if the person cannot do it themselves.

Regularly clean your hands with soap and water or an alcohol-based hand rub, especially after contact with the person who is infected, their clothes, bed sheets, towels and other items or surfaces they have touched or that might have come into contact with their rash or respiratory secretions (e.g., utensils, dishes). Wash the person’s clothes, towels and bedsheets and eating utensils with warm water and detergent. Clean and disinfect any contaminated surfaces and dispose of contaminated waste (e.g., dressings) appropriately (4).

No monkeypox cases have been reported or confirmed till now in India.

Footnotes:

1. WHO considers declaring monkeypox a global health emergency
2. Monkeypox goes global: why scientists are on alert
3. Monkeypox: what you need to know
4. Monkeypox

5 Things to Know about Monkeypox