Will Monkeypox be the next Pandemic?

What is Monkeypox?

Monkeypox is a rare infectious disease caused by the monkeypox virus that belongs to the Orthopoxvirus genus. So, this is a member of the same family of Smallpox. However, the severity and the infectious rate are low. Still, the natural reservoir of this virus is unknown. Rodents mostly harbor the virus and infect people out of the most reported cases despite its name.

The virus was first found from research done on a pox-like disease in monkeys. Hence got the name ‘ Monkeypox.’ Mainly there are two strains of viruses, West African and Central African, as it occurs mostly in tropical rainforests of remote parts of these areas.

Roughly 250 cases have been reported so far, including cases in the USA, UK, Israel, and Singapore. Although this is a rare condition, health experts have now widened their investigations on this topic due to the increased number of suspected cases worldwide.  

Most of these cases link with international travel and imported animals. Yet, according to experts, close and prolonged exposure to an infected individual is necessary to transmit the monkeypox virus.

Symptoms

The symptoms of Monkeypox are more or less the same as the symptoms of Smallpox. However, deaths in 1 out of 10 infected people with the virus were revealed in a recent study. The symptoms of Monkeypox are not as virulent as Smallpox. It is milder. It is not as deadly as Smallpox. One of the key noticeable things in Monkeypox that can differentiate from Smallpox is lymph node enlargement. This lymph node swelling, or lymphadenopathy, is not a typical feature seen in smallpox disease.

Just like any other infection, Monkeypox begins with a prominent fever. Other subsidiary complaints include malaise, exhaustion, muscle ache, body aches, fatigue, and headaches. Usually, the incubation period ranges from 7 – to 14 days.

The patients with Monkeypox disease complain of the following symptoms at first. The initial symptoms of the disease are upper respiratory. Thus,

• Fever
• Headache
• Muscle aches
• Backache
• Swollen lymph nodes
• Chills
• Exhaustion

A rash usually appears after 1-3 days from the onset of fever. The rash originates from the face and then spreads to other body parts, including the mouth, hands, feet, and even genitals. These rashes transform into various stages. Before falling off these lesions, they progress through the following stages at first.

• Macules
• Papules
• Vesicles
• Pustules
• Scabs

Illness often lasts about 2 – 4 weeks.

Transmission

Transmission of the Monkeypox virus occurs via infected humans, contaminated materials (fomites), and animals through the respiratory tract and mucous membrane. This is transmissible via direct and indirect contact with body fluids and lesion materials as well.

The infected people need to be advised to limit contact with other people to limit the spread. However, for disease to occur, prolonged face-to-face transmission is essential. So, a pandemic like COVID -19 is unlikely due to Monkeypox, although it transmits from respiratory droplets.

Also, transmission is possible from an animal to a human from a bite. Apart from the respiratory tract, the virus can enter the body via broken skin, eyes, and mucous membranes. According to Dr. Michael Skinner, shed scabs of healed lesions can also be inhaled and may support the monkeypox virus transmission.

Monkeypox treatment

Monkeypox infectious disease is a self-limiting disease. Most infected individuals get cured without specific treatment. Monkeypox infection causes a mild condition in the infected person. However, individual factors affect the prognosis of the disease. If you are immunocompromised, this disease is no longer a self-limiting one. Comorbidities, current health status, and concurrent diseases of a person decide whether they need special attention. More attention should be paid to following individuals when infected with the virus.  

• Patients with severe diseases like sepsis
• High-risk group of people
• Pediatric population
• Immunocompromised people
• Pregnant and breastfeeding women
• Patients when presented with Monkeypox lesions in vital places in the body.

There is no specific treatment to treat this disease on the CDC website. Still, there is no big issue of not having standard antiviral treatment. Most patients do not have severe enough infection to merit antiviral therapy, but studying the use of antivirals is essential for a future outbreak. However, CDC says that antiviral treatment used for Smallpox will be beneficial in the treatment of this disease as well. 

• Tecovirimat / TPOXX
• Cidofovir / Vistide
• Vaccinia Immune Globulin Intravenous (VIGIV)
• Brincidofovir / Tembexa

Above mentioned drugs are available as the treatment options for Monkeypox. But medical guidance is strictly necessary before starting any of these drugs. 

Monkeypox vs chickenpox

Unlike Monkeypox, Chickenpox is caused by the varicella-zoster virus (VZV), which is highly contagious. In chickenpox, the rash first appears in the chest, while in Monkeypox, it first appears on the face. Further lymphadenopathy is not seen in chickenpox like in Monkeypox. Still, Monkeypox is considered rare, and chickenpox is a common disease in many tropical countries. 

Monkeypox outbreak?

The monkeypox virus was first recognized in 1970 as a smallpox-like disease among monkeys. It was then reported a Monkeypox outbreak across 10 African countries during that period. First-time a Monkeypox outbreak was found outside Africa was in 2003. That is in the USA among states of Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin. None of the reported cases during this pandemic resulted in deaths. It is found that the outbreak occurred from close contact with imported prairie dogs infected with the virus.

Since then, several outbreaks have been reported from different parts of the world, including the USA and UK, related to international travel and importation. The largest Monkeypox outbreak is reported in Nigeria, with 172 members. According to UK Health Security Agency (UKHSA), the risk of a future pandemic of the Monkeypox virus is very low. In late 2021, a Monkeypox case was recently found in the USA. That was a traveler from Nigeria. Two hundred people who had close contact with this patient were found and monitored. But any other additional case was not identified. The infectious rate is so low that we should not fear or think we are on the brink of a nationwide outbreak. 

Monkeypox 2022

But now, Monkeypox has become a prime concern with a case reported from the UK a couple of weeks ago. More importantly, about 400 cases were found in 20 non-African countries. Canada, the UK, Portugal, and Spain are among them. Another important point is that an obvious link among the reported clusters was not found. The virus has emerged across multiple nations without having a clue of any link between clusters. This has drawn the attention of scientists toward the Monkeypox.

Researchers have found that most of these reported cases resemble the Monkeypox stain of West Africa. The west African stain is less lethal than the Central African one.  

Monkeypox death rate

Compared to Smallpox, the death rate of Monkeypox infection is very low that is about 1%. But still, hospitalization and deaths are possible. This 1% death rate is reported for the west African variant. Actually, for the Central African variant, the condition is more severe. Studies show that the virus kills 1-10% of people infected. So we cannot just ignore the impact of this disease on the world if a severe outbreak arises. However, most of the recently emerged outbreaks, including the one reported a couple of weeks ago, are from the West African variant. 

Monkeypox vaccine

Monkeypox virus belongs to the same genus as the variola virus, which causes smallpox and cowpox virus. All these viruses belong to the Orthopoxvirus genus in the family Poxviridae. So vaccines used to prevent Smallpox can be used to prevent Monkeypox infection. These vaccines are important as prophylactic measures against the Monkeypox virus infection. Vaccinia virus of the Orthopoxvirus genus is mainly used to produce these smallpox vaccines.

The two vaccines recommended for preventing Smallpox are ACAM200 (Imvamune) and JYNNEOSTM (Imvanex). Out of them, JYNNEOSTM is specifically licensed for Monkeypox in America. 

JYNNEOSTM consists of non-replicating live viruses. This must be administrated in two doses four weeks apart. These are subcutaneous injections. Although Smallpox has been eradicated from the world, the vaccine has been stockpiled in case of re-emergence. 

ACAM2000 can also be administered against Monkeypox. This vaccine is recommended mostly for laboratorians who have a higher risk of infecting the virus. It, too, consists of a live vaccine. But unlike JYNNEOS, the ones who receive the ACAM2000 vaccine must take measures to prevent the spread of the vaccine virus. 

As we already discussed, both Smallpox and Monkeypox are close relatives, so there is no wonder that smallpox vaccines work very well in the prevention of monkeypox viral infection as well. According to CDC, its effectiveness is about 85% in preventing Monkeypox. These vaccines need to be given before the exposure of individuals to the virus. But still, there is a benefit of administrating them even after the exposure to reduce the severity of the disease. The earlier the infected person gets the vaccine, the better the consequences. To prevent the onset of the disease, the vaccine needs to be taken within four days from the exposure. If not, the vaccine will only reduce the symptoms.

If you wonder whether the vaccination or infecting originally with Monkeypox is better because in both ways you get the virus into your body, I suggest vaccination is better. The risk of monkeypox disease is greater than the exposure to the virus in the vaccine. 

Prevention

There are certain measures that need to be taken individually and institution-wise to prevent the emergence of this viral disease. Studies and all current research on Monkeypox are for preventing a re-emergence of a disease like Smallpox. 

Laboratory testings, further investigation of the smallpox vaccine and reprocessing of smallpox vaccines and antiviral treatments, remodeling of resources to prepare for future outbreaks, and tracking the spread of the virus, are some key interventions that need to be done to prevent the spread of Monkeypox virus. 

Further, developing a proper set of guidelines for patients, healthcare workers, and those who have a potential risk of infecting the virus needs to be done. Certain measures need to be taken during importation, international travel, and the release of certain species like rodents to reduce the emergence of various clusters from different parts of the world. Especially in the case of Monkeypox, better to impose restrictions on the movement of prairie dogs or domestically bred African rodents because the world has already experienced outbreaks from similar instances.