Monkeypox: what is this disease and is it worth fearing an epidemic

In 2020, almost the entire world is facing an epidemic of coronavirus. Of course, it is not the only one and, unfortunately, not the last one in the history of mankind. This year, COVID-19 may be replaced by monkeypox. According to WHO, cases of infection with this disease have already been confirmed in 27 countries. ^[1] How threatening the situation is, whether to expect an epidemic of the disease, and most importantly, whether monkeypox is dangerous – all these are more than pressing questions.

Smallpox: orthopoxoviruses are to blame

Monkeys and smallpox share the same genus of viruses – orthopoxviruses. This group includes 13 species that affect humans and animals. The most terrible, remembered by high mortality, is smallpox. The lethal outcome in this disease was about 30% of cases. Mass vaccination, carried out until 1980 (in America until 1972), made it possible to overcome the disease, so in the summer of 1978 the last known case of smallpox was recorded. ^[2]

Orthopoxovirus infection is a contagious disease. It is quite easily transmitted from a patient to a healthy body by airborne droplets, less often by direct contact. The incubation period is 10-12 days. The prodromal period lasts 2-3 days, accompanied by fever, headache, severe malaise, and back pain. After the end of the prodromal period, rashes appear, which can be localized:

• on the mucous membrane of the oropharynx;
• on the face, hands;
• on the body, legs.

On the face and limbs, they are more dense, they can even appear on the palms. The outcome of the disease depends on the form and type of the disease.

Where did monkeypox come from

Most residents of America, Australia, Europe and Asia only this year learned about such a disease as monkeypox. But in the west and in the center of the African continent, this disease circulates in nature, often causing outbreaks. The last case of widespread infection – about 4600 people – was recorded in 2020 in the Congo. ^[3] In addition to such epidemics, single cases of the disease are constantly detected, as well as small groups of people – 50-80 people. For example, in 2003, 70 patients were diagnosed with monkeypox in the United States of America. In 2018, a viral disease was detected in Israel and Britain, in 2019 – in Singapore, and in 2021 – again in the USA and Great Britain. ^[4]

Monkeypox was first diagnosed in 1958 in laboratory monkeys. For this reason, it received its official name – Monkeypox virus. And 12 years after the discovery, the disease was confirmed in humans, which prompted scientists to attribute it to zoonoses – infections transmitted from animals to humans. Today, not only monkeys are considered carriers of the virus, but also rats, squirrels, mice, and prairie dogs. The infection can be transmitted between these animals, which accelerates the spread of the virus.

On May 7, monkeypox was diagnosed in a British resident who had returned from Nigeria. And by the end of the month, WHO announced the discovery of cases in 19 countries around the world. And although it is too early to talk about the epidemic, it is worth learning as much as possible about the disease in order to be prepared for any outcome.

Monkeypox and natural: how are they similar and what distinguishes them

As already mentioned in the article, both monkeypox and smallpox are caused by viruses of the same family, Poxviridae, which implies their similarities. And it does exist to some extent:

1. Airborne (for a monkey is weak) and contact mode of transmission in both viral infections.
2. The incubation period is from 7 days. This indicator can vary from 5 to 21 days, but on average no more than 10.
3. The first symptomatology is also similar: temperature, headache, muscle pain, weakness. This prodromal period lasts for 2-3 days.
4. Appearance of rash and skin lesions.

This is where the similarities end, as there are also a few important differences:

• In addition to the contact and airborne transmission of a viral infection, Monkeypox virus as a zoonosis can enter the human body by eating infected meat of certain animal species. It is believed that monkeypox can also be transmitted from mother to child, while such a variant of infection is not attributed to natural;
• with a monkey, there is a strong inflammation of the lymph nodes – the patient himself can easily feel them;
• the rash appears even on the palms of the hands, which is not typical for smallpox; ^[5]
• The mortality rate for infection with the monkeypox virus is 1%. The disease proceeds quite easily, causing complications in rare cases. For comparison: the mortality rate in unvaccinated patients is 30%. ^[6]

If we consider monkeypox in terms of danger compared to natural, then we can safely say: it does not threaten life to the same extent. However, scar marks can remain forever in both cases.

Monkeypox situation in Europe and Asia

As of June 2022, 39 countries have already announced cases of detection of monkeypox patients. In seven of them, such a disease circulates constantly, but in 32 the virus appeared for the first time, so the International Committee for Health Emergencies convened an emergency meeting on June 23. In total, 1600 cases of the disease have been confirmed, and 1500 remain in doubt. For 72 patients, infection with monkeypox ended in death. But it should be clarified that all patients lived in areas of constant circulation of the virus. ^[7]

For European and Asian countries, monkeypox is a completely new disease. At the moment, it has not yet been diagnosed in Asia. But the situation in Europe is somewhat more complicated: the risk of the spread of the virus is at a high level. Cases of infection were found in the UK, Latvia, Poland, Belgium, Switzerland, Spain, Portugal, Germany, France, Italy, Sweden, Finland, and the data changes daily. According to the Ministry of Health of Ukraine, the disease can reach this country, but an epidemic is not predicted. ^[8]

Monkeypox has not yet reached Russia, Belarus and other countries of the former CIS. But given the proximity to Finland, where there are already several cases, there is a risk of the virus entering.

Who is most likely to be infected

Given the way the virus is transmitted, it’s not easy to contract monkeypox. To do this, you need to be in close contact with the patient, stay in the same room with him for a long time, or eat infected meat. But still there is a possibility, so you need to be especially careful for those who are included in such risk groups:

1. Children and teenagers.
2. Pregnant women.
3. The elderly, especially those with chronic diseases.
4. Patients with immunodeficiency diseases.

Those who are vaccinated against smallpox are more protected. It is believed that a vaccine given even in childhood can protect an adult from infection by 85% or makes the course of the disease much milder. ^[9]

It also increases the likelihood of getting monkeypox in those who travel or work on the African continent. For many countries in Africa, the disease is a natural zoonosis, constantly circulating in nature.

Why did the disease spread among people

Until the early 80s of the last century, mass vaccination against smallpox was carried out, which made it possible to prevent infection with this disease. After its termination, in each subsequent generation, immunity to this disease decreased. Monkeypox “took advantage” of this relief and turned into a viral infection that threatens the health of not only animals, but also people.

This explains the fact that laboratory workers after the discovery of the virus in 1958 did not become infected from monkeys. All of them were vaccinated, so they had immunity.

Main symptoms and differences from other types of smallpox

WHO distinguishes two types of monkeypox strains. The symptoms and course of the disease depends on how the person fell ill:

1. West African – considered easier, its fatality rate is 3,6%.
2. The Central African, also referred to as the Congolese, has slightly more severe symptoms, and the mortality rate for infection with this type of strain is just over 10%.

Symptoms of monkeypox also depend on the stage of the disease. After the incubation, the invasion period begins, which is characterized by the appearance of the first symptoms:

• fever (body temperature can rise up to 38,5 ° C);
• severe headache;
• pain in the lumbar region and back;
• weakness;
• muscle pain.

In some patients, there is an increase and inflammation of the lymph nodes. And it is this symptom that is characteristic of monkeypox, but not inherent in other types of diseases caused by the same family of viruses.

After 1-3 days after the onset of fever and pain, a period of appearance of rashes on the skin begins. Initially, they are noticeable on the face, palms and feet, and then spread throughout the body. Such rashes remain on the skin for up to three weeks, going through several stages of development: from lesions with a flat base to fluid-filled crusts. The symptoms of monkeypox are similar to those of herpes, chicken pox, and shingles. That is why additional laboratory diagnostic methods are carried out to confirm the diagnosis: bacterial culture, electron microscopy, immunohistochemistry, a blood test for antibodies, and the determination of virus DNA in epithelial scrapings.

Dangerous complications of monkeypox

The course of a viral infection is relatively mild. The only thing that patients complain about is the soreness of the papules. I also feel a little tired.

But the disease can become a serious threat to health if its complications occur. There may be several options:

• sepsis – blood poisoning;
• encephalitis – inflammation of the brain;
• corneal infection, which is potentially dangerous for the development of blindness;
• bronchopneumonia – acute inflammation of the walls of bronchioles;
• accession of secondary bronchial infections.

All these conditions require serious treatment, otherwise irreparable harm to health or even death is possible.

Features of the treatment of monkeypox

At the first symptoms or after the appearance of a skin rash, the patient should contact a general practitioner, family therapist or infectious disease specialist. The main feature of monkeypox is that there is no specific treatment. In fact, such a viral infection goes away on its own, although some experts recommend taking antiviral therapy for a quick recovery and an easier course of the disease.

There are only two approved drugs that have shown activity against monkeypox in the laboratory: brincidofovir and tecovirimat. But given that clinical trials have not been conducted on a group of patients, there is no exact confirmation of the effectiveness of the funds.

For patients with monkeypox, doctors can also prescribe symptomatic therapy: a drinking regimen to replenish fluids, taking vitamin complexes to replenish nutrients. More serious treatment will be in the event of complications, that is, the addition of secondary infections – bronchopneumonia, sepsis, corneal infections and encephalitis. In such cases, therapy is aimed at eliminating them. ^[10]

Is there a cure for monkeypox?

It is easier to prevent a disease than to treat it. But is there such a possibility with monkeypox? Yes, simple preventive measures can help reduce the risk of infection:

1. Thorough hand hygiene.
2. Wearing a mask in regions with recorded cases of the disease.
3. Avoid contact with animals in countries where the infection is considered a persistently circulating zoonosis. These include Cameroon, Nigeria, Liberia, Gabon, South Sudan, Sierra Leone, the Democratic Republic of the Congo.

Those who were vaccinated against smallpox as children are also 85% protected against monkeypox. Vulnerable may be generations born after 1980, when vaccines were no longer used.

Interestingly, American scientists developed monkeypox vaccines back in 2019. But so far, WHO does not recommend its mass use, because there is no serious threat. Vaccination is planned only among medical workers who may be in contact with potential patients. ^[11]

After the coronavirus pandemic, everyone would like to relax, return to a normal lifestyle. Although doctors and scientists do not predict the mass spread of the virus around the world, it is not yet known whether it is possible to relax. But it is definitely necessary to find out the maximum information about monkeypox.

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