Monkeypox: A new emerging global health crisis?

Monkeypox most commonly occurs in central and west Africa and is rare outside this endemic zone. Alarmingly, cases are now being detected in Europe, US, Canada and Australia. Over 100 monkeypox cases have been reported from Europe from the United Kingdom, Spain, France, Portugal, Germany and Italy, and the numbers are rapidly rising. This is “atypical”, says the WHO, as cases are being reported in non-endemic countries, with no apparent link to West and Central Africa.

Monkeypox facts

• Epidemiology:Viral zoonotic disease endemic in tropical rainforest areas of Central and West Africa with occasional outbreaks among travelers. It was called monkeypox as it was first identified in 1958 in monkeys kept for research. It was first detected in humans in the Democratic Republic of the Congo in 1970. Rodents and primates are animal hosts.
• Etiopathogen:Monkeypox virus, a member of the Orthopoxvirus genus in the family Poxviridae.
• Transmission:Close contact with lesions, bodily fluids (e.g., saliva, pus or blood from skin lesions), scabs, respiratory droplets and contaminated objects (fomites). The virus can also spread through saliva. Vertical transmission also occurs. Sexual contact is not yet known as a route of transmission.
• Incubation period:6-13 days (range 5-21 days)
• Clinical presentation:The illness starts with fever, enlarged lymph nodes, intense headache, back pain, myalgia and severe asthenia (exhaustion). The enlarged lymph nodes differentiate it from smallpox, measles and chickenpox. The skin rash appears 1-3 days after onset of fever; in 95% of cases, rash appears on the face and in about 75% the rash is present on palms and soles. The trunk is spared. Rash is also present in oral mucosa (70%), conjunctiva (20%) and genitalia (30%). The rash progresses from macules to papules, vesicles, pustules that form a crust, which dry up and fall off.
• Differential diagnosis:Chickenpox, measles, scabies, bacterial skin infections, syphilis and other diseases presenting with rash
• Complications:Skin infections, pneumonia, confusion, eye infections leading to loss of vision.
• Case fatality ratio:3-6%.
• Treatment: Self-limiting disease, usually lasting for 2-4 weeks. No specific treatment for monkeypox. Mouth rinses and eye drops (avoid steroid containing preparations) and for severe cases, vaccinia immune globulin (VIG) can be used.
• Vaccine:A newer two-dose vaccine developed for smallpox based on modified vaccinia virus (Ankara strain) has been approved for the prevention of monkeypox in 2019.
• Prevention: Smallpox vaccine provides some protection against monkeypox but precautions are still required. Smallpox vaccination was discontinued after the disease was eradicated in 1980. Hence, the younger population is less likely to be vaccinated against smallpox.

1. Avoid contact with people known or suspected to have monkeypox.
2. The patient should also wear a mask, especially if there are oral lesions.
3. Wear a medical mask if contact with the infected person is required such as changing the bed linen etc.
4. Frequently hand wash with soap and water.
5. Surfaces within the vicinity of the patients should be cleaned and disinfected regularly.
6. Contact with wild animals should be avoided.
7. Animal meat should be thoroughly cooked before eating.