All You Need To Know About: Monkeypox Transmission
There is a multi-country outbreak of monkeypox. A growing number of countries which do not usually have the disease (non-endemic) are reporting cases. Urgent investigations into the extent of spread are underway. International SOS is monitoring the situation closely.
Monkeypox is a disease caused by a virus in the same group as the smallpox virus. Its symptoms and progression are similar to smallpox infection (though milder). The case fatality rate is between 1-6% in countries where monkeypox is common (endemic). People can contract it from an infected animal or from other infected humans. Animal-to-human transmission (zoonosis) is from the consumption of meat of an infected animal or by coming into contact with body secretions, getting bitten or scratched. A major reservoir of monkeypox infection are rodents, who can infect non-human primates and possibly other mammals. In humans, the disease can spread by the following means:
Close contact:
Sexual contact or direct contact with the body fluids of an infected person
Contact with rashes or pustules of an infected case
Prolonged face-to-face contact with a sick person
After touching virus-contaminated objects, such as bedding or clothing.
Monkeypox isn’t a new disease. It was first discovered in monkeys over 70 years ago, with the first human case found in the Democratic Republic of the Congo in 1970. Monkeypox is a non-common disease that is caused by a virus from the same family as smallpox (which was eradicated in the 1970s through mass vaccination). Most monkeypox cases could be traced back to direct contact with infected animals and human to human transmission was rare.
Monkeypox has been endemic in the African continent and has rarely travelled outside of this geography. The first report of cases outside the African continent was in 2003, in the United States. In the following years, some cases were reported in Israel, Singapore and the United States. In early May this year, the UK reported an imported case from Nigeria. With healthcare providers on alert, a week later two more cases were found. However, these two cases had no links to Nigeria or to the previous case. Soon other cases were identified with no known links to endemic countries and health authorities in Europe and beyond were alerted to an unusual outbreak. There are now cases reported in at least 23 countries outside Africa. It appears many of the cases are in people who had prolonged close and intimate contact associated with mass gatherings in early May in Europe.
People usually become sick about 6 to 13 days after they have contact with the monkeypox virus, but it can take as long as 21 days. The first symptoms are flu-like: fever, headache, muscle aches, backache, swollen lymph nodes, chills and a general feeling of discomfort and exhaustion. About one to three days after the fever begins to subside, patients develop a rash. It usually first appears on the face and affects the arms, legs, hands and feet. However, in the current outbreak, the rash can involve the genital and perianal area. The rash progresses through several stages, forming pus-filled blisters, before crusting and falling off. People are infectious until all the crusts have fallen off. Most people usually recover within about 2 to 4 weeks. The disease can be severe and rarely, even fatal. Children and people with immune deficiency are at higher risk of severe disease.
Until more is known, healthcare providers are being cautious – suspected patients will likely need to be housed in isolation rooms. Contact tracing is imperative to stop further transmission. Confirmatory diagnosis is made by laboratory testing of blood and microscopic study of swabs of the rash. Generally, only specialised laboratories can test for monkeypox.
A vaccine and antivirals that were developed against smallpox are effective against monkeypox. People who have been vaccinated against smallpox in the past appear to have 85% protection from monkeypox. A newer vaccine that protects against smallpox and monkeypox is available in a few locations, mainly for clinical research personnel in high risk areas.
The good news is this is an outbreak that may be contained and stopped from growing futher. Primed with lessons learned from COVID-19, authorities are responding quickly - collaborating, sharing information and guidance. Measures organisations used in the past to reduce the risk of COVID-19 transmission are still relevant. Firstly stay informed, raise awareness – this is an evolving situation. There will be misinformation and disinformation! Seek advice early. Hygiene measures, appropriate isolation, contact tracing and quarantine are all still useful.
Prevention is through:
Observing good personal hygiene.
Washing hands well and often.
Avoiding close contact with sick people.
Avoiding touching objects which have been in contact with a sick person.
In areas where monkeypox is present in animals, additional preventive measures are:
Avoiding contact with wild animals.
Avoiding touching objects which have been in contact with animals.
Avoid preparing or eating "bush meat" (wild game).
RISK TO TRAVELLERS
Monkeypox is found in Central and West Africa, particularly in the Democratic Republic of the Congo (DRC) and Nigeria. The risk to travellers is low if they avoid contact with animals and sick people. Unusual health hazards seem to be popping up with increasing speed. While we may have our attention focused on monkeypox at the moment, we can’t let down our guard against whatever else the 21st Century has in store for us.
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