As people are slowly coming out of the Covid-19 scare, the news about monkeypox, a milder cousin of smallpox, is causing growing unease amongst people. First described in 1958, fewer than 19000 cases reported in humans since 1970. Majority were reported from Central and West Africa. Only 8 cases were reported outside of Africa over last 5 years since a small epidemic broke out in Nigeria in 2017. Each of these 8 cases had history of travel or contact with infected person. What is puzzling is the simultaneous appearance of the cases in multiple countries without a travel or contact history.
More than 75 countries where monkeypox is not endemic have reported outbreaks of the viral disease, which the World Health Organization has declared a global health emergency, as confirmed cases crossed 25,000 and non-endemic countries reported first deaths with India reporting its first death on August 1 2022 says Dr Krishna Reddy Nallamalla, , President, InOrder, the Health Systems Institute.
What is Monkeypox?
While Covid-19 is caused by a RNA virus, monkeypox is caused by a DNA virus. Though related to smallpox virus, it causes mild illness in majority with case fatality rate less than 4%. Smallpox carries a case fatality rate of ~30%. It spreads through close contact with affected people, contact with clothes worn by the affected person and also through air droplets. It takes about one to two weeks for the symptoms to appear after a contact. It generally starts as fever, headache, muscle pains and enlargement of lymph nodes followed by appearance of rash with firm lesions that soon evolve into blisters that dry out into scabs.
How monkeypox differs from Covid-19?
Being a DNA virus, monkeypox evolves slowly compared to Covid-19. Asymptomatic people do not spread the infection with monkeypox, while Covid-19 can spread from asymptomatic people also. Unlike Covid-19, lungs are not involved in monkeypox. Monkeypox is less contagious than Covid-19. However, contagiousness of current outbreak of monkeypox is still under evaluation.
How to prevent and treat monkeypox?
Treatments that were earlier tested against smallpox may work in smallpox. However, they have not been evaluated adequately. Smallpox vaccine is effective in preventing monkeypox. However, routine use of smallpox vaccine has been discontinued from 1979 in India. Hence, people who were born before 1979 and received smallpox vaccine will have protection against monkeypox. Some countries are offering the vaccine to people at high risk. Vaccine is also effective if given up to 4 days after exposure as the incubation period is long in monkeypox compared to Covid-19.
What we do not know about monkeypox?
We do not know why there is a sudden spread of the virus across the globe. Smallpox vaccination has been decreasing from 1980 when smallpox was declared as eradicated. We do not know why majority of the cases are reported in men who have sex with men. It may be because of close contact involved. We do not know whether new variants have emerged recently with different transmission characteristics. We do know that there has been no death so far in affected cases.
What is it telling us?
Monkeypox is a reminder that the world now is interconnected and interdependent more than ever. As our contact with wild animals is increasing through trade, deforestation and urbanization, we are at risk of contracting more zoonotic diseases. Climate change is altering ecological systems in unknown ways. We need to do what we can do at personal level, family level, and community level. Governments should strengthen public health system to have robust disease surveillance, alert, and containment systems and should provide resources to prevent, detect, and treat novel pathogens.
By Dr Krishna Reddy Nallamalla. The author is President, InOrder, the Health Systems Institute.