At the time of writing this blog, there have been two reported cases of monkeypox in the United States. 22 cases have been confirmed in Canada. Worldwide, there have been 145 reported cases. Monkeypox isn’t a new disease. The first confirmed human case was in 1970 in the Democratic Republic of Congo (DRC). Most of the cases since then have been centered around the same area.
The first reported cases of monkeypox in the US wa s in 2003, from an outbreak in Texas linked to a shipment of animals from Ghana. There were travel-associated cases in 2021 in Maryland. This is an emerging disease. It has been emerging for the last 20 to 30 years. The name “monkeypox” comes from the first documented cases of the illness in 1958 when two outbreaks occurred in monkeys kept for research. However, the virus did not jump from monkeys to humans, nor are monkeys major carriers of the disease. The animal reservoir carrier of the virus is not really known, though it is frequently linked to a rodent species in Africa.
Monkeypox causes lesions that resemble pus-filled blisters. These lesions do scab over. Several recent cases have been linked to the spreading on genitalia from intimate contact. That is a big reason that this will not spread like other viruses have. Experts have warned that although monkeypox is not a sexually transmitted disease, it could be passed on through skin-to-skin contact during intimate contact.
Monkeypox is caused by the monkeypox virus, which belongs to the Poxviridae family of viruses called Orthopoxvirus. This subset includes smallpox, vaccinia, and cowpox viruses. Because monkeypox is closely related to smallpox, the smallpox vaccine can provide protection against infection from both viruses. The current administration, in an abundance of caution, has ordered more smallpox vaccines to be ready.
The last naturally occurring case of smallpox was reported in 1977. In 1980, the World Health Organization declared that smallpox had been eradicated. Currently, there is no evidence of naturally occurring smallpox transmission anywhere in the world. That eradication is attributable to the effective use of vaccines. Because smallpox was eradicated 40 or more years ago, we stopped vaccinating for it. Fortunately, we have some history with smallpox and exposure to it through previous generation vaccinations. Smallpox-type viruses are far from novel viruses.
SYMPTOMS, TREATMENT, & LETHALITY
Health officials are worried the virus may currently be spreading undetected through community transmission, possibly through a new mechanism or route. Where and how infections are occurring are still under investigation. Symptoms usually don’t appear until one to two weeks after infection. While the virus is incubating in the body of its host, it is not currently spreading. Its infectious state is after the host shows outward signs of infection in the form of lesions.
There is some discussion concerning the virus spreading via respiratory droplets, but to date, transmission in this manner appears to still be confined to the period following the outward expression of the virus in the form of severe rash, lesions, and pus-filled wounds. Overall, symptoms usually last for two to four weeks, while skin lesions usually scab over in 14 to 21 days. Typically, the virus enters the body through broken skin, inhalation, or the mucous membranes in the eyes, nose, or mouth. The key here is that the virus spreads primarily when an infected person is expressing symptoms. That’s much different than COVID where a person can be asymptomatic for over a week while still actively spreading the virus.
In the world’s past, smallpox killed a third of all the infected people. That was before any vaccine existed, however. There is no treatment for monkeypox, but vaccinating someone with the smallpox vaccine after exposure and within 3-days offers the same level of protection as a fully vaccinated person. Vaccinating within 7-days after exposure will tend to lessen the severity of the illness. Past data from Africa suggests that the smallpox vaccine is at least 85% effective in preventing monkeypox. This vaccine, however, has changed very little since its early days. It is estimated that one out of every million people vaccinated will die from the vaccination. Fifteen will become seriously ill. 16 out of a million is a very low risk, but it is significant enough to weigh it against the actual risk of exposure.
Right now, there are probably ample vaccine doses in the strategic reserve, and the US has pre-emptively ordered 13 million additional doses. So, there isn’t a need to formulate any new vaccine compounds. So, there probably won’t be a big push to get vaccinated, especially since there is such a big push to get people vaccinated against COVID. However, vaccine doses will be offered to high-risk areas where outbreaks are occurring. There also won’t be a big push for vaccination here because of the low rate of lethality. While monkeypox is rare and usually non-fatal, one version of the disease kills around 10 percent of infected people. The form of the virus currently circulating is thought to be milder, with a fatality rate of less than 1 percent.
While we always suggest an abundance of caution, especially since my undergrad was in microbiology, we don’t think we need to panic about this monkeypox virus. If we do, it will be because we are seeing an asymptomatic, higher lethality, and a more widespread area of infection. So, while it should definitely be on your radar, if you avoid areas where infections have been known to occur, you avoid people who are expressing lesions on their skin, you postpone your purchase of or handling of any rodents, including Guinea Pigs and Prarie Dogs, we think you are probably safe from a monkeypox pandemic.
As always, stay safe out there.