Monkeypox Virus: Information, News and Updates

Definition

Monkeypox

Monkeypox is a zoonotic pox virus infection that can occur in both humans and some other animals. Monkeypox in humans and animals is caused by infection with the monkeypox virus - a double-stranded DNA virus in the genus Orthopoxvirus, family Poxviridae. Two recognized distinct types are described as the Congo Basin clade and the milder West African clade.

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What is Monkeypox?

Monkeypox is a rare disease caused by infection with the monkeypox virus. The monkeypox virus is part of the same family of viruses as the variola virus, which causes smallpox. Monkeypox symptoms are similar to smallpox symptoms but milder, and monkeypox is rarely fatal. Monkeypox is not related to chickenpox.

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When the outbreak of monkeypox expanded earlier this year, racist and stigmatizing language online, in other settings, and in some communities were observed and reported to WHO. Following consultations with global experts, WHO will begin using a new preferred term, "mpox," as a synonym for monkeypox. Mpox will become a preferred term, replacing monkeypox, after a transition period of one year.

The World Health Organization (WHO) recently declared monkeypox a global health emergency. On July 23, 2022, the WHO Director-General declared the escalating global monkeypox outbreak a Public Health Emergency of International Concern (PHEIC).

Monkeypox was first identified as a distinct illness in 1958 among laboratory monkeys in Copenhagen, Denmark. Several mammals are suspected of acting as natural reservoirs of the Monkeypox virus. Although it was once thought to be uncommon in humans, cases have significantly increased since the 1980s, possibly due to waning immunity since the stopping of routine smallpox vaccination.

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Monkeypox Questions and Answers

Should I Get Vaccinated to Prevent Monkeypox?

At this time, public health authorities have not recommended the general public needs to be vaccinated against monkeypox. Public health authorities have only recommended select individuals receive the vaccination. For example, vaccination is recommended for those who have been exposed to monkeypox and for individuals with certain risk factors - (https://www.cdc.gov/poxvirus/mpox/clinicians/vaccines/vaccine-considerations.html)

If Someone Received a Smallpox Vaccine, Do They Have Immunity Against Monkeypox?

Individuals who received a smallpox vaccine may have some protection against monkeypox. However, several factors could affect whether immunity was present, including the "take" (the lesion that develops at the injection site) of the vaccine when administered and the time since vaccination.

Is There a Test for Monkeypox?

Yes. Moreover, since monkeypox was first detected in the U.S., the FDA has been working closely with the CDC, commercial laboratories, and traditional manufacturers to make monkeypox tests more readily available to patients and providers.

Colorized transmission electron micrograph of monkeypox particles (teal) found within an infected cell (brown) cultured in the laboratory. Image captured, and color-enhanced at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland - Image Credit: National Institute of Allergy and Infectious Diseases (NIAD) - Monkeypox Outbreak Highlights Need to Prevent Future Zoonotic Diseases

Is There a Saliva-Based Test for Monkeypox?

There is only one FDA-cleared test, the CDC's Non-variola Orthopoxvirus Real-time PCR Primer and Probe Set (K221834), for use in CDC-designated laboratories, and it uses swab samples taken directly from a lesion (rash or growth). The FDA lacks clinical data supporting other sample types, such as blood or saliva, for monkeypox virus testing.

Is There Treatment for Monkeypox?

There is no FDA-approved or authorized treatment for monkeypox. However, the CDC holds an expanded access Investigational New Drug (EA-IND) protocol, sometimes called "compassionate use," that allows for the use of an antiviral medication called TPOXX (tecovirimat) for the treatment of monkeypox. The safety and efficacy of TPOXX to treat monkeypox in humans have not been established.

How Does Monkeypox Spread?

Humans can be infected by an animal via a bite or scratch, bush meat preparation, or contact with an infected animal's bodily fluids or lesion material. The virus is thought to enter the body through broken skin, the respiratory tract, or the mucous membranes of the eyes, nose, or mouth.

Human-to-human transmission can occur through exposure to infected body fluids or contaminated objects, by small droplets, and possibly through the airborne route. Monkeypox is most likely primarily spread through close contact, including close contact during sexual activity. Still, it is not classified as a sexually transmitted disease as it does not require contact with genital fluids to spread. Most cases have been in men. A significant proportion of cases, although not all, are in men who have sex with men (MSM), notably in Canada, Spain, and the UK, with many cases diagnosed in sexual health clinics.

The U.S. Centers for Disease Control and Prevention has emphasized the importance of reducing stigma in communicating about the demographic aspects of monkeypox, specifically with regard to gay and bisexual men.

Symptoms of Monkeypox

Monkeypox is a viral infection that manifests a week or two after exposure with fever, swollen lymph nodes, and other non-specific symptoms. It then produces a rash with lesions that usually last 2-4 weeks before drying up, crusting, and falling off. The rash can look like pimples or blisters on the face, inside the mouth, and on other body parts, like the hands, feet, chest, genitals, or anus. Early symptoms include headache, muscle pains, fever, and fatigue, initially resembling influenza. The classic presentation of fever and muscle pains, followed by swollen glands, with lesions all at the same stage, is not common in all outbreaks.

The time from exposure to onset symptoms ranges from five to twenty-one days. The duration of symptoms is typically two to four weeks. 75% of affected people have lesions on the palms and soles, more than two-thirds in the mouth, a third on the genitals, and one in five have lesions in the eyes.

In infections before the current outbreak, 1 to 3 percent of people with known infections have died (without treatment). Cases in children and immunocompromised people are more likely to be severe.

Complications include secondary infections, pneumonia, sepsis, encephalitis, and vision loss with a severe eye infection. If infection occurs during pregnancy, stillbirth or congenital disabilities may occur.

2022 Monkeypox Outbreak

An ongoing outbreak of monkeypox, a viral disease, was confirmed in May 2022. The 2022 outbreak has a different spread pattern than prior monkeypox outbreaks outside Africa. The initial cluster of cases was found in the United Kingdom.

The first case was detected on 6 May 2022 in an individual with travel links to Nigeria (where the disease is endemic). The outbreak marked the first time monkeypox has spread widely outside Central and West Africa. From 18 May onwards, cases were reported from an increasing number of countries and regions, predominantly in Europe but also in North and South America, Asia, Africa, and Australia.

On 23 July, the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC), raising the outbreak's status to a global health emergency. As of 28 July, there were a total of 20,846 confirmed cases.

Many cases in the 2022 monkeypox outbreak presented with genital and peri-anal lesions, fever, swollen lymph nodes, and pain when swallowing, with some patients manifesting only single sores from the disease.

The Centers for Disease Control and Prevention has emphasized the importance of reducing stigma in communicating about the demographic aspects of monkeypox, specifically with regards to gay and bisexual men.

Treatment of Monkeypox

There is currently no known cure for Monkeypox. A study in 1988 found Smallpox vaccines containing vaccinia, such as Imvanex (Jynneos) and ACAM2000, can provide around 85% protection in preventing infection in close contact and lessening the severity of the disease. This protection level is calculated from studies using smallpox vaccines tested in late 1980 in Africa.

On 23 June, the New York City Department of Health announced a clinic at the Chelsea Sexual Health Clinic to offer the two-dose JYNNEOS vaccine to "...all gay, bisexual, and other men who have sex with men (cisgender or transgender) ages 18 and older who have had multiple or anonymous sex partners in the last 14 days."

Monkeypox Outcome

If you've been infected with the monkeypox virus, your local public health authority may require that you isolate yourself to prevent further spread. They may recommend that you isolate at home or in a different location, depending on your living situation.

The illness is usually mild, and most infected will recover within a few weeks without treatment. Estimates of the risk of death vary from 1% to 10%, although very few deaths as a consequence of monkeypox have been recorded since 2017.

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