Monkeypox: It may cause symptoms like that of smallpox, usually milder
Monkeypox is a mild pox-like illness caused by the monkeypox virus, a close cousin of the more severe and now eradicated smallpox virus. A colony of monkeys being used for research purposes was the first to be infected by this virus in 1958, hence the disease was called ‘monkeypox'. We still do not understand what the actual source of the infection was but the name stuck for this viral illness. It is believed that rodents and monkeys in Africa have been the harbour of infection and later on transmitted it to humans. Previously, human infections were limited to people in African countries or international travel to these countries. However, the monkeypox cases have now surfaced on multiple continents ringing alarm bells about whether this is another global emergency in the making. The good news is that this disease is rarely fatal.
There are two different types of this virus-the West African and the Congo basin virus. The present outbreak is by the West African subtype. The West African strain has a higher probability of causing scarring after the rash subsides but a fatality rate of 1% whereas the Congo Basin strain can be more deadly and kill up to 10% of patients. The complications are seen more often in immunocompromised patients with co-morbidities, pregnant women, and very young children.
The monkeypox virus spreads by direct contact with the rash or body fluid of an infected patient or through airborne droplets when the patient coughs or sneezes. Prolonged physical and sexual contact, as well as mother-to-child transmission of the virus, are known to happen. The virus also spreads through clothes, towel,s and bedding of infected persons due to contamination by body fluids. Infected animals cause infection through scratches or bites.
The incubation period is 1-2 weeks and the entire spectrum of illness lasts a fortnight to a month before the rash heals fully. The infection is spread from one infected person to another person in contact. Asymptomatic people do not spread the disease. The patient with monkeypox presents with fever with chills, headache, muscle pains, and sore throat but the two characteristic symptoms are swollen lymph glands and a rash resembling blisters or pimples. The patient remains infective to other people till the rash heals, the scabs fall, and a fresh layer of skin forms over the blisters.
In case any individual is suspected to have monkeypox, he should isolate himself and get examined by a doctor. He will need to undergo tests for monkeypox. Since the samples are sent to specialised virology labs, the reports may take a few days to confirm the diagnosis. Avoid using public transport in order to avoid exposure to others. In case you need to visit the hospital, wear long sleeve clothes and trousers and a proper mask.
There are no specific medicines for monkeypox but we have been wiser from our experience with handling smallpox and are using the same drugs and vaccines to counter this infection. An antiviral drug called Tecovirimat (TPOXX) is being used in immunocompromised monkeypox patients. The Americans had stockpiled a large number of smallpox vaccines- JYNNEOS and ACAM2000 in anticipation of an outbreak of pox and are now recommending the use of these vaccines in people or healthcare workers in close contact with a monkeypox case. As of now, mass vaccination drives have not been undertaken. People with multiple sexual partners or with one partner suffering from monkeypox are under the scanner and being offered the vaccine in the USA. At this point in time, we are unsure whether people living with HIV get a more severe form of monkeypox or not.
To protect yourself, avoid contact with any person with a rash suspected to be monkeypox. Avoid sharing utensils or tumblers with such a patient. Do not touch the clothing or bedding of the patient with bare hands.
There are many unanswered questions about this disease. How contagious is the virus? Will it mutate easily? Will it be transmitted through pet animals? Do we need mass immunisation to eradicate it? The world is on the lookout as the cases surge and we decipher the mystery of this old but re-emerging virus.
Content by: Dr. Monica Mahajan, Director Internal Medicine, Max Healthcare, New Delhi
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