Pre-Collegiate Global Health Review
Understanding the Multi-Country Outbreak of Monkeypox
Fatimah Amer, BASIS Scottsdale, Scottsdale, Arizona, USA
Summary Monkeypox is a rare but potentially serious viral disease caused by a virus belonging to the Orthopoxvirus genus. The variola virus that causes smallpox is also a member of this genus. Although monkeypox and smallpox are very similar, monkeypox is much milder and less transmissible. The spread of monkeypox may be due to close contact between exposed people. As of September 2022, there are currently more than 64,000 confirmed monkeypox cases globally. However, even as cases increase, monkeypox remains fairly new to the majority of the public.
Monkeypox was first discovered in 1958 when outbreaks of a pox-like disease were found in a colony of monkeys (Blazer, 2022). However, the first human case of monkeypox was only reported in 1970 when a nine-year-old boy developed smallpox-like symptoms in the Democratic Republic of Congo. Since then, its prevalence has been largely limited to the rainforests of Central and West Africa (Graham, et al., 2022).
Recently, however, the number of human monkeypox cases have spiked, most significantly in Congo, but also in non-endemic countries in the Western Hemisphere. The increase in monkeypox cases may be due to the cessation of smallpox vaccines after the disease’s eradication in 1980 (Beer & Rao, 2019). Data regarding the similarity between monkeypox and smallpox has indicated that the smallpox vaccine is nearly 85% effective against monkeypox (State of New Jersey: Department of Agriculture, n.d.).What is even more concerning is that the limited number of people vaccinated for smallpox creates a social vulnerability as monkeypox cases continue to rise.
Figure 2: This world map shows the confirmed cases of monkeypox in non-endemic countries (WHO, 2022)
Monkeypox is usually transmitted through contact with animals, however, it has also been transmitted through person-to-person contact. Exposure to infected fluids, respiratory droplets, and contaminated materials such as clothes and linen may allow the virus to spread (CDC, 2022). Although monkeypox cannot be sexually transmitted, it has largely been reported in men who identify as gay or bisexual. Nevertheless, while some groups may be more vulnerable to the viral illness, anyone can get monkeypox through close contact, regardless of sexual orientation. The sudden global rise of monkeypox in humans is particularly concerning, so it is imperative that the general public, along with doctors and physicians, are aware of the early indicators of monkeypox.
In humans, monkeypox symptoms appear as a milder version of smallpox, along with the addition of swollen lymph nodes (lymphadenopathy) (Vanderbilt Health, n.d.). Initial signs include fever, chills, headaches, muscle aches, exhaustion, and other flu-like symptoms. Some severe cases of monkeypox may include dyspnea, which is shortness of breath, or labored breathing (State of New Jersey: Department of Agriculture, n.d.). Within one to three days of patients experiencing monkeypox symptoms, they may develop rashes on the face, which often appear as macules and papules. As the lesions progress, they develop throughout the body as flat red bumps which are often painful, and then finally as blisters (Cleveland Clinic 2022). These body rashes appear on the extremities, but also develop as raised bumps and blisters on the torso (CDC, 2022). Infected individuals may be contagious from a day before rashes and lesions appear, to 21 days after symptoms stop appearing and the skin lesions have formed scabs (Blazer, 2022).
Figure 3: This image shows skin lesions characterized by macules on hands (CDC, 2022)
Monkeypox can be diagnosed by the presence of skin lesions, or more accurately by using electron microscopy to identify the presence of orthopoxvirus on rashes. Along with this, serology, immunohistochemistry, or polymerase chain reaction (PCR) tests are helpful for confirming monkeypox infections (State of New Jersey: Department of Agriculture, n.d.).
Current treatments for monkeypox are more fragmented. Although the smallpox vaccine is effective in preventing monkeypox to some extent, the benefits do not outweigh the expense. Health officials are only encouraging people exposed to the viral illness to get a smallpox vaccination (CDC, 2022).
While health officials provide updates on monkeypox symptoms and treatments, it is important that countries promptly identify and report cases, and provide timely treatment for patients. Additionally, it would be beneficial for the general public to become more aware of monkeypox symptoms and methods of transmission, in order to do their part for the overall health and safety of our society.
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