May 30, 2022
Not Monkeying Around
Who knew we would all become so knowledgeable about infectious diseases? Now, along comes a new outbreak. Well, actually not so new. Monkeypox has been known since the 1950’s, with the first case in humans seen in 1970 in Democratic Republic of Congo. In the past, it was transmitted from monkeys to humans, rarely human to human. It is related to Smallpox. The best writing I’ve seen to explain Monkeypox, is Katelyn Jetelina’s blog Your Local Epidemiologist. She gives the history of it, how it is transmitted, and other details.
Since Monkeypox is not a “novel virus”, much is already known about it. Some of that came from an outbreak in 2018-2019 and earlier ones. Monkeypox is transmitted via contact with bodily fluids or monkeypox lesions, respiratory droplets and aerosols from prolonged face-to-face contact (much longer and much closer than for SARS-CoV-2 which causes COVID) and indirect contact with contaminated items like clothing or bedding. It has a long incubation period of 5-21 days before people start to show symptoms. People aren’t thought to be infectious until they have symptoms. People are sick for 2-4 weeks starting with a fever, body aches, and swollen lymph nodes. They develop a rash1-3 days later, which can be a source for spread. In Africa, the death rate is as high as 1-10%, but lower in the European outbreaks in the past. In an outbreak in the US in 2003, none died although 15% had severe disease. 53 cases were identified and ultimately the outbreak was contained. That one was associated with pet prairie dogs who had been infected by rodents imported from Ghana.
Scientists are already hard at work looking for signs of mutations that might be worrisome. GLOBAL HEALTH, whose mission is to help with rapid sharing of public health data, is keeping track of data. Genomic sequencing is already being shared, looking for more concerning mutations. Right now the outbreak has been mostly in men who have sex with men, several cases traced back to some large Raves in Europe. No signs yet that it is sexually transmitted but the prolonged close contact at those parties would set the right conditions for spreading.
We already have vaccines that can help and are being offered to people exposed. Anti-virals also have some data that show mixed results in treating Monkeypox. Some protection seems to come from Smallpox vaccination. Smallpox vaccinations stopped being given regularly after it was eradicated in 1980. Epidemiologists wonder if we are seeing more Monkeypox because immunity from Smallpox vaccines has waned in older people who were vaccinated and the younger generations are not immunized. They have no cross-immunity. Very interesting ideas.
Monkeypox is different than SARS-CoV-2 and is not as easily transmitted. Infants and younger adults are the most at risk. Health experts are hopeful it can be contained, which is back to case reports and contact tracing. Outbreaks in the past have been contained. But concern over mutations making it more infectious are concerning. The experts are waiting for more data regarding that. The good news is that the same Swiss cheese, multi-layered prevention techniques we use for COVID-19 will protect us from Monkeypox.
Wash your hands, cover your nose, don’t worry about Monkeypox too much for now.
https://www.global.health
https://www.medpagetoday.com/infectiousdisease/publichealth/98908
https://www.cdc.gov/poxvirus/monkeypox/symptoms.html
https://www.seattlemet.com/health-and-wellness/2022/05/monkeypox-virus-outbreak-seattle-king-county-washington
https://dgnews.docguide.com/article/study-reports-first-use-of-antivirals-in-patients-with-monkeypox-highlights-challenges-in-treatment
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5223a1.htm
https://www.vox.com/science-and-health/23140315/contain-public-health-epidemic-vaccine-monkeypox-outbreak
https://thehill.com/policy/healthcare/3502648-cdc-nine-monkeypox-cases-confirmed-across-seven-states/
https://pubmed.ncbi.nlm.nih.gov/17715329/
https://www.nytimes.com/2022/05/26/health/monkeypox-vaccine-immunity.html?referringSource=articleShare
https://www.cnn.com/2022/05/24/health/monkeypox-vaccine-explainer-us/index.html
https://www.cdc.gov/mmwr/volumes/71/wr/mm7122e1.htm