Here’s some more background on Monkeypox, following my item from Friday.
Let’s be very clear, right up front … We are not witnessing another Covid, and we’re not days away from lockdowns to contain the spread of monkeypox. However, this is an unusual and unprecedented monkeypox outbreak which has taken scientists who specialise in the disease by surprise – and that’s always a concern. [4]
Spread & Behaviour
- Monkeypox is so rare that that most doctors will never see a case in their lifetimes. [2]
- Monkeypox is not known to spread easily between people, although cases emerging in several countries at once, and signs of transmission in the community is striking. [1,2]
- However the UKHSA saying the risk to the population “remains low”. [1]
- The US Centers for Disease Control (CDC) states: “Human-to-human transmission is thought to occur primarily through large respiratory droplets. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required.” [1]
- The virus doesn’t usually spread easily between people as it requires prolonged close contact. [3]
- Its R value is generally less than 1, so outbreaks naturally peter out. [3]
- Monkeypox can also spread through close contact or by contact with clothing, towels or bedding used by an infected person. [1,3]
- It isn’t regarded as a sexually transmitted infection, but it can be passed on during sex via skin-to-skin contact. (This should not be surprising!) [1]
- It’s not clear why gay and bisexual men are disproportionately affected. Are sexual behaviours making it easier to spread, or is this just coincidence? After all this is, in general, a community that is more aware of sexual health and getting checked out. [4]
- So the latest cases raise many questions and the scientists don’t really have the sense yet of what’s driving this, especially as there’s no travel link that’s identified that links the cases. [2]
- So the scientists are very much in response mode: trying to identify cases and trace potential contacts. And because many of the cases don’t join up scientists are aware they’re seeing only the tip of the iceberg. [2,4]
Symptoms
- The incubation period between infection and symptoms is long, ranging from five to 21 days. [3]
- The first symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. [1]
- A rash can also develop, typically on the face first and then on other parts of the body, mainly hands, feet and genitals. The rash can initially look like chickenpox, before forming scabs. [1]
- Swollen lymph nodes are a defining feature found in monkeypox but not so common in chickenpox. Currently there are very few kids with monkeypox but the UK is seeing a big surge in chickenpox. So sick kids are more likely to have chickenpox, but be vigilant. [5]
- The pictures of large blisters and scabs in the media are an unusual presentation and thought to be more common with the more serious Congo strain of the virus. Most presentation is with small pustules and lesions which are no more than 5mm in size. (Pictures in the references.) [5]
Different Strains
- There are two main types of monkeypox: the Congo strain and the West African strain. Only the West African strain has been identified in the UK. [1]
- The death rate from the Congo strain is thought to be 1 in 10, whereas it is only 1 in 100 for the West Africa strain.
These are likely to be upper estimates as it is unknown how many (mild) cases go unreported. [1] - It is unknown at this time if the current outbreak is due to a new strain of monkeypox. The sequencing work now being carried out should tell us. [1]
- Very early genetic analysis suggests the current cases are very closely related to forms of the virus seen in 2018 and 2019. It is too early to be sure, but for now there is no evidence this is a new mutant variant at play. [4]
Treatments
- The antiviral drug tecovirimat is approved in Europe for treating monkeypox, smallpox and cowpox; and approved in the US for smallpox. [1]
- The Jynneos vaccine is approved in the US and Europe for preventing monkeypox and smallpox in people aged over 18.
- In addition, those who are old enough to have been vaccinated against smallpox as babies should have some protection. Routine smallpox vaccination ended in the UK in 1971 and in the US in 1972. [1]
Pandemic?
- Monkeypox isn’t COVID. They’re very different diseases caused by different viruses with markedly different properties. COVID was completely unfamiliar when it first appeared, but monkeypox is a known quantity, and experts on the virus actually exist. [3]
- While researchers aren’t completely ruling out a pandemic, they don’t think it is at all likely. [1]
- Experts stress that monkeypox is very different from coronavirus. Monkeypox is a DNA virus so it does not mutate as rapidly as Covid or flu. [4]
- They’re also saying it’s important not to put this on the same level as a novel coronavirus. [1]
- Nevertheless monkeypox is a test of the lessons that the world has (or hasn’t) learned from COVID. [3]
- The US, at least, is in a better position with monkeypox than with Covid. They had not planned for a coronavirus pandemic, but they have spent decades thinking about how to handle smallpox bioterrorism. [3]
- The UKHSA are saying the risk to the UK population amid the ongoing outbreak “remains low”. [1]
Finally … Be vigilant. If you’re at all concerned phone 111 (in UK) or your doctor. But if you think you might have monkeypox DON’T just turn up at a doctor’s surgery (or sexual health clinic, or hospital); phone ahead so they know you’re coming and can prepare appropriate PPE and protective measures. [5]
References
[1] https://www.newscientist.com/article/2321212-could-monkeypox-become-a-pandemic-heres-everything-you-need-to-know/
[2] https://www.washingtonpost.com/health/2022/05/18/monkeypox-faq/
[3] https://www.bbc.co.uk/news/health-61524508
[5] Meaghan Kall of UKHSA on Twitter; https://twitter.com/kallmemeg/status/1528044499288657920