Monkeypox: What Is It?!

On occasion, I write about medicine. Why not more often? Because let’s be honest—writing about music and fantasy football is more fun. But, hey, when everyone is talking about some virus, it becomes a part of pop culture. On that note, here’s a breakdown of monkeypox, using the phenomenal site UpToDate as a guide.

 

Background

Monkeypox, as indicated above, is caused by a virus. To get a bit more technical, the virus is in the genus Orthopoxvirus, which also contains the variola virus (the causative agent of smallpox) and the vaccinia virus (the one used to make the smallpox vaccine). The genetic information in the monkeypox virus comes in the form of double-stranded DNA, a point that becomes relevant in regards to testing (see below).

The virus has been endemic to Central Africa (home to one strain) and West Africa (home to a less virulent strain) for quite some time, meaning that in contrast to SARS-CoV-2, the causative agent of COVID-19, this pathogen is not new.

The natural reservoir (i.e. the usual host) for the virus is unknown, though it is speculated to be one or more rodents. Infection was first identified in laboratory monkeys in Denmark during the 1950s, explaining the somewhat misleading terminology. The first human case was reported in the Democratic Republic of the Congo (formerly Zaire) in the 1970s.

From that time on, cases were generally confined to the aforementioned endemic regions, though numbers may have increased after widespread vaccination against smallpox was discontinued in the 1970s and 1980s. (Due to similarities between the viruses, vaccination against smallpox provides reasonable protection against monkeypox.) Reports of cases outside those areas were typically able to be traced back to Africa. As an example, a 2003 outbreak in the United States was determined to have stemmed from animals that had been imported from Ghana.

In 2022, however, what had been a relatively predictable entity somehow began popping up in various parts of the world, in many instances having no clear link to the African continent. And that’s why you’re reading this article.

 

The Medicine

What follows is what the international healthcare ecosystem is learning.

Transmission 

The virus can gain entry to the human body through broken skin, the respiratory tract, or certain mucous membranes (eyes, nose, and mouth for example). This can occur via an animal—courtesy close contact, bites, or consumption—or another human. In the latter case, contact with skin lesions (see below) or contaminated clothing/bedding can do the trick. Respiratory droplets can also spread the virus. While men who have sex with men are more likely to be affected, it’s debated whether this relates to skin contact during intercourse or sexual transmission via semen.

Incubation period

This refers to the time between exposure and the onset of symptoms and can range anywhere from 4 to 21 days.

Symptoms

While asymptomatic disease is uncommon, mild symptoms are par for the course. Fevers, chills, headaches, muscle aches, and swollen lymph nodes have all been reported. Then comes the rash, which eventually turns into pustules that crust and scab. Abnormal skin pigmentation or scarring can result. All told, symptoms can last from 2 to 4 weeks.

In more severe cases (for example in those with suppressed immune systems), complications such as pneumonia and encephalitis (inflammation of the brain) can occur. Fetal complications in affected pregnant women are quite possible.

No deaths have been reported in the 2022 outbreak, in part due to the fact that the causative virus is related to the less virulent West African strain.

Diagnosis

The documentation of viral DNA in skin lesions (often via PCR) can be used to make a diagnosis. Similarly, viral culture can be performed. A blood test looking for antibodies against the virus might be an option in some cases.

Treatment

As the disease can be mild and self-limited, specific treatment is often unnecessary. More severe cases may warrant vaccinia immune globulin (preexisting antibodies to the closely related vaccinia virus that might also help fight monkeypox). Finally, antiviral therapy designed to treat other viruses—including smallpox—can be used.

 

The Big Picture

It goes without saying that despite a relatively benign outlook in many cases, no one actually wants to get monkeypox. And that’s where public health infrastructure takes over. As guidance trickles in from the experts, these are some points worth keeping in mind.

• Contact with known cases of monkeypox should be avoided.
• Testing should be obtained if a diagnosis of monkeypox is suspected.
• Those with a positive test should isolate.
• Two vaccines (originally designed for smallpox) are available. Vaccination may be recommended for individuals who have been exposed to the virus in order to prevent or blunt the impact of illness. Vaccination as a preventative measure for the unexposed will be an option for individuals in high-risk populations. The exact details remain a work in progress.

 

No songs. No gambling. To be honest, monkeypox is rather mundane. Let’s hope it stays that way.