New and suspected cases of monkeypox have cropped up in in Europe and North America and reached Israel, Australia and Argentina in recent days, in signs that the rare and potentially deadly cousin of the smallpox virus traditionally confined to regions in Africa is now seeded across the world. The global eradication of smallpox more than 40 years ago was one of the greatest achievements in public-health history, vanquishing a cause of death, blindness and disfigurement that had plagued humanity for at least 3,000 years. But, on the downside, it also led to the end of a global vaccination program that provided protection against other pox viruses. That includes monkeypox, which has been spilling over from its animal hosts to infect humans in Africa with increasing frequency since the 1970s.
1. What’s monkeypox?
Monkeypox is a misnomer resulting from the fact that it was first discovered in 1958, when outbreaks of a pox-like disease occurred in monkeys kept for research. While monkeys are susceptible to it, just like humans are, they aren’t the source. The virus belongs to the Orthopoxvirus genus, which includes the variola virus, the cause of smallpox; the vaccinia virus, which is used in the smallpox vaccine; and cowpox virus. Monkeypox is less contagious than smallpox and the symptoms are milder. About 30% of smallpox patients died, while the fatality rate for monkeypox in recent times is around 3% to 6%, according to the World Health Organization.
2. What does monkeypox do?
After an incubation period of usually one to two weeks, the disease typically starts with fever, muscle aches, fatigue and other flu-like symptoms. Unlike smallpox, monkeypox also causes swelling of the lymph nodes. Within a few days of fever onset, patients develop a rash, often beginning on the face then spreading to other parts of the body. The lesions grow into fluid-containing pustules that form a scab. If a lesion forms on the eye, it can cause blindness. The illness typically lasts two to four weeks, according to the WHO. The person is infectious from the time symptoms start until the scabs fall off. Mortality is higher among children and young adults, and people whose immune system is compromised are especially at risk of severe disease.
3. How is it normally transmitted?
Monkeypox doesn’t spread easily between people. Contact with the virus from an animal, human or contaminated object is the main pathway. The virus enters the body through broken skin, the respiratory tract or the mucous membranes in the eyes, nose or mouth. Transmission from one person to another is thought to occur through respiratory droplets during direct and prolonged face-to-face contact. But it can also happen through contact with body fluids or lesion material, or indirectly through contact with contaminated clothing or linens. Common household disinfectants can kill it.
4. What’s unusual this time?
There’ve been multiple chains of transmission in clusters in multiple countries that don’t normally report monkeypox.
Cases don’t involve recent travel to places in West and Central Africa where the disease is endemic, meaning perpetually present.
Flu-like symptoms haven’t always preceded the rash, and some patients first sought medical care for lesions in the genital and perianal region, according to the US Centers for Disease Control and Prevention.
A large proportion of cases have been among men who have sex with men, and many have occurred within sexual networks.
5. Where does monkeypox come from?
The reservoir host or main carrier of monkeypox disease hasn’t yet been identified, although rodents are suspected of playing a part in transmission. It was first diagnosed in humans in 1970 in the Democratic Republic of the Congo in a 9-year-old boy. Since then, most cases in humans have occurred in rain forest areas of Central and Western Africa. In 2003, the first outbreak outside of Africa occurred in the US and was linked to animals imported from Ghana to Texas, which then infected pet prairie dogs. Dozens of cases were recorded in that outbreak.
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