Monkeypox: the next pandemic?

Cases of monkeypox have been reported from European countries that are not endemic for the virus, prompting fears for yet another pandemic. Malaysian academics from the School of Medicine, Faculty of Health and Medical Sciences at Taylor’s University, Dr. Punithavathy Shanmuganathan, Senior Lecturer of Family Medicine and Dr. Lim Yin Sear, Senior Lecturer of Paediatrics, explain about this rare zoonotic viral disease and highlight precautionary measures to prevent infection.

A monkeypox infection is caused by the monkeypox virus, belonging to the Orthopoxvirus genus which includes the smallpox and cowpox virus. It is important to note that the monkeypox virus is different from the varicella-zoster virus (a herpes virus) which causes chicken pox.

The first case of monkeypox was reported in laboratory monkeys in 1950 but became more prevalent after smallpox was eradicated in 1980. The virus’ main reservoir is rodents, contrary to the name monkeypox, but has been found to infect other animals including Gambian giant rats, striped mice, and squirrels native to Central and West Africa.

The disease is spread through close contact with an infected person or animal, or with material contaminated with the virus. Human-to-human transmission occurs via close contact with lesions, bodily fluids, and sexually transmitted and contaminated materials like blankets and towels.

The World Health Organisation (WHO) has said a monkeypox outbreak outside Africa is ”unlikely” to lead to a pandemic, however, the current monkeypox outbreak is seeing a new pattern: many of these cases have been found among sexually active communities, especially those with lesions on their genitals and adjacent areas.

The incubation period for the monkeypox virus ranges from 6 to 14 days beginning with a fever, headaches, muscle aches, and swelling of the lymph nodes, then progressing to a rash on the face and body at day-3 of fever. The rash can be found on either the face (95%), palms and soles (75%), oral mucosa (70%), genitalia (30%), and around the eye area (20%) – unlike chicken pox, monkeypox lesions are usually larger and can be painful.

The presence of the lymph node enlargement before and concomitant with the appearance of the rash helps to point towards a diagnosis of monkeypox rather than smallpox or varicella. Laboratory testing of the lesion(s) or bodily fluids will confirm the presence of the virus. The Institute for Medical Research (IMR) offers this type of testing in Malaysia.

There is no specific treatment for monkeypox.

WHO is expecting the cases of monkeypox to rise. As with most countries quick to increase surveillance, the Malaysian Ministry of Health also has guidelines in place to handle monkeypox:

. People diagnosed with monkeypox as well as close contacts are encouraged to self-isolate for 21 days and should not donate blood, cells, tissue, organs, breast milk, or semen while they are under symptom surveillance.

. International travellers should always practice good self-hygiene including proper handwashing using soap and water.

. The use of alcohol-based sanitisers is strongly recommended when water and soap is not available.

. Travellers should avoid contact with sick, dead, or live animals (rodents, marsupials, primates) that could be infected with the virus; they also should not eat or handle bush meat.

. Travellers with any illness during travel or upon return should seek immediate medical advice.

Category: Features, Top Story