Monkey pox is a rare disease that is caused by infection with monkey pox virus. Monkey pox virus belongs to the Orthopoxvirus genus in the family Poxviridae.
By Abdul Samad, Ifra Chaudhry, Hafsa Javaid Malik, Rabbya Rayan Shah
The Orthopoxvirus genus also includes variola virus (which causes smallpox), vaccine virus (used in the smallpox vaccine), and cowpox virus. Monkey pox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkey pox.’ The first human case of monkey pox was recorded in 1970 in the Democratic Republic of the Congo (DRC) during a period of intensified effort to eliminate smallpox. Since then, monkey pox has been reported in people in several other central and western African countries: Cameroon, Central African Republic, Cote d’Ivoire, Democratic Republic of the Congo, Gabon, Liberia, Nigeria, Republic of the Congo, and Sierra Leone. The majority of infections are in Democratic Republic of the Congo. Monkey pox cases in people have occurred outside of Africa linked to international travel or imported animals, including cases in the United States, as well as Israel, Singapore, and the United Kingdom. The natural reservoir of monkey pox remains unknown. However, African rodents and non-human primates (like monkeys) may harbor the virus and infect people.
Sign and Symptoms of Monkey Pox
In humans, the symptoms of monkey pox are similar to but milder than the symptoms of smallpox. Monkey pox begins with fever, headache, muscle aches, and exhaustion. The main difference between symptoms of smallpox and monkey pox is that monkey pox causes lymph nodes to swell (lymphadenopathy) while smallpox does not. The incubation period (time from infection to symptoms) for monkey pox is usually 7−14 days but can range from 5−21 days.
The illness begins with:
- Muscle aches
- Swollen lymph nodes
Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body. Lesions progress through the following stages before falling off:
The illness typically lasts for 2−4 weeks. In Africa, monkey pox has been shown to cause death in as many as 1 in 10 persons who contract the disease.
Monkey pox virus can spread when a person comes into contact with the virus from an infected animal, infected person, or materials contaminated with the virus. The virus can also cross the placenta from the mother to her fetus. Monkey pox virus may spread from animals to people through the bite or scratch of an infected animal, by handling wild game, or through the use of products made from infected animals. The virus may also spread through direct contact with body fluids or sores on an infected person or with materials that have touched body fluids or sores, such as clothing or linens. Monkey pox spreads between people primarily through direct contact with infectious sores, scabs, or body fluids. It also can be spread by respiratory secretions during prolonged, face-to-face contact. Monkey pox can spread during intimate contact between people, including during sex, as well as activities like kissing, cuddling, or touching parts of the body with monkey pox sores. At this time, it is not known if monkey pox can spread through semen or vaginal fluids. It is not yet known what animal maintains the virus in nature, although African rodents are suspected to play a part in monkey pox transmission to people.
There are number of measures that can be taken to prevent infection with monkey pox virus:
- Avoid contact with animals that could harbor the virus (including animals that are sick or that have been found dead in areas where monkey pox occurs).
- Avoid contact with any materials, such as bedding, that has been in contact with a sick animal.
- Isolate infected patients from others who could be at risk for infection.
- Practice good hand hygiene after contact with infected animals or humans. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer.
- Use personal protective equipment (PPE) when caring for patients.
JYNNEOSTM (also known as Imvamune or Imvanex) is an attenuated live virus vaccine which has been approved by the U.S. Food and Drug Administration for the prevention of monkey pox. The Advisory Committee on Immunization Practices (ACIP) is currently evaluating JYNNEOSTM for the protection of people at risk of occupational exposure to orthopoxviruses such as smallpox and monkey pox in a pre-event setting.
Many individuals infected with monkey pox virus have a mild, self-limiting disease course in the absence of specific therapy. However, the prognosis for monkey pox depends on multiple factors such as previous vaccination status, initial health status, concurrent illnesses, and comorbidities among others. Persons who should be considered for treatment following consultation with CDC might include:
- Persons with severe disease (e.g., hemorrhagic disease, confluent lesions, sepsis, encephalitis, or other conditions requiring hospitalization)
- Persons who may be at high risk of severe disease:
- Persons with immunocompromise (e.g., human immunodeficiency virus/acquired immune deficiency syndrome infection, leukemia, lymphoma, generalized malignancy, solid organ transplantation, therapy with alkylating agents, antimetabolites, radiation, tumor necrosis factor inhibitors, high-dose corticosteroids, being a recipient with hematopoietic stem cell transplant <24 months post-transplant or ≥24 months but with graft-versus-host disease or disease relapse, or having autoimmune disease with immunodeficiency as a clinical component)1
- Pediatric populations, particularly patients younger than 8 years of age2
- Pregnant or breastfeeding women3
- Persons with one or more complications (e.g., secondary bacterial skin infection; gastroenteritis with severe nausea/vomiting, diarrhea, or dehydration; bronchopneumonia; concurrent disease or other comorbidities)4
- Persons with monkey pox virus aberrant infections that include its accidental implantation in eyes, mouth, or other anatomical areas where monkey pox virus infection might constitute a special hazard (e.g., the genitals or anus)
Center of disease control and prevention (CDCP)
Abdul Samad, Ifra Chaudhry, Hafsa Javaid Malik, Rabbya Rayan Shah
Faculty of Veterinary and Animal Sciences MNS University of Agriculture, 25000, Multan, Pakistan.