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Monkeypox (MPox) – What Is It and Should You Be Concerned?

Medically reviewed by Chhavi Gandhi, MD on January 14, 2023

Over 2022, news outlets have been reporting the discovery of new monkeypox, now known as MPox, cases in several countries.


What is MPox?


The word “monkey” in the name refers to the fact that this disease was first discovered in monkeys. The virus that causes it is called a zoonotic virus or zoonotic disease because it can be transmitted from animals to humans. In other words, it can be passed between people who live or work around animals and cause disease in humans. It is also referred to as an orthopoxvirus infection because it belongs to the same family of viruses and infectious diseases as smallpox, cowpox, and the vaccinia virus.


According to the Centers for Disease Control and Prevention (CDC), “Monkeypox is a rare but serious disease caused by infection with variola major, which causes smallpox”. Smallpox is one of only three diseases still considered eradicated worldwide, along with polio and rinderpest. However, because the virus can be transmitted through direct contact with infected animals or people, the CDC notes that monkeypox poses a greater threat than smallpox.


The virus is spread through direct contact with an infected animal or its bodily fluids. For example, if someone touches something contaminated with the virus or is bitten by an infected animal, they could become sick.


MPox is also spread through human infection via close personal contact. This includes touching an open wound or through sharing bodily fluids during sexual contact with someone infected. In general, person to person transmission is low. Recent outbreaks are thought to have been spread through sexual contact.


In addition to the risk of transmission through direct contact, MPox is also transmissible via respiratory droplets. This means that if someone becomes ill with the virus, they may infect others even though they do not come in physical contact with them. Respiratory transmission may require hours of close contact to infect someone within a six foot radius if they aren’t wearing any personal protective equipment.


The most common signs and symptoms of MPox are a fever that usually comes on before a rash. Patients may also get chills, enlarged lymph nodes, headaches and muscle pains. As with other viruses, complications can occur that can be life threatening. MPox can only be diagnosed by special lab testing. Other viruses such as varicella (Chicken pox/Shingles), herpes simplex virus, and smallpox can look similar and need to be ruled out.


The Emergence of Monkeypox


The disease was first discovered in 1958 when scientists noticed an outbreak among captive primates. At the time, they didn’t know what caused the illness, but they did know that it had killed several of the monkeys. They also knew that the monkeys were infected by a virus. Scientists later found out that the virus was similar to poxviruses that infect humans. That meant that it could potentially cause human diseases as well.


What is Human MPox?


The first case of MPox infection in humans was identified in 1970 when researchers in Africa began noticing cases of a new type of rash. The patients had no history of exposure to animals or their bodily fluids. Instead, they reported being bitten by mosquitoes while working in fields near villages where there were outbreaks of the disease.


Researchers believe that the virus entered the body through these bites. After entering the bloodstream, the virus then traveled throughout the body causing damage to cells. As a result, the patient developed a painful red rash all over his/her body. Sometimes, this rash would look like chickenpox. Other times, it looked like smallpox.


Since then, there have only been two known outbreaks of human MPox: one in 1970 in the United States and another in 1978 in the Democratic Republic of Congo. Both of these outbreaks occurred after contact with wild rodents. During the 1970 outbreak, more than 200 people became sick. Of those, about 20 died. Those who survived usually recovered within 10 weeks.


The second outbreak occurred in the central African nation of the Democratic Republic of Congo. During the outbreak, which lasted almost a year, about 1,000 people became ill, and about 100 died. Most of the deaths occurred among children under five years old.


Since the 1970s, MPox has remained relatively rare. Until recently there were no reports of this virus being contracted outside Africa. In 2003, there was a case in the Congo where the patient fully recovered. 


However, since then there have been two cases of MPox in the United States. One occurred in 2003 and the other in 2007. Both patients were children who had recently traveled to West Africa. As mentioned above, these were the only cases of human MPox ever recorded. Fortunately, both patients survived.


Is MPox the same as Smallpox?


MPox can be similar to smallpox but differs in several ways. First, smallpox killed millions of people during the 20th century while monkeypox kills fewer than 100 people each year. Second, smallpox is still found only in certain parts of Africa and Asia where routine smallpox vaccination programs are being carried out. In fact, thanks to the success of the smallpox vaccine, most countries have reported the complete eradication of smallpox leading to the cessation of smallpox vaccination in those populations. MPox has never been eradicated anywhere in the world. Third, smallpox is now mostly considered extinct in the United States, but monkeypox remains a threat.


Although MPox can look like smallpox, it belongs to a different class of viruses call orthopoxvirus. These viruses include cowpox, swinepox, vaccinia, variola major, and variola minor. All of these viruses are capable of causing infections in human populations. However, MPox is unique because it can cause a much more serious form of the disease than any of the other poxviruses.


The most common signs and symptoms of Monkeypox are a fever that usually comes on before a rash. Patients may also get chills, enlarged lymph nodes, headaches and muscle pains. As with other viruses, complications can occur that can be life threatening.

Are there different strains of the virus?


There are two main types of MPox viruses. These include the Congo Basin strain and the West African strain. The Congo Basin strain was originally isolated from wild rodents in Congo in Central Africa. The West African strain was initially identified in 1970 in Nigeria, and in recent years, the West African strain has become more prevalent than the Congo Basin strain.


What is the status of the current outbreak?


As of December 5, 2022, according to the Center for Disease Control,  there are approximately 30,000 reported cases in the US,  with 21 deaths and 85,000 cases worldwide and include almost every country globally.


Where have cases of MPox previously been found?


The WHO reports that there were over 1,000 confirmed cases in humans and over 100 deaths. The majority of these cases have occurred in Nigeria, the Democratic Republic of Congo, North America, and Western and Southern Europe, as well as other parts of Africa.


In the U.S., the first case was found on September 30th, 2011, when an individual developed symptoms after being exposed to a sick animal while visiting Ohio. Due to this, the CDC announced that they were investigating a cluster of human infections caused by the same strain of the virus that was currently circulating in West Africa. The CDC stated that the patients had visited the Columbus Zoo and Aquarium between August 10-16, 2011. They also noted that the patient’s exposure to animals at the zoo did not occur until two weeks after their onset of illness. Since then, there have been at least 15 additional cases in the U.S., including one death.


While MPox is not a new disease, it has become more prevalent in recent years. There has also been an increased geographical spread to previously unaffected countries. This may be due to the increased number of people traveling to and from Africa.


The virus is spread through direct contact with an infected animal or its bodily fluids. For example, if someone touches something contaminated with the virus or is bitten by an infected animal, they could become sick.


How Do I Get Sick With MPox?


People can contract human MPox in several ways. It may be after being exposed to the virus through direct contact with an animal that carries it. If you think you might have been exposed to MPox, call your healthcare provider right away.


Like most diseases, MPox also spreads when people come into close contact with one another. People can get the virus from coming into contact with the blood or bodily fluids of an infected person. They can also catch the virus by inhaling tiny droplets of fluid that contain the virus but it may require hours of exposure, closer than six feet, without any personal protective equipment. 


While anyone can get sick with MPox, children and adults over 50 years old seem to be at higher risk. Other groups at high risk include pregnant women, people with existing medical conditions such as compromised immune systems, and anyone with a weakened respiratory system.


The number of reported cases of MPox has increased over time. The reason behind this increase is unknown. One theory is population immunity, which means the virus is spreading more easily because people are becoming less immune to it. Another possibility is that the virus is being introduced into new areas more frequently.


It’s important to note that many people have never even heard of MPox before. This means they don’t know if they’re immune to it. If you’ve had chickenpox, measles, rubella, or polio as a child, you may have some level of immunity to MPox.


Before the latest outbreak, human MPox virus infection rates were low. This means most people who contracted the virus never got sick enough to seek medical attention. Those who did often recovered without treatment.


Can I Spread MPox to Others?


Person-to-person transmission is possible but was historically not common. Newer outbreaks are thought to have spread via sexual contact.


People usually get sick within 2-4 weeks after exposure. Human-to-human transmission is then possible and they can then infect other people. If you think you might have gotten sick with MPox, call your healthcare provider right away so that they can test you for the virus.


If you are not sure whether you have been exposed to MPox, do not go to see a doctor until you have talked to them about what happened. Also, tell your doctor if anyone else has had similar symptoms. Your doctor will want to know if you were near an animal or came into contact with any of its bodily fluids.

What Are The Symptoms Of MPox?


If you have MPox, you will probably begin feeling ill within 2 to 10 days after infection. Symptoms typically start with flu-like illness. You may also experience a fever, rash, lymph node swelling, chills, joint pains and muscle aches. 


Once you become symptomatic, you may need to take medicine for up to some time, as determined by your doctor. This can help prevent complications from developing, which occur in approximately 15% of cases. These are rare but can include pneumonia, meningitis, encephalitis (inflammation of brain tissue), and hemorrhagic disease (bloody nose, mouth, eyes, stomach, intestines, bladder, vagina, rectum).


How Can I Prevent Getting Sick With MPox?


Health officials recommend specific preventative measures that a person can take to avoid human monkeypox infection. They include not handling wild animals and avoiding contact with sick animals. You should also make sure you keep children away from wildlife.


If you work in an area where you will come into contact with rodents, you should make sure to wear gloves. Also, make sure to clean cages, pens, feeders, and water dishes frequently.


Additionally, you should closely monitor your pets for signs of illness. Like with most viruses, early detection of monkeypox can slow the spread of the disease.


Health care workers should always wear protective clothing when dealing with patients who could potentially have MPox. These clothes must cover the entire body but still allow access to the hands and arms.


People usually get sick within 2-4 weeks after exposure. Human-to-human transmission is then possible and they can then infect other people. If you think you might have gotten sick with monkeypox, call your healthcare provider right away so that they can test you for the virus.


How serious is MPox in humans?


MPox can be contagious. Most people who get it recover completely without treatment. However, people who get this virus may become seriously ill. In rare cases, it can develop into severe disease and cause death.


Is There A Vaccine For MPox?


As of January 2023, vaccination against MPox is available. According to the CDC, “JYNNEOS is a 2 dose vaccine developed to protect against MPox and smallpox infections. People need to get both doses of the vaccine for the best protection against MPox. The second dose should be given 4 weeks after the first dose.”


What are the treatments for MPox?


Most people who get MPox recover without medical intervention. For symptoms, supportive care is given and when needed antiviral agents are used.


Written by Chaim Ford

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