An unusual outbreak of monkeypox has now spread to at least 15 countries, with Australia registering the first two cases of the viral disease on Friday.
Most important points:
- More than 100 confirmed or suspected cases of monkey pox have been discovered outside of Africa since May
- Monkeypox doesn’t spread easily from person to person, and the outbreak suggests a possible shift in the virus’s behavior
- Experts say risk to the general population remains low and there is no need to panic
Monkeypox, which is caused by the monkeypox virus – a member of the same family of viruses as smallpox – is rarely seen outside Africa and is not known to spread easily from person to person.
Since the beginning of May, at least 120 confirmed or suspected cases have been discovered outside Africaincluding in Europe, the US, Canada, Israel and Australia, according to the World Health Organization (WHO).
While monkeypox is significantly less contagious than respiratory diseases such as COVID-19, and the outbreak is no cause for alarm, the virus’s rapid spread appears to signal a shift in its behavior.
“Monkeypox is not on the same scale as COVID-19 … it doesn’t send a lot of people to the hospital,” infectious disease expert Sanjaya Senanayake told ABC News Breakfast.
What exactly is monkey pox?
Monkeypox is a viral zoonotic disease first discovered in monkeys in the 1950s and first reported in humans in 1970s in the Democratic Republic of the Congo.
It causes flu-like symptoms and a distinctive skin rash or lesions – very similar to what has been seen in the past in smallpox patients, although much less severe.
The virus spreads through close physical contact with lesions, bodily fluids, respiratory droplets, and contaminated materials such as bedding. Transmission via respiratory droplets usually requires “prolonged face-to-face contact”.
Monkeypox is mainly found in tropical rainforest areas where animals that carry the virus, especially rats, live. It is endemic to parts of West and Central Africa.
There are two main strains or “clades” of the virus — the Congo Basin clade and the West African clade, the latter of which was identified in the most recent outbreak, says epidemiologist and global biosecurity expert Raina MacIntyre.
†[The West African clade] has a mortality rate of about 1 percent, which is comparable to SARS-CoV-2, while the Congo Basin clade has a mortality rate of 10 percent,” Professor MacIntyre of the Kirby Institute told the health report†
So far, no deaths have been reported in this outbreak.
Why are experts concerned?
There are a few thousand cases of monkeypox each year across West and Central Africa, but it’s unusual to see cases in places like Europe and North America — especially in people with no history of travel to endemic areas.
“Monkeypox found outside Africa is usually imported from travelers infected abroad or people exposed to infected animals brought into the country,” said Professor Senanayake.
“These cases in humans often infect other people, so the amount of person-to-person transmission we’re hearing about seems more than expected.”
The earliest known case of the outbreak was related to travel in Nigeria, but later cases have not been linked to travel or other previously confirmed cases, indicating some degree of spread in the community.
Since human-to-human spread is not common – previous research estimates that only 3 percent of close contacts from a case of monkeypox will become infected – scientists have speculated whether the virus may have mutated to become more transmissible.
Until now, the WHO says there is no evidence for this†
It has also been speculated that monkeypox can spread asymptomatically; however, people with monkeypox are normally contagious while they have symptoms, and it’s not clear whether people who don’t have symptoms can spread the disease.
Another unusual feature of the outbreak is that most – but not all – cases have been reported are detected through sexual health services and in men who have sex with mensaid Professor MacIntyre.
Monkeypox has not been previously characterized as a sexually transmitted infection, but it can be transmitted through close physical contact during sex.
“The WHO and other organizations are speculating that it’s sexually transmitted, but I think if you’re in really close contact, it’s hard to tell whether it’s sexual contact per se or just close contact,” Professor MacIntyre said.
Health authorities say it’s too early to say why cases have been reported more often in men who have sex with men, but it’s may amount to “positive health-seeking behavior” in this demographic†
Monkeypox rash can resemble some sexually transmitted diseases, including herpes and syphilis, which may explain why these cases are being picked up in sexual health clinics, the WHO said.
It added that the likelihood of seeing more cases in non-endemic countries — including other populations — was high given “unidentified transmission chains.”
Why are we seeing cases of monkey pox now?
According to the WHO, the wide geographic distribution of monkey pox cases may indicate that transmission of the virus has been going on for some time†
Early genomic sequencing of a handful of cases has also suggested that the species currently spreading is similar to a strain identified in Europe in 2018, Professor Senanayake said.
“Potentially it’s been in Europe for a while and just under the radar, causing small outbreaks that haven’t made people too sick and missed,” he said.
“People are moving closer together now, especially in the Northern Hemisphere, allowing it to spread.”
The number of monkey pox outbreaks has increased in recent years, which Professor MacIntyre believes may be due – at least in part – to declining levels of immunity to smallpox viruses in the general populationprovided by the smallpox vaccine.
“Smallpox was declared eradicated in 1980 and the last mass vaccination programs stopped in the 1970s,” she said.
“The smallpox vaccine protects against many of the orthopox viruses, including monkeypox.”
Since mass vaccination against smallpox ended 40-50 years ago, the number of unvaccinated people has grown to most people under the age of 50, and the immunity of older, vaccinated people has declined.
What are the symptoms of monkey pox?
Monkeypox is rarely fatal, especially in countries like Australia, where people generally have good access to health care.
When you become infected, the disease usually has two parts, with symptoms lasting two to four weeks, Professor Senanayake said.
“The first part is about five days with very high fever, very annoying headache, muscle aches and pains,” he said.
“And then a rash sets in – usually this rash involves the face and spreads downwards and encompasses the palms [of the hands] and soles [of the feet]†
The rash, which consists of skin lesions that are filled with pus (before they crust, dry up, and fall off), can also be found on the mouth, genitals, and eyes.
Monkeypox is usually self-limiting and symptoms resolve on their own within a few weeks, but the disease can be severe in some individuals.
To control monkeypox outbreaks, epidemiological measures such as contact tracing and isolating close contacts are usually very effective, Professor MacIntyre said.
Health authorities abroad have already started offering smallpox vaccines to some health professionals and contacts who may have been exposed, which research suggests are about 85 percent effective against monkeypox.
However, WHO says outbreak does not require mass vaccinationsas measures such as good hygiene and safe sexual behavior will help control its spread.
How concerned should we be?
While health officials have asked doctors and nurses to be alert to potential cases, they say the risk to the general population remains low.
“While the new clusters of monkeypox cases in the UK and Europe need to be monitored, there is no need to panic,” said Fasséli Coulibaly, an associate professor at Monash University’s Biomedicine Discovery Institute.
“First, the mode of transmission of viruses from this family does not exhibit the explosive propagation power of respiratory viruses such as SARS CoV-2 and the influenza virus.
“Second, monkey pox is caused by a virus that is not new.
“It’s been known to infect humans since the 1970s, and it’s closely related to viruses that we know how to fight.”
Maria van Kerkhove, WHO leader of emerging diseases and zoonoses and technical leader on COVID-19, said the situation was “manageable”, especially in Europe.
“But we can’t take our eyes off the ball with what’s happening in Africa, in countries where it’s endemic,” said Dr van Kerkhove.
Posted † updated
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