How concerned should we be as cases of monkey pox are spreading around the world?

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.

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”.

Symptoms of Monkeypox include fever, headache, muscle aches, swollen lymph nodes, and skin rash or lesions.Reuters

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.”

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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.

Illustration of poxviruses that are oval in shape and have double stranded DNA.
In the past, monkeypox outbreaks were limited because the virus does not spread easily between humans.Getty Images: ROGER HARRIS / SCIENCE PHOTO LIBRARY

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.”

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