Health authorities are investigating a recent outbreak of monkeypox cases reported in countries outside Central and West Africa, where the rare disease is endemic.
On May 21, the World Health Organization (WHO) reported 92 confirmed cases of monkeypox and 28 suspected cases from 12 non-endemic countries, including several European countries, the United States, Canada and Australia.
Two cases have been identified in Australia – the first was a man in his thirties in Victoria, announced by the state’s health department on May 19.
A second case – a man in his forties – was confirmed in NSW the following day. Both had recently traveled to Europe and are now isolated.
Officials are investigating the likely source of this outbreak, as reported cases so far have no regular travel connections to Central and West Africa, where the virus is endemic. The WHO expects to see more cases in the coming weeks as surveillance expands in non-endemic countries.
Experts say monkeypox is usually a mild viral infection that spreads through close contact.
While the risk to the general population is low — and the outbreak is “limitable,” they say awareness is important as the research progresses.
Here’s what you need to know.
What is monkey pox?
Monkeypox is a viral zoonosis, meaning it is a virus transmitted to humans from animals, including a range of rodents and non-human primates.
According to University of NSW epidemiologist Professor Raina MacIntyre, it is closely related to the virus that causes smallpox, but is less serious clinically.
“It’s mostly found in animals, including monkeys, as well as other animals, and occasionally it can spread from animal to human, and very occasionally from human to human,” Professor MacIntyre told SBS News.
With the eradication of smallpox in 1980 and the subsequent termination of smallpox vaccination, the WHO says monkeypox has emerged as the “main public health orthopox virus”.
According to the WHO, the first human case of monkey pox was diagnosed in a nine-year-old boy in 1970 in the Democratic Republic of Congo. Smallpox had been eradicated from the region two years earlier.
There are two main strains of monkeypox virus in Central and West Africa.
“One [strain] has a death rate of about one percent, comparable to COVID-19. And the other has a death rate of about 10 percent, which is comparable to the first SARS,” said Professor MacIntyre.
The current outbreak in non-endemic countries appears to be the less severe form.
How is it spread and what are the symptoms?
Monkeypox can spread to humans through close contact with an infected person or animal, the WHO says. It is passed from one person to another through close contact with lesions, bodily fluids, or material contaminated with the virus.
Chris Moy, vice president of the Australian Medical Association (AMA), said that unlike viruses like COVID-19, it requires “a fair bit of contact, so it’s not something that will spread like wildfire”.
“It’s actually quite difficult to catch. In general, it requires very close physical contact with someone else who is infected with it and it goes through your skin, broken skin or through your eyes or nose,” he told SBS News.
dr. Moy said most cases are mild and include symptoms of a high fever, headache, swollen lymph nodes, muscle and body aches and a blistering, pox-like rash on the body.
People with monkeypox are generally contagious for up to 21 days, until the lesions have healed and symptoms no longer persist.
Who is at risk?
People at risk are those who have had close physical contact with someone who is infected while they are symptomatic.
Associate Professor John Blakey, a pulmonologist at Sir Charles Gairdner Hospital, told SBS News, “we are all at risk of contracting a virus to which we do not have such a natural immunity”.
According to the WHO, several of the cases reported from non-endemic countries have been identified in men who have sex with men.
“The reason we are currently hearing more reports of monkeypox cases in communities of men who have sex with men may be because of positive health-seeking behavior in this demographic,” it says.
Professor Blakey said this was probably due to the mode of transmission rather than this community being more or less vulnerable to contracting the virus.
“It seems like there has been a major spreading event … that’s why there seem to be a lot of reports of transmission between men having sex with men,” he said.
The United Nations AIDS Agency (UNAIDS) on Sunday that some reports of monkeypox have used language and imagery that “reinforce homophobic and racist stereotypes” of exacerbating stigma and undermining response to the growing outbreak.
“Stigma and guilt undermine confidence and the ability to respond effectively during outbreaks such as these,” said Matthew Kavanagh, UNAIDS Deputy Director.
Thorne Harbor Health is a community organization that supports LGBTIQ+ communities in Victoria.
Director of Promotion Policy and Communications, Colin Batrouney, said these stories “were embraced in the early decades of the HIV and AIDS epidemic with catastrophic consequences for gay men, their loved ones and the community at large.”
“You’d hope we’re over that by now,” he said.
He said the consequences of stigmatizing language are many.
“For some, it amplifies both internalized and externalized homophobia, which can have devastating effects on the mental health and well-being of gay men,” he said.
“In addition, it may prevent gay men from seeking diagnosis or treatment when they need it, leading to increased transmission and acquisition of infections.”
But the WHO emphasizes that the risk of monkeypox is not limited to people who are sexually active or men who have sex with men.
“Anyone who has close physical contact with someone who is contagious is at risk. Anyone who has symptoms that may resemble monkeypox should seek immediate advice from a health professional,” it reads.
How concerned should we be?
At this point, experts advise that the risk to the general population is low, but awareness is important in managing the outbreak.
Sylvie Briand, WHO director for Global Infectious Hazard Preparedness, said on Tuesday that while the outbreak was “not normal”, it was “manageable”.
“Let’s not turn a molehill into a mountain,” she said at the World Health Assembly in Geneva.
In Australia, Dr. Moy that there is currently no reason for the general public to panic.
“It’s really more of a medical issue that we need to look out for, and hopefully as we get more information we’ll have a better idea of what to do,” he said.
“We’ve all been in shock after COVID-19, but I don’t think we’re going to be talking about anything like monkey pox.”
Professor Blakey said people should take simple measures that have already become commonplace due to the COVID-19 pandemic, including keeping physical distance, being careful when coughing and sneezing, wearing masks in crowded public places and sanitizing your hands .
He said people should also be aware that the virus can also spread by handling contaminated clothing and linen.
What about a vaccine?
According to the WHO, vaccines used during the smallpox eradication program also provide protection against monkeypox, while newer vaccines have also been developed and approved for use against the virus.
The WHO is working on new guidelines for countries on vaccination strategies and is holding further meetings to support member states with more advice on how to handle the situation.
Some countries are already taking precautions to vaccinate people who may have been exposed to the virus.
France and Denmark have started vaccinating close contacts against the virus, while Germany has ordered 40,000 doses to be ready to deploy a similar strategy if an outbreak in the country becomes more severe.
dr. Moy said there is currently no monkeypox vaccination strategy in Australia, but if there were a need for one in the future, it would focus mainly on close contacts.
Victorian Chief Health Officer Brett Sutton said on Saturday talks were underway with the Commonwealth about the national medical supply and use of smallpox vaccine for those who may have been exposed, along with the potential need for a small proportion of frontline health workers to get vaccinated.
He said close contacts of anyone with the virus would likely need to be quarantined. Who is considered to be in close contact and a time frame for isolation would be determined, he said.
The state health department is asking anyone who develops symptoms, especially if they have recently traveled abroad or been in contact with a case, to seek medical attention.