Monkeypox: Causes, Symptoms, Transmission, Treatment and Prevention

Monkeypox is a viral zoonosis (a virus transmitted to humans from animals), with symptoms similar to those observed in the past in patients with smallpox, although it is clinically less severe.

The virus belongs to the Orthopoxvirus genus. Diseases associated with this genus include smallpox, cowpox, horsepox, and camelpox.

The natural reservoir of monkeypox remains unknown. However, African rodents and monkeys can harbor the virus and infect humans. In Africa, it has been demonstrated that this virus can cause death in 1 in 10 people who contract the disease.

Monkeypox was first discovered in 1958, when two outbreaks occurred in colonies of monkeys kept for research. The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo, during a period of intensified smallpox eradication efforts. Since then, monkeypox has been reported in people in several other countries in Central and West Africa: Cameroon, the Central African Republic, Côte d'Ivoire, the Democratic Republic of Congo, Gabon, Liberia, Nigeria, the Republic of the Congo, and Sierra Leone. Most infections are recorded in the Democratic Republic of Congo.

In 2022, several endemic outbreaks were reported in Europe, particularly in the UK. Subsequently, cases were also confirmed in Spain, Portugal, Germany, as well as in Romania.

Cases have also been reported in Canada, the United States, the United Arab Emirates, and Australia.

According to the data, most infected patients are part of the LGBTQ community, but this is not a condition specific to this minority, and any person can contract the virus.

Mode of transmission

Transmission occurs when a person comes into contact with the virus from an animal, a human, or materials contaminated with the virus.

In the case of animals, the virus is contracted following a bite, by touching the skin, lesions, or fluids, or by consuming improperly prepared meat.

The virus is transmitted from person to person through sexual contact or through saliva droplets expectorated during sneezing or coughing, but also through other fluids (semen, vaginal secretions, saliva, blood, sputum, fluid from skin lesions).

The virus enters the body through broken skin (even if not visible) or through the respiratory tract (eyes, nose, or mouth).

Anyone who has close contact with a monkeypox case can become infected. The virus does not spread easily between humans, but requires direct contact. Any person presenting with an unusual rash should consult a doctor.

Symptoms

In humans, the symptoms of monkeypox are similar to, but milder than, those of smallpox. Monkeypox begins with fever, headache, muscle aches, swollen lymph nodes, chills, and fatigue.

The incubation period for monkeypox is usually 7-14 days. Within 1 to 3 days (sometimes longer) after the onset of fever, the infected individual develops a rash that often starts on the face and then spreads to all parts of the body. The disease usually lasts 2-4 weeks.

Symptoms can be mild or severe, and the lesions can be very itchy or painful. They include vesicular rashes across the entire body or lesions concentrated on any part of the body.

The disease can be more severe in young children, pregnant women, or people with chronic diseases, whose organisms do not produce an adequate immune response.

Most cases that have recently presented at sexual health clinics in Europe have exhibited rashes and lesions on the genitals and anus. The ano-genital rash or lesions may be accompanied by fever, sore throat, enlarged lymph nodes, as well as lesions in the mouth and eyes.

The disease is often self-limiting, with symptoms disappearing spontaneously within 14-21 days of onset.

Diagnosis

Diagnosis is made using RT-PCR tests to detect the MPXV DNA genome in crusts or fluid-filled skin lesions (vesicles, pustules). Sample handling is only performed in a Class II Biological Safety Cabinet (BSC) to reduce the risk of exposure.

Treatment

Currently, there is no safe and proven treatment for monkeypox virus infection. Most patients recover within a few weeks without treatment.

Following diagnosis, the doctor will monitor your condition and attempt to alleviate your symptoms, prevent dehydration, and administer antibiotics to treat secondary bacterial infections, should they occur.

Currently, there is no antiviral treatment approved for monkeypox. Antiviral drugs may help, but their effectiveness as a treatment for monkeypox has not been proven. Several experimental antivirals with activity against monkeypox are available, but only as part of a research study.

Prevention

Monkeypox infection can be prevented by:

• avoiding close, skin-to-skin contact
• avoiding contact with animals that could harbor the virus (including sick animals or those found dead in risk areas)
• avoiding contact with materials and surfaces touched by a sick patient
• isolating infected patients
• washing hands with soap and water or using an alcohol-based hand sanitizer after contact with infected animals or people

It is important that any person with suspected monkeypox be isolated, and that those caring for them use appropriate personal protective measures.

There is a vaccine approved for the prevention of monkeypox, JYNNEOS™, but the traditional human smallpox vaccine also offers protection. However, these vaccines are not widely available.

References
https://www.nfid.org/infectious-diseases/monkeypox/
https://www.reginamaria.ro/articole-medicale/variola-maimutelor-o-noua-amenintare-pentru-sanatate
https://www.sfatulmedicului.ro/Infectii-cu-streptococi–stafilococi-si-alte-bacterii/cum-se-transmite-variola-maimuteii_19385
https://insp.gov.ro/wp-content/uploads/2022/05/Intrebari-si-raspunsuri-despre-variola-maimutei-Monkeypox-.pdf
https://cantacuzino.mapn.ro/pages/variola-maimutei
https://www.unicef.org/romania/ro/pove%C8%99ti/ce-%C8%99tim-despre-variola-maimu%C8%9Bei-simptome-%C8%99i-mod-de-transmitere
https://my.clevelandclinic.org/health/diseases/22371-monkeypox
https://www.nhs.uk/conditions/monkeypox/