Everything You Need to Know About Monkeypox

While the current monkeypox outbreak will be the first time many have heard of the disease, the virus is thought to have been infecting people for centuries, possibly even millennia. A member of the same virus family as chickenpox and smallpox, monkeypox’s first documented cases were back in 1958, when there were two outbreaks in colonies of lab monkeys being kept for research—hence the name.

This, though, is a bit of a misnomer. The virus is usually carried by rodents such as squirrels, pouched rats, and dormice, among others. Cases tend to occur near tropical rainforests in Central and West Africa, where the virus is endemic. From the 1980s through to 2010, cases in the Democratic Republic of the Congo (DRC) rose more than 14-fold, and in 2020 alone there were nearly 4,600 suspected cases of monkeypox in the DRC. There have also been more than 550 suspected cases in Nigeria since 2017. Given these numbers and how interconnected the world is thanks to air travel, the current global outbreak isn’t actually that surprising.

But while cases have been rising, the risk of monkeypox to the general population is low. If you think you have the virus—or have come into contact with someone with it—stay calm. You probably won’t need any treatment, but you should do what you can to avoid spreading the virus further.

Monkeypox infections occur in two distinct stages. Initially people develop flu-like symptoms such as exhaustion, fever, body aches, chills, and headache as the virus enters their cells, followed by enlarged lymph nodes as their immune system gears up to fight off the infection.

The second stage is the development of the “pox”—a nasty rash that usually begins on the face before spreading to the arms, legs, hands, feet, and trunk. Some of the patients in the latest outbreak have reported a rash around the genital area.

Doctors caution that you shouldn’t assume you have monkeypox just because you have a rash. This can also occur with diseases such as chickenpox and scabies, while genital rashes can also be a sign of sexually transmitted infections like herpes. The monkeypox rash is quite distinct—skin eruptions that begin flat and red, before starting to blister and fill with white pus. These then dry out into scabs, which eventually heal and fall off. While unpleasant, the illness is usually not too severe and resolves within two to four weeks.

Monkeypox typically affects people who have come into contact with infected animals—usually rodents that are capable of harboring the virus. People catch the virus either through a bite or scratch or, in some cases, by consuming undercooked meat.

Despite the recent rise in cases, someone catching the virus and passing it on isn’t that common. It takes prolonged close contact for someone to give it to someone else. Specifically, there are three known ways in which monkeypox can be transmitted—direct contact with pus from the sores, handling an infected person’s clothing (or perhaps sharing a towel), or inhaling respiratory droplets. In the current outbreak it appears that sexual contact has provided one route of transmission—most likely through skin-to-skin contact.

The infection rate is far lower than for Covid-19 or many common respiratory viruses, so outbreaks tend to end quite quickly. An example of this was in 2003, when monkeypox reached the US after infected animals were shipped from Ghana to Illinois. The virus was spread to prairie dogs being sold as pets in multiple Midwestern states, and 47 people became infected. But none passed it on to anyone else, and the outbreak was over shortly after it had begun.

That said, this time around, scientists aren’t sure whether the usual rate of transmission for monkeypox has increased, given the rise in cases, so health agencies are monitoring the outbreak closely.

Unlike with Covid-19, people with monkeypox do not become contagious until they start developing symptoms. But once they are symptomatic, the virus can still be transmitted until their scabs have fully healed.

If you think you might have monkeypox, remain at home and contact your country’s health service for advice—this is what both the US Centers for Disease Control and Prevention and the National Health Service in the United Kingdom advise. You will probably be told to self-isolate. In the UK, for example, all suspected and confirmed cases are being advised to self-isolate for 21 days.

In some countries PCR tests are being offered to people who have rashes or who have been in contact with a positive case. These tests are required to confirm that you have monkeypox. If you are offered one, you should take it if you’re able to.

Again, avoid contact with others and contact your health service for guidance. You might be asked to self-isolate and may also be offered a vaccine.

Monkeypox is usually mild and clears up on its own without treatment. It can, though, be lethal. The West African strain—which is the one responsible for the current outbreak—has a fatality rate of between 1 and 3 percent. The Congo Basin strain has a fatality rate of 10 percent. Severe cases that result in death are more likely to occur in young children, pregnant women, or those with underlying immune deficiencies. The virus can also lead to pneumonia or complications such as vision loss if the infection moves into the eyes. So disease prevention is therefore the best protective strategy.

There are two vaccines approved by regulators that are capable of doing this. Danish drugmaker Bavarian Nordic has a vaccine (known as Jynneos in the US and Imvanex in Europe) that protects against both smallpox and monkeypox. It was approved by the US Food and Drug Administration (FDA) in 2019 for over-18s deemed to be at high risk from monkeypox, such as the immunosuppressed. There is also a vaccine called ACAM200, licensed in the US for use against smallpox, that can be used to protect against monkeypox. Moderna has announced that it is testing potential vaccines against monkeypox in preclinical studies as well.

Based on previous data from Africa, the two available vaccines are thought to be up to 85 percent effective at preventing a monkeypox infection. They can also be given up to four days after exposure to monkeypox to prevent infection, and up to two weeks after exposure to reduce the severity of symptoms in someone who is ill.

Other treatments include an antiviral drug called TPOXX that is approved in the European Union to treat monkeypox, although there are currently no antivirals approved for monkeypox by the US FDA for the disease. However the US CDC has recommended an antiviral—cidofovir—as a treatment, while a monoclonal antibody called vaccinia immune globulin could be used in the case of severe monkeypox illness. Data shows that cidofovir is capable of inhibiting smallpox and other viruses from the same family in lab tests.

The World Health Organization, US CDC, and UK Health Security Agency have been providing regular Twitter updates on the monkeypox outbreak. Global.health—an international collaboration that provides real-time data on infectious diseases—has also created a monkeypox tracker to monitor confirmed and suspected cases as they occur. These all offer reliable information on the current outbreak.

It’s important to avoid stigmatizing those infected. One of the main falsehoods circulating is that monkeypox only affects men who have sex with men, or that this group is responsible for the outbreak. People of any gender or sexual orientation can contract the disease.

Other particularly wild mistruths include the claim that certain Covid-19 vaccines are causing monkeypox because they inject chimpanzee genomic information into your cells, that the virus is airborne, that infections are doubling every three days, that monkeypox is as deadly as smallpox, and that it is a man-made virus leaked from a lab—none of which is true.

Everything You Need to Know About Monkeypox

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