Monkeypox and us

By Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech

                Monkeypox is a rare disease caused by infection with monkeypox virus.  Monkeyfox was first discovered in 1958 when two outbreaks of pox-like disease occurred in colonies of monkeys kept for research.  The first human cause of monkeypox was recorded in 1970.  Since then, monkeypox has been reported in people in several central and western African countries, but it has appeared in other countries before.  Usually this has been isolated cases or outbreaks closely connected to travel to Africa or the international pet trade (as it happened in U.S. in April 2003, with 47 people confirmed monkeypox virus in six states).

                Rarely seen outside Africa before the spring 2022, the monkeypox virus, a less deadly cousin of smallpox, was confirmed in early May 2022, beginning a cluster of cases found in the United Kingdom.  Since then worldwide there have been more than 30,000 cases (August 10, 2022) in 81 countries (not including Africa), with maximum cases of nearly 22,000 in combined five countries – United States (± 9,000), Spain (± 4,900), UK (± 2,900), Germany (± 2,900), and France (± 2,400).    

                Monkeypox is a part of the same family of viruses as smallpox; however, smallpox virus had been eradicated to human worldwide in 1980.   Symptoms of monkeypox can include fever, headache, muscle aches, swollen lymph nodes, chills, exhausted, a rash that look like pimples or blisters in all places in the body, including mouth, genitals and anus.  The illness typically lasts 2-4 weeks.  Unusually, most cases so far have been concentrated in a specific community – those who identify as gay, bisexual, or other men who have sex with men (MSM).  It doesn’t fully understand the reasons of this, and further research is needed to understand why this community is particularly affected.

                Unlike the coronavirus that causes Covid-19, monkeypox is not thought to be infectious during a person’s incubation period, meaning people are not thought to spread the disease if they don’t have symptoms.  It also requires close contact to spread.  Combined, these factors are likely to limit how widely the disease is transmitted.  However, in can infect different animal species.  There is a worry that monkeypox could become endemic in new parts of the world if there comes poor surveillance, if it manages to become established in animal populations.  So, while it’s unlikely that monkeypox will become the next pandemic, if it were to enter new animal populations there is a small but real risk that we could see further outbreaks outside of its historically endemic range.

                Already the scientists have key tools to control the disease – effective vaccines and treatments.  There were primarily developed to control smallpox, not monkeypox, so research to understand how well these work against monkeypox is a priority in the current outbreak.  Although data is limited, it’s thought the smallpox vaccine provides 85% protection against monkeypox.  Many governments have historically maintained stockpiles of smallpox vaccine for emergency use, which are now being assessed to combat the spread of monkeypox.  The USA, EU, UK and others have also requested additional purchases of vaccines. 

                Vaccines prevent infection, but we also need drugs or treatments for people who are sick with monkeypox.  Because the disease is so rare, it’s difficult to test drugs in the real world.  However, a drug called tecovirimat or ‘TPOXX’ has been shown to be safe and effective in animal studies at treating disease.  This is now being used on a limited level in those who get sick, which allows us to further understand how effective it is for treating people.

                The expanded use of TPOXX and a smallpox vaccine in preventing monkeypox is an important opportunity to collect data on the effectiveness of these tools.  As more cases of monkeypox are reported in new areas globally, disease surveillance, contact tracing and preventing will be controlling this outbreak and others in the future!

                On July 23, 2022, The World Health Organization and the United Nations had declared monkeypox a global emergence.  Although the current strain of the virus appears to be mild, monkeypox can cause severe disease and, rarely death.  Monkeypox is not new.  It has been causing illness (and death) in large numbers for decades.  Now is a key moment.  The United Nations warrant the strongest medical, scientific, and political global efforts.