Monkeypox, a resurgence

For a disease that has had a history of only being seen in very isolated numbers, the virus has spread across different countries and continents where cases are being sighted like never before. There are concerns over the increase in cases outside of the disease’s endemic regions, Central and Western Africa. As of May 21, however, the WHO had confirmed monkeypox among 92 people across 12 countries in Europe and North America, where it is not endemic, with another 28 suspected cases.

A worrisome observation from this outbreak is the fact that many of the infected have no travel history, indicating a human-to-human transmission to be the risk and cause of a rapid spread. The advantage is that monkeypox has been a well-known virus with decades of research on it. However, the concern lies in the rapidity of the outbreak, along with hardly noticeable symptoms, as it could lead to healthcare facilities and systems becoming overwhelmed with patients to care for. 

Monkeypox is a zoonotic virus, meaning it is typically transmitted through close contact between an animal and a human, often through a bite, scratch, or contact with the rash and with “fomites”; material like bedding or clothes contaminated with material from monkeypox lesions.

Typically the early symptoms of the disease develop 1 to 2 weeks after a person is infected with the monkeypox virus and can include fever, chills, and swollen lymph nodes. Given a few days, it develops a rash. The lesions of the pox progress over several stages from blister-like lesions to scabs that eventually fall off. The process usually takes 2 to 4 weeks after the onset of the disease before an infected individual can be safe from infecting others. 

It has a relatively low fatality rate for an epidemic, with around a thousand a year being victims in Central and Western Africa. Monkeypox also has a relatively low fatality rate of 11%, when compared to its sister virus; smallpox with a 30% fatality rate. However, the presentation of the illness has been unusual during this recent outbreak. 

What is being seen now is a Monkeypox with mild to not even noticeable early symptoms, where the rash has been one of the first indicators that the individual has even fallen sickly. Another anomaly with the present outbreak is how the rash presents in the genital or perianal region unlike the typical nature of it progressing from the head and down the limbs. Some patients have been presented with proctitis, or inflammation of the rectum as well. Although the current outbreak displays an atypical progression of the disease, there is no solid evidence that the virus had mutated, although the potential for the virus mutating exists.

The sudden rise in Monkeypox cases can be understood by the timely changes in society. One such is when smallpox was declared eradicated back in 1980, there has been a gradual decrease in the number of people getting vaccinated for it. This going together with the increase in international trade and travel can be one combination that exposes susceptible individuals to the virus. 

A vaccine has recently been approved for monkeypox, although it is not yet widely available. Some countries may hold smallpox vaccine products which could be considered for use according to national guidance. Any request for vaccine products may potentially be available in limited quantities through national authorities, depending on the country. Countries may want to consider timely vaccination of close contacts as post-exposure prophylaxis or for certain groups of health care workers for pre-exposure vaccination.

Based on available information at this time, WHO does not recommend that Member States adopt any international travel-related measures for both, incoming and outgoing travellers.