Monkeypox T
by Ethan Bentley Illustration & Design: Veronica Richmond
he World Health Organization (WHO), effective July 23, 2022, announced that the outbreak caused by monkeypox, a viral zoonosis, is a public health emergency of international concern (PHEIC). This declaration is the highest health alert given by the WHO and it is meant to trigger a more coordinated response across international health organizations and nations. While endemic in Africa for decades, the new monkeypox immersion has spread to over 75 countries reaching up to 1,600 cases in a very short period of time. This resurgence in so many non-endemic countries including much of Europe as well as the United States has caused concerns that a new, more infectious strain has arisen. This concern has caused alarm as many of the cases came from those without a history of travel to areas where monkeypox is prevalent, which suggests a high amount of human to human transmission. In 1970, a child in the Dominican Republic was found with the first ever detected case of the monkeypox virus. Since that time, the disease has been endemic to Africa and several outbreaks have emerged across the region with mortality reaching as high as 10 percent. The disease has an incubation period of 6-13 days before symptoms appear; these symptoms include fever, headache, myalgia, aches, and chills. A couple of days after symptoms start, victims will develop rashes on their face, limbs, torso, and other areas of the body. Monkeypox victims can usually recover within 2-4 weeks, however, the virus can leave significant scarring which can disfigure and debilitate patients long after the disease’s main effects have subsided. The virus is from the Poxviridae family and thus has similar symptoms to other more well-known diseases such as chickenpox and smallpox. The name “monkeypox” is based on the fact that the virus was first isolated from a monkey and while it is unknown what the natural animal reservoir is, the virus has been detected in several species of rats and mice. The main method of transmission for the virus is animal to human, however, human to human transmission is also possible through respiratory droplets, sexual intercourse, contact with bodily fluids, and through mother to child. While the disease delivers relatively mild symptoms and hasn’t sent many people to the hospital, if the disease continues to spread, the severity could increase in more vulnerable populations such as children, the elderly, pregnant women, and immunocompromised individuals. The current resurgence has seen a significant amount of sexual transmission amongst men who have sex with other men. This suggests that monkeypox is exploiting a specific social group, however, this observation should not be linked to a social stigma amongst individuals who may fall into this category; if anything, it just stresses the need for a united approach in order for the
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greater good of all. The alarming spread of the monkeypox virus and its potential to increase in severity demonstrates the need for the international community to provide a coordinated response to control the disease. With the world still recovering from the economic and healthcare impacts of COVID-19, monkeypox is quickly becoming the next major viral outbreak. The experience gained from COVID-19 may be helpful in planning how to combat this new virus and safely treat patients. The declaration of the disease as a PHEIC should allow for greater funding and effort to be placed on disease containment. The first emergency committee initially did not declare monkeypox to be a PHEIC however this decision was reversed due to the unexpected increase in the rate of infection. While the WHO assigned monkeypox a moderate risk internationally, the risk was assessed as much higher in European nations. The first step in controlling the recent outbreak of monkeypox is surveillance and while this is easier to do than with other viruses, clinicians have had difficulty diagnosing patients with monkeypox due to many patients only presenting milder symptoms. The necessity for improved surveillance is important to the process of isolating and aiding victims to prevent them from infecting others. This surveillance effort is hindered by the limited amount of tests available which obscures how prevalent the disease is in certain countries. Also, the negative social stigma attached to the disease has hampered case detection as individuals suffering symptoms do not seek immediate medical attention. Preventative measures underway to limit further spread of monkeypox include self-isolation of patients, use of personal protective equipment, and the development of vaccines. Currently, the smallpox vaccine is considered as possibly providing some protection from monkeypox infection but more refined vaccines are under development to limit the virus’s spread. As for treatments, patients can usually recover without therapy and there are currently no specific medical treatments. While some smallpox antiretroviral treatments have shown some limited effectiveness new antiretrovirals are under development. The disfiguring nature of monkeypox as well as the lack of medical therapy has made prevention rather than treatment the main priority for controlling the current outbreaks. Monkeypox has the potential to develop into a pandemic and as such, healthcare services need to prepare for such an event. The infrastructure to counteract the spread of monkeypox exists, however, it will take a more coordinated international approach including surveillance, prevention, and treatment to stop the virus from turning into a global epidemic.
