Monkeypox Q&A: how do you catch it and what are the risks? An expert explains
The
latest outbreak of monkeypox has, at the time of writing, reached 17 countries
with 110 confirmed cases and a further 205
suspected cases. It’s a fast-moving story, so if you need to catch
up on the latest, here are answers to some of the most pressing questions.
The
first patient in the current outbreak had returned to the UK from travels to
Nigeria where monkeypox is endemic. However, cases are now
spreading among people who have not travelled to west or central Africa,
suggesting local transmission is occurring.
Monkeypox
usually spreads by close contact and respiratory droplets. However, sexual
transmission (via semen and/or vaginal fluid) has been posited as an additional
possible route. The World
Health Organization (WHO) says: “Studies are needed to better
understand this risk.”
Most
cases in the current outbreak have been in youngish men,
but the virus can spread to anyone.
What
are the symptoms?
Early
symptoms are flu-like, such as a fever, headaches, aching muscles and swollen
lymph nodes.
Once the fever breaks, a rash can develop, often beginning on the face and then spreading to other parts of the body – most commonly the palms of the hands and soles of the feet.
How
deadly is monkeypox?
Monkeypox
is mostly a mild, self-limiting disease lasting two-to-three weeks. However, in
some cases, it can cause death. According to the WHO, the fatality rate “in
recent times” has been around 3% to 6%.
The west African monkeypox virus is considered to be milder than the central
African one.
Monkeypox
tends to cause more serious disease in people who are immunocompromised – such
as those undergoing chemotherapy – and children. There have been no deaths from
monkeypox in the current worldwide outbreak, but, according to the Daily Telegraph,
one child in the UK is in intensive care with the disease.
Why
is it called monkeypox?
Monkeypox
was first identified in laboratory monkeys (macaques) in Denmark in 1958,
hence the name. However, monkeys don’t seem to be the natural hosts of the
virus. It is more commonly found in rats, mice and squirrels. The first case in
humans was seen in the 1970s in the Democratic
Republic of the Congo.
Is
monkeypox related to smallpox and chickenpox?
Monkeypox
is related to smallpox – they are both orthopoxviruses – but it is not related
to chickenpox. Despite the name, chickenpox is a herpes virus, not a poxvirus.
(How “chicken” got in the name is not entirely clear. In his dictionary of
1755, Samuel Johnson surmised that it is so named because it is “of no very great danger”.)
Nevertheless, the vesicles (little pus-filled blisters) caused by monkeypox are
similar in appearance to those of chickenpox.
Are
cases likely to continue rising?
Cases
are likely to continue to rise significantly over
the next two-to-three weeks, but this is not another pandemic in the making.
Monkeypox doesn’t spread anywhere near as easily as the airborne virus
SARS-CoV-2 that causes COVID-19.
Has
monkeypox evolved to be more virulent?
RNA
viruses, such as SARS-CoV-2, don’t have the ability to check their genetic code
for mistakes each time they replicate, so they tend to evolve faster. Monkeypox
is a DNA virus, which does have the ability to check itself for genetic
mistakes each time it replicates, so it tends to mutate a lot slower.
The first genome sequence of
the current outbreak (from a patient in Portugal) suggests that the virus is very similar to
the monkeypox strain that was circulating in 2018 and 2019 in the UK, Singapore
and Israel. So it is unlikely that the current outbreak is the result of a
mutated virus that is better at spreading.
How
is monkeypox diagnosed?
In
the UK, swab samples taken from the patient are sent to a specialist laboratory
that handles rare pathogens, where a PCR test is run to confirm monkeypox. The
UK Health Security Agency has only one rare and imported
pathogens laboratory.
Is
there a vaccine for it?
Vaccines
for smallpox, which contain the lab-made vaccinia virus, can protect against
monkeypox. However, the vaccine that was used to eradicate smallpox can have
severe side-effects, killing around one in a million people
vaccinated.
The
only vaccine specifically approved for
monkeypox, Imvanex, is made by a company called Bavarian Nordic. It
uses a nonreplicating form of vaccinia, which causes fewer side-effects. It was
approved by the US Food and Drug
Administration and the European Medicines Agency in 2019 – but
only for use in people 18 years of age or older.
UK
health secretary Sajid Javid said that the UK government will be stocking up on
vaccines that are effective against monkeypox. The UK currently has about 5,000 doses of
smallpox vaccine, which has an efficacy of around 85% against monkeypox.
Are
there drugs to treat it?
There
are no specific drugs to treat monkeypox. However, antivirals such as cidofovir
and brincidofovir have been proven to be effective against
poxviruses in animals and may also be effective against
monkeypox infections in humans.
[The
writer, Ed Feil, is a Professor of Microbial
Evolution at The Milner Centre for Evolution, University of Bath.]
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