Saachi Jain, University of Toronto Schools, Toronto, Ontario, Canada
Introduction
On July 23, 2022 a new, rapidly spreading, and severe disease was declared a public health emergency of international concern by the World Health Organization (WHO). Monkeypox, of unknown origin, has nearly infected an extraordinary 65,000 people globally in just the last five months. With daily life only just recently returning to a pre-COVID cadence due to the remarkable development and distribution of vaccines, we must consider whether it is too early to celebrate with another potential pandemic on the way.
What are the origins of Monkeypox?
Monkeypox was discovered in 1958, when a pox-like disease occurred in monkeys kept for research purposes (Centers for Disease Control and Prevention [CDC], 2022). However, humans, African rodents, and non-human primates can harbor the virus and infect others (WHO, 2022). Despite the name “monkeypox” the source of the disease remains unknown (CDC, 2022).
According to the WHO, monkeypox is an enveloped double-stranded DNA virus that belongs to the Orthopoxvirus genus of the Poxviridae family. The monkeypox virus is a part of the same family as the variola virus, which causes smallpox; however, despite common belief monkeypox is not related to chickenpox (CDC, 2022).
The first recorded case of monkeypox affecting a human was in 1970 (WHO, 2022). Most cases were reported in individuals from Central or Western African countries (CDC, 2022). Cases outside of the continent were traced to international travelers or imported animals (CDC, 2022).
How is monkeypox transmitted?
Monkeypox is transmitted via direct contact with a contaminated surface, including between humans and animals (Government of Canada, 2022). Monkeypox can spread through contact with infected lesions or scabs, sexual intercourse, and from mother to child during pregnancy (CDC, 2022). Research on asymptomatic transmission is ongoing (Government of Canada, 2022). Close contact with infected livestock can also increase the likelihood of transmission.
Monkeypox transmission does not discriminate on the basis of sex, race, gender, or sexual orientation (Government of Canada, 2022). Yet, international trends show that the majority of those infected with monkeypox are sexually active homosexual men. This is due to the fact that many of these men have multiple sexual partners, which can easily increase one’s risk of infection (Government of Canada, 2022).
What are the symptoms of monkeypox?
Monkeypox symptoms typically start within three weeks of exposure to the virus. Similar to COVID-19, symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills, exhaustion, in addition to painful red rashes, and skin lesions (CDC, 2022). Monkeypox is generally associated with a new, unexplained rash that develops into hard, round, fluid, or pus-filled skin lesions (Figure 1) (CDC, 2022). The monkeypox rash usually develops within one to three days post-fever; however, others have not had fever-like symptoms and have developed rashes first (Wisconsin Department of Health Services, 2022).
Figure 1: Skin lesions and blisters caused by the monkeypox virus (Cleveland Clinic, 2022).
How prevalent is monkeypox worldwide?
So far, monkeypox has been reported in 106 countries with a total of 65,415 cases, and the number of daily cases has been drastically increasing worldwide (Figure 2) (CDC, 2022). The United States is in the lead with a total of 24,845 reported cases (CDC, 2022). Following the WHO’s declaration of a global health emergency, New York State and the city of San Francisco have also declared a state of emergency (Picard, 2022). The U.S., Canada, Brazil, France, and Spain have reported the highest number of daily cases (CDC, 2022). Due to limited accessibility to monkeypox tests, the true case count is likely significantly greater (Picard, 2022).
Figure 2: Cumulative confirmed cases of the monkeypox virus globally as of October 14, 2022, (Our World in Data, 2022).
There have been recent outbreaks of monkeypox all around the world and daily confirmed cases have been climbing, increasing the risk of a global pandemic. Without data-driven response strategies, monkeypox will continue to affect many communities around the world. However, monkeypox may not evolve into a pandemic of the same magnitude as the COVID-19 pandemic due to a few key reasons. First, due to monkeypox not being as transmissible as COVID-19, this disease will spread at a slower rate (Cunningham, 2022). Secondly, monkeypox is not a severe disease for the average healthy individual. Monkeypox is usually a self-limited disease with symptoms only lasting two to four weeks (WHO, 2022). Additionally, the rash-like symptoms of monkeypox are easily visible and individuals are more likely to seek healthcare (Cunningham, 2022). Third, monkeypox is not a lethal disease with over 99 percent of cases surviving (CDC, 2022). Finally, health care professionals globally are aware of monkeypox and the treatment process for this virus (Cunningham, 2022).
Is there a treatment for monkeypox?
So far, there are two vaccines that may be used for the prevention of monkeypox known as JYNNEOS (also known as Imvamune or Imvanex) and ACAM2000 (CDC, 2022). Both of these vaccines have been approved by the U.S. Food and Drug Administration and their production has been set to increase (CDC, 2022). However, the effectiveness of these vaccines has not been tested in the current 2022 outbreak (CDC, 2022) More research is currently being conducted to study other potential vaccines and treatments for monkeypox.
The most important prevention method for someone is to avoid close, skin-to-skin contact, including intimate contact, with someone who has monkeypox. Staying home and isolating if any symptoms of monkeypox occur can help to prevent the spread to other individuals. Currently, the WHO is initiating a coordinated international response to develop strategies to prevent monkeypox cases (Kimball, 2022). However, as cases of monkeypox increase globally, it is vital to educate ourselves and take precautions in our own lives.
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