Monkeypox, as defined by the World Health Organisation, is an illness caused by the monkeypox virus. It is a viral zoonotic infection. It can spread from animals to humans. It can also spread from person to person. So far it has spread to four people in India.
Monkeypox symptoms
According to WHO, Monkeypox can cause a range of signs and symptoms. While some people have mild symptoms, others may develop more serious symptoms and need care in a health facility. Those at higher risk for severe disease or complications include people who are pregnant, children and persons that are immunocompromised.
The most common symptoms of monkeypox
Fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes.
This is followed or accompanied by the development of a rash which can last for two to three weeks.
The rash can be found on the face, palms of the hands, soles of the feet, eyes, mouth, throat, groin, and genital and/or anal regions of the body.
The number of lesions can range from one to several thousand. Lesions begin flat, then fill with liquid before they crust over, dry up and fall off, with a fresh layer of skin forming underneath.
How long does the symptoms last?
WHO says symptoms typically last two to three weeks and usually go away on their own or with supportive care, such as medication for pain or fever. People remain infectious until all of the lesions have crusted over, the scabs fallen off and a new layer of skin has formed underneath.
Anyone who has symptoms that could be monkeypox or who has been in contact with someone who has monkeypox should call or visit a health care provider and seek their advice.
Does monkeypox kill?
WHO says - In most cases, the symptoms of monkeypox go away on their own within a few weeks. However, in some people, an infection can lead to medical complications and even death. Newborn babies, children and people with underlying immune deficiencies may be at risk of more serious symptoms and death from monkeypox. Complications from monkeypox include secondary skin infections, pneumonia, confusion, and eye problems.
In the past, between 1% to 10% of people with monkeypox have died. It is important to note that death rates in different settings may differ due to a number of factors, such as access to health care. These figures may be an overestimate because surveillance for monkeypox has generally been limited in the past. In the newly affected countries where the current outbreak is taking place, there have been no deaths to date.
How does monkeypox spread?
Monkeypox spreads from person to person and from animals to person, says WHO.
WHO says - Monkeypox spreads from person to person through close contact with someone who has a monkeypox rash, including through face-to-face, skin-to-skin, mouth-to-mouth or mouth-to-skin contact, including sexual contact.
Environments can become contaminated with the monkeypox virus, for example when an infectious person touches clothing, bedding, towels, objects, electronics and surfaces. Someone else who touches these items can then become infected. It is also possible to become infected from breathing in skin flakes or virus from clothing, bedding or towels. This is known as fomite transmission.
Ulcers, lesions or sores in the mouth can be infectious, meaning the virus can spread through direct contact with the mouth, respiratory droplets and possibly through short-range aerosols. Possible mechanisms of transmission through the air for monkeypox are not yet well understood and studies are underway to learn more.
The virus can also spread from someone who is pregnant to the fetus, after birth through skin-to-skin contact, or from a parent with monkeypox to an infant or child during close contact.
Although asymptomatic infection has been reported, it is not clear whether people without any symptoms can spread the disease or whether it can spread through other bodily fluids. Pieces of DNA from the monkeypox virus have been found in semen, but it is not yet known whether infection can spread through semen, vaginal fluids, amniotic fluids, breastmilk or blood. Research is underway to find out more about whether people can spread monkeypox through the exchange of these fluids during and after symptomatic infection.
Who is at risk of catching monkeypox?
WHO says - People who live with or have close contact (including sexual contact) with someone who has monkeypox, or who has regular contact with animals who could be infected, are most at risk. Health workers should follow infection prevention and control measures to protect themselves while caring for monkeypox patients.
Newborn infants, young children and people with underlying immune deficiencies may be at risk of more serious symptoms, and in rare cases, death from monkeypox.
People who were vaccinated against smallpox may have some protection against monkeypox. However, younger people are unlikely to have been vaccinated against smallpox because smallpox vaccination stopped in most settings worldwide after it was eradicated in 1980. People who have been vaccinated against smallpox should continue to take precautions to protect themselves and others.
Who long does the illness last?
We are still learning about how long people with monkeypox are infectious for, but generally they are considered infectious until all of their lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath: WHO.
Vaccine for monkeypox?
A vaccine was recently approved for preventing monkeypox. Some countries are recommending vaccination for persons at risk. Many years of research have led to development of newer and safer vaccines for an eradicated disease called smallpox, which may also be useful for monkeypox. One of these has been approved for prevention of monkeypox. Only people who are at risk (for example someone who has been a close contact of someone who has monkeypox) should be considered for vaccination. Mass vaccination is not recommended at this time.
While the smallpox vaccine was shown to be protective against monkeypox in the past, current data on the effectiveness of newer smallpox/monkeypox vaccines in the prevention of monkeypox in clinical practice and in field settings are limited. Studying the use of vaccines for monkeypox wherever they are used will allow for rapid generation of additional information on the effectiveness of these vaccines in different settings.
Treatment for people with monkeypox
The WHO says people with monkeypox should follow the advice of their healthcare provider. Symptoms normally resolve on their own without the need for treatment. If needed, medication for pain (analgesics) and fever (antipyretics) can be used to relieve some symptoms. It is important for anyone with monkeypox to stay hydrated, eat well, and get enough sleep. People who are self-isolating should take care of their mental health by doing things they find relaxing and enjoyable, staying connected to loved ones using technology, exercising if they feel well enough and can do so while isolating, and asking for support with their mental health if they need it.
People with monkeypox should avoid scratching their skin and take care of their rash by cleaning their hands before and after touching lesions and keeping skin dry and uncovered (unless they are unavoidably in a room with someone else, in which case they should cover it with clothing or a bandage until they are able to isolate again). The rash can be kept clean with sterilised water or antiseptic. Saltwater rinses can be used for lesions in the mouth, and warm baths with baking soda and Epsom salts can help with lesions on the body. Lidocaine can be applied to oral and perianal lesions to relieve pain.
Many years of research on therapeutics for smallpox have led to development of products that may also be useful for treating monkeypox. An antiviral that was developed to treat smallpox (tecovirimat) was approved in January 2022 by the European Medicines Agency for the treatment of monkeypox. Experience with these therapeutics in the context of an outbreak of monkeypox is limited. For this reason, their use is usually accompanied by collection of information that will improve knowledge on how best to use them in future.
