Dr Gabriel UguruDepending on how current in the news you are, you might have or have not heard about the latest “infectious” disease to grace the world. The new kid on the block is called monkeypox – move over COVID-19, you are so yesterday!
Monkeypox is a viral disease caused by the Monkeypox virus. The virus has double-stranded DNA unlike “good” old Coronavirus SARS-CoV-2, which is a single-stranded RNA virus. Monkeypox virus belongs to the Orthopoxvirus genus just like Cowpox virus and the Variola virus. The later causes small pox, a disease similar to monkeypox but more lethal with very severe and scarring rashes. Smallpox does not cause lymphadenopathy (swelling of the lymph nodes) unlike monkeypox. The disease was eradicated in the 1970s and was the only human pathogen to date to have been eradicated, but in the interest of mutual “destruction”, samples of smallpox virus still exist at laboratories in the USA and Russia.
Monkeypox virus acquired its moniker when in 1958 an outbreak of pox-like disease occurred in a colony of crab-eating monkeys kept for research purposes. But don’t let the name fool you, the natural hosts of Monkeypox virus are suspected to be rodents and other smaller mammals like squirrels. The virus was first identified as a human pathogen in 1970 when in the Congos (now the Democratic Republic of the Congo) it was discovered to cause fever, headaches, muscle pain, and swelling of the lymph nodes (lymphadenopathy), followed by an eruption of pus-filled blisters, which resembles smallpox and chickenpox lesions.
Monkeypox is both zoonotic i.e. animal-to-human transmission via contact with animal bodily fluids and animal bites, and human-to-human transmission via contact with bodily fluids, such as saliva from coughing or pus-contaminated clothing. The incubation period is averagely between 5 and 14 days before the onset of symptoms though in rare cases it could take up to 21 days. The fluid-filled lesions appear on the body, face, hands and feet. Vaccines developed for smallpox is also effective in combating monkeypox, but generally people recover from the condition in a few weeks without treatment.
Don’t hit the panic button yet, monkeypox is not as readily transmissible and deadly as SARS-CoV-2! The latter is spread through airborne droplets (aerosol), but Monkeypox virus is spread by close contact with bodily fluids as aforementioned, which means that it infects far fewer people than Coronavirus SARS-CoV-2. Moreover because Monkeypox virus is a DNA virus, and like other DNA viruses, it is better at detecting and repairing mutations than an average RNA virus, such as SARS-CoV-2. Thus, rapid mutational adaptation at human-to-human transmission ranges from rare to impossible. Asymptomatic transmission unlike SARS-CoV-2, is also impossible especially given the development of skin lesions characteristics of monkeypox.
There are two strains of the virus: Congo Basin strain with 10% mortality and West African strain with a mortality rate of just 1%. Cases of the disease are sporadic. From 1981 up to 1986, only 37 cases were documented; and between 1996 and 1997, about 92 cases of the disease were reported accompanied by 3 deaths in the Democratic Republic of the Congo. In 2003 about 70 cases of monkeypox were reported in Illinois, Wisconsin, Indiana, and New Jersey, USA, with a young girl reported to have developed the disease after being bitten by her pet prairie dog. Prairie dogs produce sounds like dogs, but are not actually dogs. They are squirrels! Almost all the monkeypox cases in the USA in 2003 were linked to prairie dogs sold by a pet shop whose owner had a sick Gambian giant rat, later discovered to be the source of the infection.
Since 2017, there were about 500 suspected cases of the disease in Nigeria with more than 200 confirmed. In 2018 and 2019, travellers from Nigeria spread the disease to Israel, Singapore and the USA. The recent case of the disease in the UK was linked to somebody who returned from Nigeria, but that was a separate incident as the person had no connection to other detected cases in the UK. The USA had its recent case from somebody who travelled to Canada. The disease has since the middle of May, 2022 spread to 21 other countries that are not endemic for Monkeypox virus, including Spain, Portugal, Germany, Sweden, Canada, Belgium, Finland, France, UK, USA, Israel, Australia, UAE, Morocco, Argentina, Switzerland, Austria, etc. As at the time of writing, 226 cases of the disease have been confirmed worldwide, excepting endemic countries.
What puzzles scientists is that almost all of the cases reported so far are men aged between 20 and 50 who are homosexuals (or MSM i.e. men who have sex with men). Monkeypox is not known to be sexually transmitted although sexual activity involved close contact. A 2017 report by Nigerian scientists did suggest sexual transmission might be possible because several of the patients examined then, had genital ulcers. And with respect to the recent outbreak, a Spanish health official did confirm that, “Most of the cases have lesions exclusively perigenital, perianal, and around the mouth.”
The explanation is that the virus was fortuitously introduced into the MSM community and started to spread before May 2022 when it was detected, and given the focus on COVID-19 and the attendant lockdowns, the spread of monkeypox was slowed down, but suddenly erupted with the relaxed and in most cases complete removal of covid conditions (i.e. increase in social interaction and mobility help spread the disease).
Caution though: the observation that the recent emergence of the monkeypox virus in separate populations across the globe not known to be endemic for the virus and, which appears to be disproportionately amongst the MSM community, should not be interpreted that monkeypox is exclusively an MSM disease. Anybody can contract the disease. This clarification is important to avoid erroneous stigmatisation and persecution of people afflicted with monkeypox!
There are drugs in the market for treatment of monkeypox, which include tecovirimat, originally developed to treat smallpox, and brincidofovir. Vaccines that are capable of preventing monkeypox even when used up to 4 days after exposure to the virus, are also available. The vaccines could also protect against contacts with suspected or confirmed cases of monkeypox.
Two vaccines currently available for both smallpox and monkeypox in Europe and the North America are manufactured by Emergent Bio-Solutions and Bavarian Nordic, respectively. The Emergent Bio-Solution vaccine is modelled after the smallpox vaccine used to eradicate the disease in the 1970s, and does have severe side effects and can even cause death, especially in people with compromised immune systems. The Bavarian Nordic vaccine, which has been specially approved for monkeypox vaccination, uses non-replicating form of Vaccinia virus, and is tailored to cause fewer side effects.
For a virus dubbed by conspiracy theorists to be the next big pandemic after SARS-CoV-2, with a particular Armageddon website alleging that the virus had been weaponised and predicting a death rate of over 250 million people, its transmissibility of only 226 recorded cases after more than two weeks, and its lack of fatality so far, should be rather “disappointing” to morbid conspiracy theorists!
Coronavirus SARS-CoV-2 has set the bar very high, and we are yet to see anything that will rival the virus in its global outreach and ferocity. Therefore, as far as diseases go, there is nothing remotely interesting about monkeypox. That the disease is currently elevated to superstardom is only because the world is looking for something to focus attention to, especially after the “highs” of COVID-19 and the lows of the boring Russian-Ukrainian war. Incursions of monkeypox outside its area of endemicity is well documented. The only difference this time is that it appears to be enjoying the company of the MSM community; apart from that, monkeypox is a nonentity – a very long yawn, indeed.
As infectious diseases go, monkeypox right now is a massive flop – just like two of the so-called world’s superpowers flopped, one in Afghanistan and the other in Ukraine.
Move over monkeypox, you are a flop. Next disease please, state your name and where you come from!
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