Monkeypox

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Monkeypox is a disease caused by the Monkeypox virus. First identified in 1958 as a pathogen of cynomolgus monkeys, it is an orthopoxvirus with a clinical presentation similar to mild smallpox.

Human monkeypox is a zoonotic viral disease that occurs primarily in remote villages of Central and Western Africa close to tropical rainforests where there is frequent contact with infected animals. Monkeypox is usually transmitted to humans from rodents, pets and primates through contact with the animal's blood or through a bite.

Epidemiology

In addition to monkeys, giant pouched rats (Cricetomys sp.), dormice (Graphiurus sp.) and African squirrels (Heliosciurus, Funisciurus) have all been implicated as reservoirs of the virus and their use as bushmeat may be an important means of transmission to humans.

Monkeypox is a disease first associated with human illness in Zaire and West Africa during 1970-1971. A second outbreak of human illness was identified in Zaire in 1996-1997. As of 2003, a small outbreak of human monkeypox in the United States appears to be in progress.

A second African focus of infection has been discovered in Sudan.

Monkeypox Disease in Humans

Symptoms and Course

In humans, monkeypox is similar to smallpox, although it is often milder. Unlike smallpox, monkeypox causes lymph nodes to swell (lymphadenopathy). The incubation period for monkeypox is about 12 days (range 7 to 17 days). The illness begins with fever, headache, muscle aches, backache, swollen lymph nodes, a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a papular rash (i.e., raised bumps), often first on the face but sometimes initially on other parts of the body. The lesions usually develop through several stages before crusting and falling off.

Vaccination against smallpox, which is no longer routinely administered, also gives protection against the monkeypox virus. Limited person-to-person spread of infection has been reported in disease-endemic areas in Africa. Case-fatality ratios in Africa have ranged from 1% to 10% (for additional information about monkeypox, see [2]).

Prevention and Treatment

Currently, there is no proven, safe treatment for monkeypox. Smallpox vaccine has been reported to reduce the risk of monkeypox among previously vaccinated persons in Africa. The United States Centers for Disease Control and Prevention (CDC) recommends that persons investigating monkeypox outbreaks and involved in caring for infected individuals or animals should receive a smallpox vaccination to protect against monkeypox. Persons who have had close or intimate contact with individuals or animals confirmed to have monkeypox should also be vaccinated. These persons can be vaccinated up to 14 days after exposure. CDC does not recommend preexposure vaccination for unexposed veterinarians, veterinary staff, or animal control officers, unless such persons are involved in field investigations.

2003 U.S. Outbreak

As of June 7, 2003, cases of suspected monkeypox in the United States had been reported among residents of Wisconsin (18), northern Illinois (10), and northwestern Indiana (1). The disease stemmed from a giant Gambian pouch rat imported by a pet shop in Texas and is believed to have infected domesticated prairie dogs, which were then distributed by other outlets in the Midwest. Electron microscopy and serologic studies were used to confirm that the disease was human monkeypox.

By June 9, CDC officials said the number of suspected or confirmed cases was 22 in Wisconsin, 10 in Indiana, and five in Illinois.

As of June 11, a total of 54 persons with suspected monkeypox had been reported in Wisconsin (20), Illinois (10), Indiana (23), and New Jersey (1). Monkeypox had been confirmed by laboratory tests in nine persons. At least 14 of the people with suspected monkeypox had been hospitalized for their illness; there have been no deaths related to the outbreak. The number of cases and states involved in the outbreak will likely change as the investigation continues. The CDC Web site has updates for this and other current information about the outbreak.

The onset of illness among patients in the United States began in early May 2003. Patients typically experienced a prodrome consisting of fever, headaches, myalgias, chills, and drenching sweats. Roughly one-third of patients had nonproductive cough. This prodromal phase was followed 1-10 days later by the development of a papular rash that typically progressed through stages of vesiculation, pustulation, umbilication, and crusting. In some patients, early lesions have become ulcerated. Rash distribution and lesions have occurred on head, trunk, and extremities; many of the patients had initial and satellite lesions on palms and soles and extremities. Rashes were generalized in some patients. After onset of the rash, patients have generally manifested rash lesions in different stages. All patients reported direct or close contact with prairie dogs, most of which were sick. Illness in prairie dogs was frequently reported as beginning with a blepharoconjunctivitis, progressing to presence of nodular lesions in some cases. Some prairie dogs have died from the illness, while others reportedly recovered.

2022 Global Outbreak

There has been cases of monkeypox recorded periodically over the past few years in non-endemic regions. All of these cases were traced back to travel history to endemic areas or healthcare providers involved in the treatment.

In May 2022, case clusters of monkeypox were traced around the world over a short period of time. Unlike previous cases, most of present cases were not related to travel history to endemic areas of monkeypox, namely Central Africa and West Africa.

Patient zero is believed to be the confirmed case on May 4, 2022 of a British resident returning back to England from Nigeria. Additional cases were then identified in the UK that were not travel-associated and had no connection to previous cases. On May 18th, 2022, 5 cases were confirmed in Portugal, 7 in Spain, and 1 in the United States. As of May 22, 2022, a total of 109 cases were recorded and 87 suspected around the world. Although monkeypox is not known as a sexually transmitted disease, most of the cases were identified among men who have sex with men.

External links

• CDC - Monkeypox Fact Sheet
• CDC Questions and Answers About Monkeypox
• CDC - Human Monkeypox -- Kasai Oriental, Zaire, 1996-1997
• CDC - Outbreak of Human Monkeypox, Democratic Republic of Congo, 1996 to 1997
• CDC Preliminary Report: Multistate Outbreak of Monkeypox in Persons Exposed to Pet Prairie Dogs
• National Library of Medicine - Monkeypox virus
• Virology.net Picturebook: Monkeypox
• Associated Press: Feds Collect Giant Rats in Florida

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