Monkeypox: Why it is now a health emergency, and how to avoid infection

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The WHO has declared monkeypox a global health emergency. How can a person prevent infection? Image credit: Al Diaz/Miami Herald/Tribune News Service via Getty Images.
  • Earlier this month, the World Health Organization (WHO) declared the recent monkeypox outbreak a global health emergency.
  • There are more than 16,000 reported cases of monkeypox within 75 countries and territories.
  • Monkeypox has a current fatality rate of between 3-6%.
  • A recent study found 95% of monkeypox cases between April and June 2022 occurred during sex between men.
  • Two vaccines are currently available to help protect against monkeypox.

On July 23, 2022, WHO’s Director-General Tedros Adhanom Ghebreyesus declared the recent monkeypox outbreak a “public health emergency of international concern (PHEIC).”

According to Dr. Tedros’ official press statement, this decision stems from the current monkeypox outbreak growing to more than 16,000 reported cases within 75 countries and territories, along with five deaths.

“I welcome the decision of the WHO Director to declare the current global monkeypox outbreak a PHEIC,” comments Dr. Boghuma K. Titanji, assistant professor of medicine at Emory University. “For several weeks now the criteria for making monkeypox a PHEIC had been met.”

“I hope that this will raise the international priority level on monkeypox and galvanize a more coordinated global response which has sadly been lacking so far,” she continues.

“It is also an opportunity to get things right on global health equity and access to resources such as testing, vaccination, antiviral medications, etc. which are areas in which historically we have seen many failures, resulting in countries with limited resources being left behind.”

– Dr. Boghuma K. Titanji

Monkeypox is a zoonotic virus, meaning it transfers from animals to humans. Some animals that can carry monkeypox include various species of monkeys, giant-pouched rats, African dormice, and certain types of squirrels.

The disease belongs to the Orthopoxvirus genus of viruses, which also includes smallpox. Because of that, its symptoms are generally similar to, but not as severe as those of smallpox.

Medical clinicians found the first cases of monkeypox in 1958 during two outbreaks in monkeys being kept for research.

Researchers recorded the first human case of the disease in 1970 in the Democratic Republic of the Congo. Since then, 11 African countries have reported cases of monkeypox.

The first monkeypox outbreak outside of Africa happened in the United States in 2003. Scientists tied this incident to prairie dogs infected with monkeypox.

As previously mentioned, monkeypox is a virus that transfers from infected animals to humans. Transfer of the virus from an animal to a human occurs through:

  • being bitten or scratched by an infected animal
  • eating meat or using products from an animal with monkeypox
  • coming into contact with an infected animal’s body fluids.

Once a human becomes infected with monkeypox, they can transfer the virus to another human through:

  • respiratory droplets during prolonged face-to-face contact
  • intimate physical contact, including kissing and sexual intercourse
  • directly touching the infectious rash or body fluids of an infected person
  • touching clothing, bedding, and other materials that have been in contact with an infected person’s rash or body fluids.

Because monkeypox is spread between humans through close contact, the Centers for Disease Control (CDC) offers guidelines for people who are sexually active to protect themselves and their partners from contracting the virus.

A recently released study in the New England Journal of Medicine found that, between April and June 2022, 98% of the persons with a monkeypox infection were gay or bisexual men, and 95% of monkeypox cases occurred through sexual transmission.

Is monkeypox, then, a sexually transmitted disease (STD)?

According to Prof. Piero Olliaro, director of clinical research at the Epidemic Diseases Research Group Oxford (ERGO) and International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC), not so.

He emphasized it is important to remember that monkeypox is transmitted on the occasion of close contact via a variety of means. That includes sexual intercourse, but that is not the only means of transmission.

While the virus does not only circulate through intercourse, the fact that it can transmit through respiratory droplets might mean that it may more easily transmit between members of close-knit communities, such as LGBTQIA+ communities.

“The fact that the current outbreak in non-endemic countries is — so far — essentially involving men who have sex with men means the involvement and buy-in of the LGBTQ+ community is essential,” Prof. Olliaro also told Medical News Today.

“This has proven to work in other similar circumstances to help identify what would work, and make it happen to break the chains of transmission,” he added.

If a person becomes infected with monkeypox, the incubation period before they begin to show symptoms lasts anywhere from 5 to 21 days.

Most people experience two sets of monkeypox symptoms. The first symptoms occur for about 5 days and include:

A few days after having a fever, a rash normally appears on the person infected with monkeypox. The rash looks similar to pimples or blisters and can appear on many parts of the body, including:

  • face
  • chest
  • palms of the hands
  • soles of the feet
  • inside the mouth
  • genitals and/ or anus.

Symptoms normally last between two to four weeks. Monkeypox currently has a fatality rate of 3% to 6%.

Disease treatment normally includes medications to treat certain symptoms.

Tecovirimat (TPOXX) is an antiviral drug developed by SIGA Technologies for the treatment of smallpox and related diseases. According to Dr. Dennis Hruby, chief scientific officer at SIGA Technologies, TPOXX is the only approved antiviral for the treatment of monkeypox.

The public health agencies that have so far approved TPOXX for the treatment of monkeypox infection are the European Medicines Agency (EMA) and the Medicines and Healthcare Products Regulatory Agency (MHRA) in the United Kingdom.

In the United States, the Food and Drug Administration (FDA) approved Tecovirimat for the treatment of smallpox, but not currently monkeypox.

For that reason, the CDC holds a non-research expanded access Investigational New Drug (EA-IND) protocol allowing clinicians to use tecovirimat to treat all orthopoxvirus infections, including monkeypox, in both children and adults.

“The U.S. has 1.7 million courses of TPOXX in the strategic national stockpile,” Dr. Hruby told MNT. “It is distributed by the CDC under an EA-IND for the treatment of monkeypox. SIGA has donated small quantities of tecovirimat to the U.K. for use in the most severe cases.”

Two vaccines are currently available for monkeypox.

The FDA approved the JYNNEOS vaccine — also known as Imvanex — for preventing smallpox and monkeypox. The U.S. Health and Human Services announced in early July the ordering of 2.5 million additional doses of the JYNNEOS vaccine.

The EMA recently recommended the use of Imvanex to help protect adults from monkeypox.

The JYNNEOS vaccine includes two shots, with people considered fully vaccinated about 2 weeks after the second shot.

The second vaccine, ACAM2000, is approved to prevent smallpox in the U.S. and has an expanded access IND for monkeypox.

The ACAM2000 vaccine includes only one shot and considers a person vaccinated about 4 weeks after. Additionally, clinicians recommend certain populations do receive the ACAM2000 vaccine, including:

While vaccination is important, Prof. Olliaro stressed it may not be the complete solution.

“Vaccination alone may not work unless supported by other measures — including also capacity to diagnose and treat early,” he emphasized.

Medical professionals suggest people take the following steps to help prevent the spread of monkeypox:

  • avoid intimate and skin-to-skin contact with a person who has a rash similar to that of monkeypox
  • try not to touch bedding, clothing, or other materials that may have touched a person with monkeypox
  • wash hands frequently with soap and water
  • in certain African regions, keep away from known animal carriers of monkeypox, and do not touch sick or dead animals.
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