A 2022 outbreak of the viral disease monkeypox was initially identified in the UK, but has rapidly been gaining global momentum after a period of what scientists suspect involved significant undetected transmission. Monkeypox has been around for a few decades in human history, and fortunately effective counteragents have previously been established.
Monkeypox was first identified as a distinct illness in 1958 in a monkey laboratory in Denmark 1. However, the first documented cases of monkeypox in humans were not until in 1970. The first case in history was a 9-month-old boy in the Democratic Republic of the Congo, preceding monkeypox cases in Liberia and Sierra Leone 2. From 1981 to 1986, over 300 cases of human monkeypox were reported in the Democratic Republic of the Congo, most of which resulted from close contact with animals 3. In total, between 1970 and about 2019, monkeypox was documented across 10 distinct African countries, mostly spanning Central and Western Africa.
The year 2003 saw the first monkeypox outbreak on American soil, all cases of which were traced to infected rodents imported from Ghana. Infected prairie dogs were concluded to have transmitted the disease to their owners. However, the outbreak remained mild and did not result in any deaths 4.
In 2018, cases of monkeypox were diagnosed in the UK, at the same time that the first human-to-human transmission was confirmed outside of the African continent. The UK subsequently experienced additional cases in 2019 and 2021 5.
From mid-May 2022 onwards, cases of monkeypox were reported across a rapidly increasing number of countries and regions, predominantly in Europe, but also across North and South America, Asia, Oceania, and Africa. In late July 2022, the Director-General of the World Health Organization (WHO) officially declared the outbreak a public health emergency of international concern 6. As of mid-August 2022, a total of 34,000+ confirmed cases have been documented spanning 82 countries 7.
Throughout history, monkeypox has been far less transmissible than its counterpart, smallpox. Symptoms include fever, headache, muscle pains, shivering, and a blistering rash, alongside a handful of secondary complications. Its onset is anywhere from 5 to 21 days post-exposure, and the disease typically lasts a total of 2 to 4 weeks.
There are no treatments specifically for monkeypox virus infections and there remains no known cure. However, given its similarity to smallpox, monkeypox can be treated using smallpox-tailored treatments, including antiviral medications, such as Tecovirimat, or vaccinia immune globulin. In addition, the smallpox vaccine has been shown to have a certain degree of effectiveness against monkeypox 8. While individuals tend to naturally recover from the disease 5, treatment options continue to be actively developed 9.
Monkeypox spreads through close, physical contact between people. Therefore, effective preventive behaviors, including hand washing, staying away from infected individuals, and wearing personal protective equipment, are important 10. Monkeypox remains a rapidly evolving infectious disease which will require close monitoring and swift responses. Given the late starting point for the current outbreak, communities and public health agencies have a larger hill to climb to bring cases under control.
References
1. Parker, S. & Buller, R. M. A review of experimental and natural infections of animals with monkeypox virus between 1958 and 2012. Future Virology (2013). doi:10.2217/fvl.12.130
2. Cho, C. T. & Wenner, H. A. Monkeypox virus. Bacteriological reviews (1973). doi:10.1128/mmbr.37.1.1-18.1973
3. Meyer, H. et al. Outbreaks of disease suspected of being due to human monkeypox virus infection in the Democratic Republic of Congo in 2001. J. Clin. Microbiol. (2002). doi:10.1128/JCM.40.8.2919-2921.2002
4. Monkeypox: Practice Essentials, Pathophysiology, Etiology. Available at: https://emedicine.medscape.com/article/1134714-overview. (Accessed: 17th August 2022)
5. Monkeypox: background information – GOV.UK. Available at: https://www.gov.uk/guidance/monkeypox. (Accessed: 17th August 2022)
6. WHO Director-General declares the ongoing monkeypox outbreak a Public Health Emergency of International Concern. Available at: https://www.who.int/europe/news/item/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern. (Accessed: 17th August 2022)
7. Monkeypox Data Explorer – Our World in Data. Available at: https://ourworldindata.org/explorers/monkeypox?tab=table&time=2022-05-24..latest&facet=none&Metric=Confirmed+cases&Frequency=Cumulative&Relative+to+population=false&country=~OWID_WRL. (Accessed: 17th August 2022)
8. Monkeypox and Smallpox Vaccine Guidance | Monkeypox | Poxvirus | CDC. Available at: https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html. (Accessed: 17th August 2022)
9. Treatment | Monkeypox | Poxvirus | CDC. Available at: https://www.cdc.gov/poxvirus/monkeypox/treatment.html. (Accessed: 17th August 2022)
10. Infection Control: Healthcare Settings | Monkeypox | Poxvirus | CDC. Available at: https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fpoxvirus%2Fmonkeypox%2Fclinicians%2Finfection-control-hospital.html. (Accessed: 17th August 2022)