How Dangerous Can The Monkeypox Virus Be?

Introduction

Monkeypox, a disease similar to but less severe than smallpox and endemic to some parts of Africa, specifically the western and central parts of the country, has now created an international stir. On August 14th,2024 WHO Director-General declared (mpox) monkeypox virus disease outbreak a public health emergency of international concern. Preventive measures and guidelines for the identification and management of monkeypox cases in India have already been issued by MoHFW, India and AIIMS. 

Can The Monkeypox Virus Mutate And Take More Severe Forms Like The Coronavirus?

WHO experts have explained that the Monkeypox virus is a double-stranded DNA virus when compared to the Coronavirus which is an RNA virus. DNA viruses like monkeypox have comparatively lesser chances to undergo mutations and change the presentation of disease and severity. Mutation can happen but not as frequently as that observed in RNA viruses. 

In 2022–2023 a global monkeypox virus outbreak was caused by a strain known as clade IIb (Source: World Health Organisation)

Why Is The Disease Called Monkeypox?

This rare viral disease occurs as a result of the monkeypox virus, which was initially discovered in monkeys. In the year 1958, there were a couple of outbreaks of a disease similar to pox in monkey colonies maintained for research. Thus, the disease got its name monkeypox. 

The first case in humans was recorded 12 years later in 1970 in the Democratic Republic of Congo (DRC). The disease has also been recorded in other parts of the country including Nigeria, Cameroon, Liberia etc. 

How Does Monkeypox Spread?

Even though the disease was first identified in monkeys, the natural reservoir of the virus is yet unknown. Some rodents like rope squirrels, tree squirrels, Gambian pouched rats, and dormice are said to be more susceptible to monkeypox. Thus, there is a possibility that these rodents spread the infection to other species like monkeys and dogs. 

Human beings who are bitten by an infected animal or are closely handling one (playing, cooking, skinning, hunting, or eating infected animals) can develop monkeypox symptoms. 

Human-To-Human Transmission Of Monkeypox (MPOX) Infection

Monkeypox transmission from an infected person can occur through the following ways

• Respiratory droplets can spread the monkeypox infection while talking or being in close proximity to an infected person. 
• By direct touch or vaginal/anal sex with an infected person
• Kissing or oral sex can also spread monkeypox 
• Bodily fluids, droplets or wound/scab of an infected person can transmit the monkeypox infection. 
• Contaminated objects such as clothing or linens, infected surfaces and sharp objects can also spread monkeypox infection. 
• During pregnancy, transmission from the infected mother via the placenta to the fetus is also possible.

Understanding The Monkeypox Disease

When the monkeypox virus enters the body through broken skin/mucosal surfaces (e g oral, pharyngeal, ocular, genital, anorectal)/ via the respiratory tract, it multiplies within the human body and presents monkeypox symptoms. 

Monkeypox can also be a cause of neurological disorders, frequent headaches, mood disturbances, anxiety and depression.

Dr. Ashish Bajaj, M.B.B.S., M.D in Clinical Pharmacology and Toxicology

Symptoms Of Monkeypox

Monkeypox symptoms are very similar to smallpox, but in this case a bit milder. At the initial stage of the infection, one may develop:

• Fever 
• Headache and body aches 
• Swelling of the Lymph nodes 
• Exhaustion 
• Chills
• Rashes
• Sore Throat
• Skin lesions- papules, macules, blisters and pustules
• Lesions on the anal and genital regions can cause pain and difficulty while peeing or passing stools.

Number of skin lesions can vary from person to person. These can appear anywhere on the body such as:

• Palms of hands and soles of feet
• Face, mouth and throat
• Groin and genital areas
• Anal region

Course Of Monkeypox Disease

Usually, after 3 days, once the fever appears, the infected person will develop monkeypox symptoms like facial rash, which may then spread to other parts of the body. The lesions first turn to macules (flat lesions) and papules (elevated lesions), followed by vesicles (fluid-filled blisters) and pustules (pus-filled sores), finally, they dry and turn to scabs as they heal. 

Some people present with fever first, others may present a rash along with fever, and monkeypox symptoms can manifest differently in different individuals.

Incubation Period

The interval from exposure to onset of symptoms of monkeypox is usually from 6 to 13 days but can also range from 1 to 21 days. 

Contagious Period

Monkeypox infection can spread from an infected person to another person in this duration i.e. 1-2 days before the rash appears until all the scabs fall off and skin is healed.  

Monkeypox symptoms generally last for approximately 2-4 weeks, after which the condition improves. People with weak immune systems and some chronic disorders may take longer to recover.

Possible Complications Of Monkeypox Disease

Monkeypox infection can cause mild to moderate to severe illness and even death. People with weak immunity and other chronic conditions like AIDS should exercise more caution. Possible complications include

• Pain and difficulty in swallowing lead to further weakness and dehydration
• Sepsis
• Severe diarrhea and vomiting
• Swelling (inflammation) of the heart, and brain
• Inflammation and sores on genitals, anal region and urinary passage
• Corneal infection leading to vision loss

Currently, there are no specific clinically proven treatments for monkeypox infection. As with most viral illnesses, the treatment is supportive symptom management. There are, however, prevention measures that can help prevent monkeypox virus outbreak like wearing a mask.

Dr. M.G. Kartheeka, MBBS, MD(Pediatrics)

Prevention Of Monkeypox

Monkeypox prevention is important because this disease is contagious. To avoid catching the monkeypox infection one should –

• Stay away from animals that could carry the infection, especially sick animals in areas where the infection has been identified.
• Avoid contact with material or items that have been in contact with an infected person or sick animal.
• Immediately isolate monkeypox patients as per the recommended guidelines to avoid further spread.
• Maintain good hygiene, especially washing hands frequently.
• Follow respiratory etiquette and wear a mask in crowded places.
• In case of caring for an infected person use personal protective equipment (PPE).
• Handle the belongings of an infected person carefully.

Diagnosis Of Monkeypox Disease

Provisional diagnosis for Monkeypox can be made by a doctor based on the patient’s clinical symptoms and history of exposure to a known case of monkeypox. 

Clinical presentation may be confusing with chicken pox and other sexually transmitted infections.

• The preferred test for Monkeypox involves the detection of viral DNA by polymerase chain reaction (PCR). 
• Test samples for monkeypox are taken directly from the rash – skin, fluid or crusts – collected by vigorous swabbing. 
• If skin lesions have not manifested, throat swabs or anal swabs can also be used for testing. 
• India is preparing for the global emergency announced by WHO. India now has a rapid RT PCR test that delivers results in just 40 minutes, significantly faster than traditional methods which take 1-2 hours. The Central Drugs Standard Control Organization (CDSCO) has approved this novel Mpox Detection RT-PCR test kit.
•  Other lab tests for blood and urine samples may be recommended by a doctor to evaluate other parameters during Monkeypox infection. 
• Antibody detection methods may not be useful as they do not distinguish between different orthopoxviruses.

Treatment Of Monkeypox

For the treatment of monkeypox, your doctor will advise you on supportive therapy based on your individual health needs and symptoms. Reach out to a dermatologist or infection clinic if you notice a skin rash or blisters that are preceded by or accompanied by fever, weakness or swollen lymph nodes. Not every rash is monkeypox, but a doctor can evaluate and diagnose the problem well.

MPOX vaccine has also been developed and is given to people in high-risk areas in different parts of the world. Stay updated about vaccination guidelines in your area. 

Self-Care Tips For Better Recovery From Monkeypox

Most people with monkeypox recover within 2–4 weeks. The following measures can help manage symptoms and prevent the spread of infection to others:

Do’s

• Follow the isolation guidelines and stay at home
• Follow hand hygiene and respiratory etiquette
• Keep the affected area of skin dry and uncovered (unless in a room with someone else)
• Use saltwater rinses for sores in the mouth, you can ask your doctor to prescribe specific mouth paints or mouthwashes to manage the oral sores
• For painful defecation- sitz baths or warm baths may help 
• Follow the treatment prescribed by your doctor
• Drink plenty of healthy fluids and consume nutritious and easy-to-digest food. 

Don’ts 

• Scratch your sores or pop the blisters- this can lead to the spread of infection
• Shave affected areas of skin till the skin heals completely
• Go out or meet people without a mask 
• Ignore your symptoms
• Self-medicate

In A Nutshell

Need not fear about a monkeypox disease outbreak, but awareness is crucial. We must be aware and vigilant for the safety of ourselves and others. On a positive note, we must remember that smallpox has been eradicated and experts hope that with the right measures we may be able to contain the monkeypox virus outbreak as well. Understanding the symptoms, modes of transmission, and protective measures is crucial in managing and containing the spread of the virus. As research and global health efforts continue to evolve, staying informed and following recommended guidelines can help protect both individuals and communities from this emerging public health concern.

References:

1. The Lancet Infectious Diseases. The global alarm bell is ringing due to the threat of potential severe cases and deaths caused by clade I of monkeypox virus [Internet]. Available from: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00530-9/fulltext
2. Monkeypox Guidelines. [Internet]. Available from: https://ihpoe.mohfw.gov.in/RTI/Monkeypox%20Guidelines.pdf 
3. World Health Organization. WHO Director-General declares mpox outbreak a public health emergency of international concern [Internet]. Available from: https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern
4. World Health Organization. Mpox [Internet]. Available from: https://www.who.int/news-room/fact-sheets/detail/monkeypox 

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