Alerts from the World Health Organization (WHO) surfaced in May 2022 highlighting the spread of monkeypox infections in non-endemic countries. Increasing numbers of cases, particularly in Europe and North America have raised questions about the risks the virus poses, and if it would lead to another epidemic like what we are experiencing with COVID-19.
Dr Adrian Ong, infectious disease specialist at Mount Elizabeth Hospital shares answers to 12 frequently asked questions about the disease and what you can do to protect yourself from getting infected.
1. What is monkeypox?
Monkeypox is a viral zoonotic disease, which means it is a virus that is transmitted from animals to humans. While human-to-human transmission does occur, it is not thought to be very common.
Despite its name, the natural host(s) of the disease have yet to be identified, though rodents are thought to be most probable source. Certain animals are at higher risk of carrying the disease, such as rodents and non-human primates such as monkeys. The first human case of monkeypox was identified in 1970s in the Democratic Republic of Congo, and subsequent cases have been localised in Central and West Africa, often near tropical rainforests.
2. What are the signs and symptoms of monkeypox? How soon do they appear after infection and how long do symptoms last?
Symptoms of monkeypox show up within one 1 to 2 weeks of exposure to an infected animal or human, with the majority of patients reporting experiencing fever, swollen lymph nodes, headaches, fatigue and body aches that were followed soon after by a widespread rash. The rash is distinctive, resembling small fluid-filled blisters that appear on the face, palms and soles of the feet and even the insides of the mouth. It develops and goes through various stages before forming a scab..
Without treatment, monkeypox is a self-limiting condition with symptoms resolving spontaneously within 14 to 21 days.
3. Is monkeypox deadly?
Monkeypox is potentially deadly. However, the variant involved in the current outbreak is milder and has a low fatality rate. Additionally, for the majority of those infected, the illness is mild and self-limiting.
4. Can past vaccinations against smallpox protect us from monkeypox?
Symptoms of monkeypox resemble that of smallpox, albeit in a much milder form. In those who had previously been vaccinated against smallpox, the vaccine is thought be durable and long-lasting. In addition, it confers cross-protection of 85% and helps prevent and relieve symptoms of the human monkeypox infection. However, the majority of young people have never received the smallpox vaccine as routine smallpox vaccination was stopped in the late 1970s and 1980s. Singapore officially ended smallpox immunisation in 1982.
5. How is monkeypox transmitted?
Although cases in the current outbreak have been linked to sexual activity and contact, the infection can happen to anyone. At the time of publication, monkeypox is not thought to be a sexually transmitted infection.
More specifically, the disease can happen when a person comes into close contact with:
- Infected animals (rodents and non-human primates such as monkeys)
- Infected humans
- Materials contaminated with the disease, otherwise known as fomites
The disease can enter the body through several ways:
- Broken skin – even if breaks in the skin are not visible
- The respiratory tract through droplets – this usually requires prolonged face-to-face contact
- Mucous membranes through the eyes, nose, or mouth
In endemic countries (Central and West Africa), animal bites and consumption of animal meat also play a role in transmission.
6. Who is at greater risk of getting infected with monkeypox?
The determinants and distribution of the current outbreak are still being understood. While the risk is considered to be low for most people in the community, one is at greater risk when he or she has intimate and prolonged contact with an infected individual.
7. How is monkeypox diagnosed?
Human monkeypox should be first suspected in persons with an unexplained fluid-filled rash and relevant risk factors such as travel, as well as close and prolonged contact with an infected person. The disease itself can be diagnosed and confirmed through laboratory testing of the fluids from the blisters or rash.
8. How can we manage our risks of being infected with monkeypox?
Prudent preventive measures include:
- Avoiding skin-to-skin or face-to-face contact with anyone who has symptoms of the disease
- Practicing safe sex
- Hygiene measures such as hand washing and observing respiratory etiquette. This also includes using simple detergents and alcohol-based solutions to inactivate the virus.
- Avoiding contact with wild animals, especially sick or dead animals that could potentially carry the disease.
- Vaccination: There are licensed vaccines that can be used for prevention of the disease, including the smallpox vaccination.
9. How is monkeypox treated?
As the disease is mild and self-limiting, the vast majority of current monkeypox patients do not require specific treatment, save for medication to relieve the symptoms. Patients who experience severe symptoms from the disease however, can count on antiviral remedies. These antiviral agents are presently approved for use against other viral diseases including smallpox but are expected to be effective for monkeypox as well.
10. Is monkeypox similar to chickenpox? What is the difference?
Monkeypox and chickenpox have very similar sounding names but are caused by unrelated types of viruses – the monkeypox virus and varicella respectively. While both diseases could cause fluid-filled blisters, they can be distinguished clinically by features such as the pattern of rash and lymph node swelling.
11. What extra precautions should be taken when travelling?
At present, the global human monkeypox outbreak is still evolving. Given that most of the cases in the current upsurge have been identified, mainly but not exclusively amongst men who have sex with men (MSM), the risk to the wider population and casual tourists is extremely low. As such, safer sex practices as well as the measures mentioned above are advised as the key modes of precaution.
12. Will monkeypox spread as widely as COVID-19?
This is thought to be extremely unlikely, given the difference in transmission patterns between the two diseases. Monkeypox mainly requires close and prolonged contact with an infected person or animal to spread, which stands in contrast to COVID-19 that is efficiently transmitted through air-borne aerosols.
While research to understand more about the disease is still underway and the risk of human-to-human transmission is low, it pays to be aware about the symptoms of the disease and how to keep yourself and your loved ones safe. Should you experience symptoms of monkeypox, do not hesitate to book an appointment with a specialist to get an accurate diagnosis and begin the treatment you need.
Article contributed by Dr Adrian Ong, Infectious Disease Specialist at Mount Elizabeth Hospital
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