Monkeypox: Symptoms and transmission + Why does it occur?

According to the World Health Organization, monkeypox is another disease caused by a virus that has the potential to spread massively.

WHO = World Health Organization.

After the coronavirus (SARS-CoV-2), this is another viral infection that could cause pandemic spread.

Pandemic = an epidemic that has a wide geographic spread, i.e. causes disease across continents and even globally.

Monkeypox is caused by the monkeypox virus = monkeypox virus.

Monkeypox = MPX, monkeypox virus, MPXV.

Zoonosis - another disease closely related in the human-animal relationship?

This virus is a zoonosis = anthropozoonosis.

It is transmitted to humans by the infectious route from an infected animal.

It is a virus that causes disease in animals and also in humans. Transmission to humans and then transmission between humans is possible.

Whether it is domestic animals, pets, farm animals or wild animals.

Some of the best known zoonoses include rabies (wild mammals, especially foxes, rats, cats, rabbits), Lyme disease (ticks), salmonellosis (meat, poultry, eggs), toxoplasmosis (cats), and tularemia (rabbits).

Of course, the coronavirus is still present, a new variant of which has been spreading since 2019 (SARS-CoV-2).

Zoonoses have an epidemic character.

Back to the monkeypox virus

This is a rare disease. Monkeypox virus is classified in the genus Orthopoxvirus and family Poxviridae.

It resembles variola = smallpox.

The disease was first discovered in 1958 in a colony of laboratory monkeys. The disease resembled smallpox, hence its name.

Macaque monkeys are often used in laboratory experiments.

In the 1970s, monkeypox first appeared in humans in the Democratic Republic of Congo.

Since then, the disease has been repeatedly detected in countries in central and west Africa.

To date, the rarity of occurrence has focused mainly on the region of Africa where the infection spreads freely among animals, mainly rodents, rats, mice, squirrels, but also primates, i.e. monkeys.

The main range of monkeypox is the tropical rainforest region of central and west Africa.

The actual reservoir of the virus is not yet known.

Interesting fact:
Although they bear the name "monkeypox", monkeys are reportedly not the primary natural reservoir.

Transmission to humans is possible in several forms. After a bite or scratch, through transmission of body fluids, also after eating meat from an infected animal.

Transmission by contact (through clothing, linen, towels) is also an example.

The occurrence of outbreaks outside Africa is mainly associated with a history of travel and importation of infected animals.

Smallpox and monkeypox? Do I have immunity after contracting chickenpox?

Chickenpox is not monkeypox.
Varicella is NOT MPX.

Chickenpox is caused by a different virus, namely varicella zoster virus.

They are two completely different diseases. However, they have similar names and skin manifestations.

Therefore, overcoming chickenpox will not provide immunity against monkeypox.

Read more in the article.

The cause of monkeypox infection is monkeypox virus (MPXV) from the Orthopoxvirus genus and the Poxviridae family.

It is therefore a zoonosis. The virus is spread between animals with possible transmission to humans.

Rodents and mammals are both reservoirs. Although rodents are identified as the primary reservoir, this is not specified.

The virus is named after monkeys because it was originally identified when it was spread among them.

Animal-to-human and human-to-human transmission

It is reported that close contact is required for transmission. It is not a completely simple form of contagion, such as influenza or coronavirus.

It is mainly close contact with an infected animal.

Possible modes of transmission from animal to human:

• Scratching
• bite
• contact with body fluids - blood, saliva, blisters
• consumption of meat with imperfect cooking
• contact with contaminated skin and fur

Human-to-human transmission is similar to other smallpox.

A person comes into contact with the virus or an object after contamination with the virus.

The monkeypox virus enters the body through broken skin, e.g. through an injury that may not even be visible.

It then enters the respiratory tract through the nose and mouth.

Then often through the eyes - the conjunctiva.

People routinely touch their faces and eyes during the day without even realising it. This increases the risk of transmission and infection.

And so...

The transmission from person to person is primarily due to close contact with an infected person.

The first mode of transmission is through the air. The virus can be spread by droplets of body fluids carrying the virus when coughing, sneezing.

The second way is through contact with body fluids. It is transmitted by contact with contaminated objects of normal daily use. Transmission can also occur through sexual contact.

Transmission of the virus usually occurs through:

• contact after contamination of clothing, bed linen, towels, everyday objects
• touching blisters, warts
• coughing and sneezing by persons with a monkeypox rash

Transmission from a pregnant woman to the fetus has also been described.

What supports the risks of spreading the infection nowadays?

• The increase in the earth's population
• travel
• climate change
• closer contact with animals, especially exotic species

Read more in this article where Dr. Stefania Laca Megyesi describes several factors in the spread of disease
Zika virus: what is it, how is it transmitted, what are the symptoms?

Symptoms of monkeypox infection appear after the incubation period.

The incubation period is the interval between
→ contact with the virus and infection in the body
→ after the outbreak of the disease and the appearance of the first symptoms.

Monkeypox incubation period = 5-21 days - usually 7-14 days.

The symptoms are usually milder and similar to smallpox. One difference is swollen lymph nodes, which are absent in smallpox.

Smallpox has been eradicated through vaccination.

The onset of the disease is characterised by general health problems as with other viral infections such as influenza and similar diseases.

The disease progresses in two stages:

1. a phase of general symptoms lasting approximately 0-5 days = prodromal symptoms
2. skin rash phase - approximately day 1 to day 10

1. Initial symptoms are:

• fever, i.e. body temperature above 38 °C.
• headache
• muscle pain
• joint and spinal pain
• body pain
• chills
• fatigue and exhaustion
• typical swollen lymph nodes - head, neck, groin
• dry cough to shortness of breath in more severe cases

2. Secondary rash that progresses in multiple stages

After about 3 days or more, skin manifestations begin to appear. The rash usually progresses from the face (even in the mouth). It also occurs on the palms of the hands and soles of the feet, in the genital area.

The gradual development of the skin manifestations usually takes between 1 and 10 days. The rashes are usually at the same stage, which can differentiate them diagnostically from chickenpox.

Stages of rashes:

1. macules - skin lesions with a flat base
2. papules - slightly raised rashes
3. vesicles - rashes filled with white fluid
4. pustules - rashes filled with yellow, yellowish fluid
5. scabs - final stage - dry and fall off

The number of skin pimples can be up to several thousand.

Severe course = confluence of lesions and peeling of larger parts of the skin, occurrence all over the body = generalized exanthema.

Other symptoms include:

• sore throat
• redness and inflammation of the conjunctivae
• itching of the skin

Is monkeypox infectious?

It is reported that MPX is infectious from the time of initial general health problems. Infectivity persists throughout the time until the scabs separate and the skin covering remains intact.

The course of the cutaneous stage to healing of the skin damage takes approximately 14-21 days.

14-21 days is the usual time until healing of the skin damage, when transmission and infectivity are possible.

Duration of disease and complications

The total duration of the disease is between 2 and 4 weeks.

You ask about complications and mortality?
Monkeypox usually runs a mild course
and
rarely causes death.

In Africa, monkeypox is the cause of death for 1 in 10 people.
Another source puts it at about 1-15% in this location.
The World Health Organization puts it at 3-6%.

Young children are most at risk.

After evaluating data from this area, complications in the form of respiratory problems occurred in 12% of those infected.

Complications include:

• bronchopneumonia - inflammation of the bronchi and lungs
• sepsis
• encephalitis
• loss of vision after infection affecting the eye, cornea
• organ failure and, in severe cases, death if left untreated

Who may experience complications and a worse course?

Those at risk include:

• Young children, infants
• pregnant women
• the elderly
• people with nutritional disorders - malnutrition
• immunocompromised and immunocompromised persons, including persons with HIV/AIDS
• persons under 40-50 years of age who are not vaccinated against chickenpox
• with associated long-term illnesses

Difference between monkeypox and smallpox

Compared to smallpox, monkeypox has:

• lower infectivity
• milder course
• lower mortality rate
• swollen lymph nodes

The diagnosis of monkeypox is based on a history of primary and secondary manifestations.

Confirmation of a definitive diagnosis is based on one of several methods, the most basic of which is PCR (polymerase chain reaction), following the collection of a mucosal swab, specifically a throat swab or direct secretion from the skin pox.

In the initial diagnosis, they may be mistaken for chickenpox, measles, shingles, mumps or cowpox. Bacterial ones include syphilis, parasitic scabies or a non-infectious problem such as allergy with skin manifestations.

+ It is important to inform your GP if you have been in contact with someone who has returned from an area at risk of spreading monkeypox in the last 3 weeks. It is also important to inform your GP if you have been in such an area yourself.

The course of monkeypox is characterized by the onset of difficulties as in any other viral disease.

First, flu-like symptoms appear, lasting an average of 3 days.

Pain all over the body, muscles, joints, fever, enlargement of lymph nodes, most often in the jaw area.

Subsequently, skin lesions appear. This leads to a second cutaneous phase.

The skin rashes start from flat skin changes to raised pimples clouded with light to yellowish fluid.

Eventually, scabs form. The scabs peel off after drying.

Transmission of the virus to the next person is possible until the last scab falls off.

It can take up to 4 weeks from start to finish.

During this time, monitoring and control of health and rest are necessary.

It is necessary to inform the doctor and isolate the patient, i.e. exclude him from the collective - quarantine.

Specialist surveillance applies especially to people at risk and children.

The course of the disease is also influenced by the general state of health of the person, associated diseases and weakening of the organism.

The prognosis depends on the severity of the course and the presence of complications.

Prevention

The key is to keep infected people in isolation - quarantine. The same applies to animals that show signs of the disease.

As with most infectious diseases that spread by the same route, it is a matter of strict adherence to hygiene habits, washing and disinfecting hands, covering the respiratory tract.

Smallpox vaccination provides a degree of protection (reportedly 85 %).

However, only persons expected to be in the area of the outbreak or in laboratories - health and veterinary workers - are vaccinated.

Plus, persons who have been in close contact with persons or animals with confirmed disease may also be vaccinated.

Observe animal handling precautions and quarantine animals after importation (importation of some animals into the European Union is prohibited).

Prevention also includes:

• avoiding contact with infected animals, including wild and stray animals
• avoiding contact with contaminated material, fur
• washing hands - with soap and water
• disinfection of hands and environment (alcohol-based products) - MPXV is sensitive to common disinfectants
• not to be in contact with a person at risk who may be ill
• sufficient heat treatment of meat
• use of protective clothing and PPE when caring for the sick, therefore healthcare workers should use gloves, gown and FFP2 respirator and eye protection - goggles/shields

How does the disease manifest itself in animals?

Symptoms include fever, rash, enlarged lymph nodes and discharge from the eyes. In addition, they will also show a change in mental status - apathy.

Monkeypox in 2022

Monkeypox was confirmed on 6 May 2022 in a British citizen who returned from Nigeria with symptoms suggestive of monkeypox (29 April 2022). He returned to the UK on 4 May 2022.

Since then, cases have been reported in Canada, Israel, Pakistan, Australia and in the EU countries of Austria, Belgium, France, Germany, Italy, Sweden, the Netherlands, Spain, Portugal, Poland.

TheECDC reports that MPX has spread mainly among men who have had sex with men. There is also a higher risk among people who have multiple sex partners.