The world has hardly begun to bounce back from the extraordinary turmoil caused by the Covid-19 pandemic, and the onslaught of a new epidemic, if not yet another pandemic, is already becoming imminent. The virus this time is monkeypox, which causes itchy skin rashes, fever, headache, back pain, muscle pain and fatigue. While monkeypox is not as transmissible and severe as Covid-19, it is expected to cause significant disruption in the global public health system in case of sustained and widespread transmission.
Already endemic (outbreak consistently present but limited to a particular region) in 11 Central and West African nations, the virus is gradually spreading in non-endemic (where the outbreak was not reported earlier) regions. Now the tally of confirmed cases of new spread is over 1,000 in 29 non-endemic countries, posing a potential risk of transmission in countries like Nepal.
But what exactly is this virus, and how significant is its risk? Let’s find out.
Monkeypox belongs to the same family as smallpox and is transmitted to humans from animals. Its name derives from its first discovery in monkeys at the Statens Serum Institut, Denmark, in 1958. The first human infection was recorded in a child in the Democratic Republic of Congo in 1970.
There are primarily two strains of monkeypox, West African and Central African, the latter being more severe than the former. While the case fatality ratio of the West African variant is up to 1 percent, that of the Central African variant is up to 10 percent, according to the World Health Organisation (WHO).
The Democratic Republic of Congo reported 1,284 suspected cases, the highest in the world, from January 1 to June 1, 2022. Nigeria reported 66 suspected cases from January to June 1, 2022. The ongoing Covid-19 pandemic has affected the virus surveillance, so scientists believe that the actual cases in endemic countries such as Nigeria may be higher.
Even as the monkeypox-endemic countries struggle to contain the virus, it has been detected in various Western countries in the last few weeks. The United Kingdom reported its first monkeypox case on May 7 with travel links to Nigeria. On May 14, two other cases were reported in the UK, having no travel history to Africa and no contact with the previous case.
From May 13 to June 2, the UK and Northern Ireland reported 207 cases. Along with the UK, 29 non-endemic countries have documented over 1,000 confirmed cases of the virus as of June 8, according to the WHO’s Director-General Tedros Adhanom Ghebreyesus.
What causes monkeypox infection?
According to the USA’s Centre for Disease Control and Prevention (CDC), monkeypox can be transmitted from bites or scratches of infected animals. In Africa, the infection has been identified in animals such as rope squirrels, tree squirrels, Gambian poached rats, dormice, different species of monkeys and others. However, its natural reservoir is yet unknown. The consumption of inadequately cooked meat and other animal products is known to pose a risk of infection.
“There is a probability of the virus entering Nepal since we are just a flight away from contracting the virus.”
Among humans, close physical contact is a well-known risk factor for transmission. Close contact with respiratory secretions, skin lesions of an infected person, or recently contaminated objects can result in transmission. Intimate contact, including kissing, cuddling, sexual intercourse or touching parts of the body that have monkeypox sores, can also lead to transmission. The WHO, however, has said it is unclear if the virus can be transmitted specifically through sexual transmission routes.
What are its symptoms?
The incubation period (between infection and symptoms generation) for monkeypox is usually six to 13 days, but this might also range from five to 21 days. According to the WHO, initial symptoms generally include fever, headache, swollen lymph nodes, back pain, muscle pain and lack of energy. After one to three days of initial symptoms, skin eruption (rash) begins. The rashes are primarily concentrated on the face and spread to other body parts.
Should we be worried?
Monkeypox develops from a DNA virus, which does not mutate much. This means that a variant generation is less likely. Experts say it is not highly transmissible like other diseases, including Covid-19.
The virus can only be transferred through close contact and is not airborne; this lessens the probability of higher human-to-human transmission. The higher the incubation period, the higher the chance to intervene with preventive measures.
The recent outbreak is different from previous outbreaks in endemic countries. What is worrying is that cases without any travel history to Africa or close physical contact with infected persons are being reported. The virus has already spread to over two dozen non-endemic countries worldwide. So there is a probability of the virus entering Nepal since we are just a flight away from contracting the virus, said Dr Sher Bahadur Pun, chief of the Clinical Research Unit at the Sukraraj Tropical and Infectious Disease Hospital, Kathmandu.
“It might have spread to the community level before the virus was detected in the UK on May 7,” he added.
Treatment and vaccination
Monkeypox is a self-limiting disease with mild symptoms, but it is an unpleasant and potentially painful disease that lasts for two to four weeks. Recently the case fatality ratio has been around 3 to 6 percent. There is no specific treatment or vaccine against monkeypox, but smallpox vaccines are known to be effective. According to a report published by CDC, smallpox has shown up to 85 percent efficacy against monkeypox.
“The antivirals used against smallpox can be used to minimise the severity,” Dr Pun told South Asia Check. “If the vaccine is administered within four days of the exposure, it can curb the disease. Even if the vaccine is given between four and 14 days, it will curb the severity of the disease.”
Dr Pun, however, emphasised the need to conduct broad research on the drug’s efficacy.
According to Dr Samir Kumar Adhikari, joint spokesperson of the Ministry of Health and Population (MOHP), the production of vaccines and antiviral drugs for smallpox is low globally, hence the unavailability of the vaccine for everyone. In other words, if we need the vaccine today, it is unlikely to be widely unavailable.
How is it different from Covid-19?
Covid-19 is caused by a Ribonucleic acid (RNA) virus, which mutates quickly. Monkeypox is caused by a Deoxyribonucleic acid (DNA) virus, which has a lesser chance of mutation. Unlike Covid-19, which transmits through tiny particles like cough droplets in the air, monkeypox does not transmit easily; it transmits through close physical contact with the infected person, such as shared clothing or bedding, or through the exchange of saliva.
According to a report published by the National Library of Medicine, USA, an asymptomatic spread—which has been a primary concern in the case of Covid-19—has not yet been documented in the case of monkeypox.
For Dr Pun, monkeypox is not a new disease as Covid-19 was. “It is not an airborne disease like Covid-19,” he assured South Asia Check. Dr Pun, however, emphasised the need for everyone to remain vigilant to prevent virus transmission, even suggesting a 21-day quarantine for people coming from abroad where monkeypox has been detected.
With monkeypox making its presence felt in over two dozen countries globally, the risk of it entering Nepal remains. While the country is yet to detect the virus, public health officials claim they are working to prevent transmission and contain it in case of transmission. According to Dr Adhikari of the MOHP, orientation programs for health officials working in provincial hospitals and laboratories are underway.
“Nepal has a facility to test the virus in PCR labs, but a reagent is yet to be imported. Against this backdrop, we have already identified testing facilities in neighbouring countries in collaboration with the WHO,” Dr Adhikari said.
This story first appeared in South Asia Check.