Monkeypox Virus : Disease Control and Prevention

Monkeypox Virus

Monkeypox is an uncommon illness caused by a monkeypox viral infection. Monkeypox virus is a member of the Orthopoxvirus genus in the Poxviridae family. Variola virus (which causes smallpox) and cowpox virus are both members of the Orthopoxvirus genus. Monkeypox was initially found in 1958, when two outbreaks of a pox-like disease occurred in study colonies of monkeys, thus the name. During a period of increased effort to eradicate smallpox, the first human case of monkeypox was documented in the Democratic Republic of the Congo (DRC) in 1970. Monkeypox has been documented in persons in a number of other central and western African nations since then, including Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Liberia. It is also causing infection in parts of India.

Signs & Symptoms of Monkeypox Virus

Monkeypox symptoms are comparable to smallpox symptoms in people - however, they are less severe. Fever, headache, muscular pains, and tiredness are the first symptoms of monkeypox. The fundamental distinction between smallpox and monkeypox symptoms is that monkeypox produces swollen lymph nodes (lymphadenopathy), but smallpox does not. Monkeypox has a 7-14 day incubation period (from infection to symptoms), although it can be as short as 5-21 days.

The disease starts with:

• Fever

• Headache

• Muscle pain

• Backache

• Swollen lymph nodes

• Chills

• Exhaustion

The patient develops a rash 1 to 3 days (sometimes longer) following the onset of fever, which usually starts on the face and spreads to other regions of the body.

Before dropping off, lesions go through the following stages:

• Macules

• Papules

• Vesicles

• Pustules

• Scabs

The disease lasts around 24 weeks on average. Monkeypox has been found to kill up to one out of every ten people who develop it in Africa.

Transmission of Monkeypox Virus

When a person comes into touch with the monkeypox virus from an infected animal, an infected person, or contaminated items, the virus can spread. The virus can potentially pass from the mother to her foetus through the placenta. The monkeypox virus can be transmitted from animals to humans by biting or scratching an infected animal, handling wild game, or using goods derived from infected animals. The virus can also spread through direct contact with an infected person's bodily fluids or sores, or through things that have come into contact with those fluids or sores, such as clothing or linens.

Monkeypox is spread mostly through direct contact with infected sores, scabs, or bodily fluids. Respiratory secretions can potentially spread it during prolonged face-to-face contact. Monkeypox spreads by close contact between people, such as during intercourse, as well as behaviors such as kissing, snuggling, and touching portions of the body with monkeypox lesions. It is unknown if monkeypox may transmit through sperm or vaginal secretions at this time.

Although African rodents are suspected of playing a role in monkeypox transmission to humans, it is unknown which species maintains the virus in nature.

Preventive Measures for Monkeypox Virus

A variety of precautions may be taken to avoid infection with the monkeypox virus:

• Avoid coming into touch with animals that may be infected with the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).

• Avoid touching any objects that have come into contact with a sick animal, such as bedding.

• Separate infectious patients from others who may become infected.

• After coming into touch with infectious animals or humans, wash your hands thoroughly. Washing your hands with soap and water or using an alcohol-based hand sanitizer are two methods.

• When caring for patients, wear personal protective equipment (PPE).

Vaccines for Monkeypox Viral Infection

JYNNEOSTM (also known as Imvamune or Imvanex) is an attenuated live virus vaccine that has been authorised for the prevention of monkeypox by the US Food and Drug Administration.

Treatment for Monkeypox Virus

In the absence of particular medication, many people infected with the monkeypox virus experience a moderate, self-limiting illness course. The prognosis for monkeypox, on the other hand, is determined by a number of variables, including past vaccination history, beginning health state, concomitant diseases, and comorbidities. 

Following consultation with the CDC, the following individuals may be considered for treatment:

• People who are suffering from a serious illness (e.g., hemorrhagic disease, confluent lesions, sepsis, encephalitis, or other conditions requiring hospitalization)

• People who are at a high risk of developing a serious illness include:

• Immunocompromised people (e.g., HIV/AIDS, leukaemia, lymphoma, generalised malignancy, solid organ transplantation, therapy with alkylating agents, antimetabolites, radiation, tumour necrosis factor inhibitors, high-dose corticosteroids, being a recipient of a hematopoietic stem cell transplant <24 months after the procedure or ≥24 months but with graft-versus-host disease or disease relapse, or having an autoimmune illness with immunodeficiency as a clinical component).

• Pediatric patients, particularly those under the age of eight.

• Women who are pregnant or nursing. 

• People who have one or more problems (e.g., secondary bacterial skin infection, gastroenteritis with severe nausea/vomiting, diarrhoea, or dehydration, bronchopneumonia, concurrent illness, or other comorbidities)

• Persons who have monkeypox virus aberrant infections, such as implantation in the eyes, mouth, or other anatomical sites where monkeypox virus infection might pose a specific risk (e.g., the genitals or anus).

Medical Countermeasures for Monkeypox Treatment

There is currently no approved treatment for monkeypox virus infections. Antivirals developed for smallpox patients, on the other hand, may be beneficial.

The Strategic National Stockpile (SNS) currently has the following medical countermeasures available for the treatment of monkeypox:

• Tecovirimat

• Cidofovir

• Vaccinia Immune Globulin Intravenous (VIGIV)

Brincidofovir (also known as Tembexa) is an antiviral medicine approved by the Food and Drug Administration (FDA) on June 4, 2021 for the treatment of human smallpox illness in adults, children, and newborns. The CDC is now working on an EA-IND to make it easier to employ Brincidofovir as a monkeypox treatment. Brincidofovir, on the other hand, is not yet available from the SNS.

References: 

1. https://www.cdc.gov/poxvirus/monkeypox/treatment.html