Monkeypox: Symptoms, Transmission, Diagnosis and Treatment

Context. A new strain of the African Mpox virus (monkeypox) in a few months spread to at least 16 African countries, and in six of them the virus appeared in just 10 days. More than 500 people died with about 20 thousand officially confirmed cases. The new Mpox virus has a higher mortality rate than Covid-19 and is spreading at almost the same rate. In this regard, the World Health Organization (WHO) may soon declare the maximum level of global danger. Currently, there is no effective vaccine against this disease.

What is monkeypox?

Monkeypox is a rare viral disease caused by a virus from the genus Orthopoxvirus, which also includes the smallpox virus. Although monkeypox is less dangerous and contagious than smallpox, it remains a significant public health problem, especially in light of the 2022 outbreak, when the virus spread outside Africa and was reported in dozens of countries around the world.

Monkeypox was first discovered in 1958 in laboratory monkeys that were used for research, giving the disease its name. The first case of human infection was reported in 1970 in the Democratic Republic of the Congo. Since then, the virus has occasionally caused outbreaks in West and Central Africa, where it is endemic. The sources of the virus are a variety of wild animals, including monkeys, squirrels and rodents.

The virus can be transmitted from animals to humans through bites, scratches, or contact with infected animals such as monkeys, squirrels, and rodents. A person can also become infected through contact with body fluids or skin lesions of the patient.

The virus is transmitted from person to person through contact with affected skin, respiratory secretions, or through shared objects (such as clothing).

Diagnosis includes a clinical examination and laboratory tests such as PCR (polymerase chain reaction) to detect the virus.

There is no specific treatment, but symptomatic therapy and supportive treatment can help patients.

Smallpox vaccination provides some protection against monkeypox, although smallpox vaccination is no longer being administered en masse.

Avoiding contact with potentially infected animals and humans, as well as practicing hygiene, can help prevent infection.

Monkeypox is most common in West and Central Africa, where outbreaks of the disease occur periodically. In recent years, cases have been reported in other regions, including Europe and North America, causing global concern.

In 2022, the WHO announced an outbreak of monkeypox in several countries outside of Africa, which drew international attention to the disease.

2022 Outbreak

In 2022, there was the largest recorded outbreak of monkeypox outside Africa. Cases have been reported in more than 100 countries, including Europe, North America and Asia. The virus spread both through close contact and through sexual contact, which was a new risk factor identified during this outbreak.

In July 2022, the World Health Organization (WHO) declared the outbreak a global public health emergency, highlighting the gravity of the situation and the need for international cooperation to combat the spread of the virus.

What are the symptoms of “monkeypox”?

Symptoms of monkeypox usually develop 5 to 21 days after infection and include two main phases: the prodromal period and the skin rash phase.

Prodromal period (early symptoms):

• Fever: Fever is one of the first symptoms. Fever can be moderate to high and is usually accompanied by chills.
• Headache: Severe headache is common.
• Muscle pain (myalgia): Muscle and joint pain often accompanies fever.
• Swollen lymph nodes (lymphadenopathy): One of the key symptoms of monkeypox, which distinguishes it from many other viral infections. Lymph nodes may enlarge in the neck, armpits, and groin.
• General malaise: Feeling weak, tired, decreased appetite.

Skin rashes:

The rash begins 1-3 days after the onset of fever and goes through several stages: macules, papules, vesicles, pustules and crusts. They can appear on the face, palms, soles and spread to other parts of the body.

1. About 1-3 days after the onset of fever, a rash begins, which goes through several stages.
2. Macules: Start as flat red patches on the skin.
3. Papules: Spots become raised above the skin.
4. Vesicles: The papules then fill with clear fluid and turn into vesicles.
5. Pustules: Vesicles fill with pus over time, turning yellowish.
6. Crusts: The pustules gradually dry out and become crusted, which fall off after a few weeks.

The rash can appear on the face, then spread to the rest of the body, including the palms and soles. However, in 2022, there were cases when rashes were localized mainly in the genital area, anus and mouth, which caused difficulties in diagnosis.

Atypical and mild forms of the disease

The 2022 outbreak showed that some patients may have less severe symptoms than was previously the case. Some patients had limited rashes or mild forms of the disease without a significant increase in temperature.

In a number of patients, symptoms began with lesions of the mucous membranes (e.g., in the mouth) and anorectal area, resulting in pain in these areas. These symptoms were especially noticeable among people infected through sexual contact.

Painful and long-lasting symptoms

Some patients complained of severe pain associated with rashes, especially in the genital and anal areas. This could be accompanied by complications such as secondary bacterial infections.

The disease could last from 2 to 4 weeks, and even after the crusts disappeared, some patients had scarring and changes in skin pigmentation.

How is monkeypox transmitted?

The monkeypox virus is transmitted from animals to humans through bites, scratches, or direct contact with the body fluids of infected animals. The main vectors of the virus are wild animals, including rodents and primates.

Human-to-human transmission of the virus is possible through:

• Common objects (e.g., clothing, bedding) that have been in contact with the patient's skin lesions.
• Direct contact with skin lesions or body fluids of an infected person.
• Respiratory drops in close face-to-face contact, which is especially important in closed spaces or when staying near the sick person for a long time.

Sexual transmission: Although the virus is transmitted through close contact with skin or body fluids, during the 2022 outbreak, it was revealed that sexual contact has become a significant factor in transmission, especially among men who have sex with men (MSM). This led to the appearance of specific symptoms, such as rashes in the genital area and anus.

Localized rashes: The rashes could remain limited to specific areas of the body, as opposed to classic spread throughout the body, which made diagnosis more difficult.

These features made the 2022 outbreak unique and required a revision of some approaches to the diagnosis and treatment of monkeypox.

Diagnosis

Diagnosis of monkeypox includes a clinical examination and laboratory tests. The main diagnostic methods:

• Polymerase chain reaction (PCR): The most reliable method to detect virus DNA in samples from skin, pharynx or blood lesions.
• Electron microscopy: Used to visualize viral particles in tissue samples.
• Serological tests: They can be used to detect antibodies to the virus, but do not always give accurate results in the early stages of the disease.

Correct and timely diagnosis is especially important to prevent further spread of the virus, especially in the context of a global outbreak.

Treatment

At the moment, there is no specific treatment for monkeypox. Treatment is aimed at relieving symptoms and maintaining the overall health of the patient. The main treatments include:

• Symptomatic therapy: Use of fever reducers to reduce fever, analgesics to reduce pain, and skin care products to speed up the healing of rashes.
• Supportive care: Includes hydration, vitamins and, if necessary, antibiotics to prevent or treat secondary bacterial infections that may occur with skin lesions.

In some cases, antiviral drugs such as tecovirimate, which have been developed to treat smallpox and have shown some efficacy against monkeypox, are used.

Prevention

Monkeypox prevention includes measures to prevent contact with potential sources of the virus and infected people. Basic recommendations:

• Avoiding contact with wildlife in endemic areas, especially dead or sick animals.
• Use of personal protective equipment (gloves, masks) when caring for patients or in contact with biological fluids.
• Hygiene: Frequent hand washing, use of antiseptics, as well as thorough disinfection of objects that may have been in contact with patients.

Particular attention was paid to vaccination. Vaccination against smallpox, which was discontinued in the 1980s after the global eradication of the disease, proved effective against monkeypox as well. In the context of the 2022 outbreak, a number of countries began vaccinating high-risk groups, such as health workers and people at increased risk of infection.

Comparison of COVID-19 and the African Mpox virus (monkeypox)

Nature of the virus and transmission rate

Monkeypox: The monkeypox virus is transmitted mainly through direct contact with infected skin rashes, body fluids or contaminated objects, and through respiratory droplets through close contact. Unlike COVID-19, the monkeypox virus is not as easily transmitted through the air and requires closer contact, which reduces its rate of spread.

COVID-19: The SARS-CoV-2 virus that causes COVID-19 is predominantly airborne and highly contagious. This means that the virus can spread rapidly in large populations, especially in dense populations and enclosed spaces.

Incubation period and symptoms

Monkeypox: The symptoms of monkeypox are usually distinct, and most people are contagious only after the onset of symptoms, such as rashes and fever. This makes it easier to identify and isolate those infected, which contributes to better outbreak control.

COVID-19: The disease can spread even before symptoms appear, making it difficult to control the spread of the virus. Latent and asymptomatic cases play a large role in the transmission of infection.

Vaccines and treatment

Monkeypox: There are vaccines developed to combat smallpox that are also effective against monkeypox. These vaccines can be used to prevent the spread of the virus, especially among high-risk groups. In addition, there are already antiviral drugs that can be used to treat severe cases.

COVID-19: COVID-19 vaccines were developed on an emergency basis and did not begin to be distributed until several months after the pandemic began. Up to this point, the pandemic has led to significant losses and overburdened health systems.

Global preparedness for monkeypox after COVID-19

The COVID-19 pandemic has prepared the world community for new threats of infectious diseases. Lessons learned from the COVID-19 response, such as the development of monitoring systems, the rapid mobilization of resources and the dissemination of information, can be used to better control outbreaks of monkeypox and other diseases.

The monkeypox outbreak in 2022 was an important reminder of the need to prepare for new infectious threats. Although the disease remains less dangerous than smallpox, the global spread of the virus has shown that even relatively rare infections can pose a serious threat in the context of globalization and changing transmission routes. Strengthening international cooperation, monitoring, vaccination and education of the population remain key elements in the fight against diseases such as monkeypox.