Monkeypox is a rare viral disease that is endemic to parts of central and West Africa. It is caused by the monkeypox virus, which is a member of the orthopoxvirus family, the same family of viruses that includes smallpox. Monkeypox was first identified in 1958 when an outbreak occurred in monkeys kept for research purposes. The first human case was identified in 1970 in the Democratic Republic of Congo (formerly Zaire).
Transmission
Monkeypox is primarily spread through contact with the blood, bodily fluids, or lesions of infected animals, such as monkeys, rodents, and squirrels. Human-to-human transmission can also occur through direct contact with infected bodily fluids or through respiratory droplets. Person-to-person transmission is more likely to occur in settings where there is close contact with infected individuals, such as within households or healthcare facilities.
Symptoms
The symptoms of monkeypox are similar to those of smallpox, but generally milder. The first symptoms typically appear within 5—21 days after infection and include fever, headache, muscle aches, backache, swollen lymph nodes, chills, and exhaustion. A rash then develops, often beginning on the face and then spreading to the trunk and limbs. The rash progresses from ma culés (flat, red spots) to pa pules (raised bumps) to vesicles (small fluid-filled blisters) to pustules (pus-filled lesions), which then crust over and heal. The rash may last for several weeks and can be accompanied by intense itching.
Diagnosis and Treatment
Monkeypox can be difficult to diagnose, as it shares many symptoms with other illnesses, such as chickenpox and measles. Laboratory tests are needed to confirm a diagnosis. Treatment for monkeypox is primarily supportive and aimed at relieving symptoms. Antiviral drugs such as cidofovir and smallpox vaccine can be effective in treating monkeypox, but their use is limited due to potential side effects and availability.
Prevention
Preventing monkeypox involves avoiding contact with infected animals and humans. In endemic areas, individuals should avoid hunting or consuming wild animals, as well as avoid contact with rodents and primates. Additionally, individuals should take steps to prevent the spread of the disease, such as practicing good hygiene (washing hands frequently, covering mouth and nose when coughing or sneezing), avoiding close contact with sick individuals, and using personal protective equipment (PPE) when caring for patients.
Outbreaks
Since its discovery in 1958, monkeypox outbreaks have occurred sporadically in central and West African countries, with the largest outbreak occurring in Nigeria in 2017. In that outbreak, over 200 cases were reported, with a mortality rate of approximately 10%. In addition to the human cases, several cases were identified in captive monkeys that were being kept as pets. The outbreak highlighted the need for improved surveillance, response, and prevention efforts to reduce the risk of future outbreaks.
Monkeypox in the United States
Monkeypox is not endemic to the United States, but cases have been reported in individuals who have traveled to or had close contact with individuals from endemic areas. The first case of monkeypox in the United States occurred in 2003, in a person who had recently returned from West Africa. Since then, several other cases have been reported, primarily in individuals who have had close contact with pet prairie dogs that were infected with monkeypox. The risk of monkeypox spreading in the United States is considered low, but healthcare providers should be aware of the signs and symptoms of the disease and take appropriate infection control measures when caring for patients.
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