Essential Facts About Monkeypox and How to Stay Safe
Monkeypox is a zoonotic disease recently declared a global health emergency by the World Health Organization (WHO) due to its rapid spread in various regions. As cases surge, particularly in Africa, with the Democratic Republic of the Congo (DRC) reporting over 15,000 cases and more than 500 deaths, understanding its transmission, symptoms, and preventive measures is critical for public health. This article provides essential information on monkeypox, including its history, how it spreads, and what to watch out for.
History of Monkeypox
Monkeypox was first identified in 1958 among laboratory monkeys, with the initial human case reported in 1970 in the DRC. The virus is part of the Orthopoxvirus genus, which also includes smallpox.
Historically, monkeypox was confined to rural areas in Central and West Africa. Recent outbreaks, particularly in the DRC, where over 15,000 cases and more than 500 deaths were reported in 2024, have raised global health concerns due to its rapid spread and the emergence of new viral strains.
How Does Monkeypox Spread?
Animal-to-Human Transmission
Monkeypox virus is primarily zoonotic, meaning it spreads from animals to humans. The virus is transmitted through direct contact with the blood, bodily fluids, or skin lesions of infected animals.
The most commonly implicated animals include various species of rodents and primates. Activities such as hunting, handling bushmeat, and involvement in the animal trade significantly increase the risk of exposure to the virus. In particular, rural populations in Central and West Africa, where these practices are common, are at higher risk.
Human-to-Human Transmission
While monkeypox traditionally spread primarily through animal-to-human contact, recent outbreaks have demonstrated that human-to-human transmission plays a crucial role in its spread. The primary mode of transmission between humans is close contact with an infected individual.
This includes direct contact with skin lesions, bodily fluids, or respiratory droplets. Such transmission is particularly significant in household settings where close, prolonged contact occurs, or in healthcare settings where proper protective measures may not be in places
In recent outbreaks, sexual transmission has emerged as a significant route of spread. The virus has been detected in semen, which suggests that sexual contact is an important mode of transmission during the ongoing outbreaks. This new mode of transmission has been particularly evident in networks associated with commercial sex and sex workers, as observed in the DRC during the 2024 outbreak.
Fomite Transmission
Fomites—objects or materials likely to carry infection, such as clothes, utensils, and furniture—are another mode of monkeypox transmission. Contaminated materials, such as bedding and clothing, can harbour the virus for extended periods.
The virus has been isolated from high-touch surfaces, highlighting the risk of fomite transmission in environments where infected individuals have been present. This mode of transmission highlights the importance of proper sanitation and hygiene practices to prevent the spread of the virus, especially in healthcare settings and homes of infected persons.
Spread Through International Travel
The rapid spread of monkeypox in 2024 has been exacerbated by international travel, which has facilitated the spread of the virus beyond endemic regions. As people travel from areas with active outbreaks, they can unknowingly carry the virus to new regions.
This has been particularly concerning with the emergence of the new MPXV clade Ib in the DRC, which has spread to neighbouring countries such as Burundi, Kenya, Rwanda, and Uganda. Cases linked to this clade have also been reported in countries that had not previously experienced monkeypox outbreaks. The WHO has highlighted the need for strengthened cross-border collaboration to manage and monitor suspect cases, especially as travel resumes to pre-pandemic levels.
Transmission Rates of Monkeypox
Monkeypox, while transmissible, spreads less efficiently among humans compared to other viruses like measles or smallpox. Historical data from outbreaks in Zaire between 1981 and 1986 showed a secondary attack rate of approximately 3% within households, indicating that close and prolonged contact is required for the virus to spread effectively. Notably, the highest attack rates were observed among unvaccinated children under four years old, where the secondary attack rate reached 11.7%.
The basic reproduction number (R0) of monkeypox, which represents the average number of secondary infections produced by a single infected individual in a fully susceptible population, has been estimated to range from 1.46 to 3.74 during recent outbreaks. These values suggest that while monkeypox can spread within communities, it is less transmissible than highly contagious diseases such as measles, which has an R0 of 12 to 18.
Recent genetic changes in the virus, particularly the emergence of new subclades like clade Ib in the DRC, could potentially influence these transmission dynamics. However, the full impact of these mutations on transmission rates and patterns is still under investigation.
Evolution and Adaptation of the Monkeypox Virus
The monkeypox virus has undergone genetic changes over time, leading to the emergence of new subclades and mutations that may influence its transmissibility and virulence. During the 2022 outbreak, researchers observed notable G-to-A mutations in the virus, which were likely driven by the APOBEC3 enzyme. These mutations suggest that the virus is adapting to human hosts, potentially enhancing its ability to spread among people.
Another critical factor in the evolution of monkeypox is the cessation of smallpox vaccination. Smallpox vaccination provided cross-immunity against monkeypox, significantly limiting its spread. However, since the global eradication of smallpox and the subsequent discontinuation of the vaccine, there has been a marked increase in the susceptibility of human populations to monkeypox. This has allowed the virus to spread more efficiently, particularly in regions with no prior exposure to orthopoxviruses, such as the new clade Ib that emerged in the DRC in 2024.
Symptoms of Monkeypox
Incubation Period: 5 to 21 days.
Initial Symptoms
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- Fever
- Headache
- Muscle aches
- Fatigue
- Swollen lymph nodes (distinguishing feature from smallpox)
Rash Development: Begins on the face, spreads to the body, including palms and soles.
Progression
- Macules (flat lesions)
- Papules (raised lesions)
- Vesicles (fluid-filled lesions)
- Pustules (pus-filled lesions)
Resolution: Pustules crust over, form scabs, and eventually fall off.
Duration: Illness typically lasts 2 to 4 weeks.
Atypical Presentations
- Fewer lesions, sometimes confined to the genital or perianal area.
- Can be mistaken for other sexually transmitted infections, particularly in cases linked to sexual transmission networks.
Preventive Measures and Treatment
Avoid Contact with Infected Animals
- Limit exposure to animals that may carry the virus, especially in regions where monkeypox is endemic.
- Avoid handling bushmeat and refrain from direct contact with animals known to harbour the virus, such as rodents and primates.
Practice Good Hygiene
- Regularly wash hands with soap and water, especially after contact with potentially infected animals or humans.
- Avoid touching contaminated materials, such as bedding or clothing used by an infected person.
Use Personal Protective Equipment (PPE)
- Healthcare workers and caregivers should use appropriate PPE, including gloves and masks, when caring for individuals suspected of having monkeypox.
- Implement infection prevention and control measures in healthcare settings to reduce the risk of nosocomial transmission.
Vaccination
- The smallpox vaccine provides some protection against monkeypox.
- Vaccination campaigns may be implemented in areas experiencing outbreaks, particularly targeting those at higher risk, such as healthcare workers and close contacts of infected individuals.
Supportive Care
- Patients are treated for symptoms such as fever and pain.
- Adequate hydration and nutrition are essential during the course of the illness.
Antiviral Medications
- Tecovirimat, an antiviral drug, is currently being explored as a potential treatment for monkeypox.
- However, access to this medication is limited and is often provided under specific protocols for monitored emergency use.
As monkeypox continues to spread, it’s important to stay alert but not overly concerned. Unlike COVID-19, monkeypox spreads less easily and has been studied for decades, providing a strong foundation for managing and preventing the disease. The experiences from COVID-19—such as the value of staying informed, following public health guidelines, and the role of vaccination—are now being applied to control monkeypox.
Exercising caution, such as practising good hygiene, avoiding contact with infected individuals or animals, and staying informed about the latest public health recommendations, are effective ways to protect yourself and your community. Staying educated and aware is the most powerful tool we have to manage the situation without unnecessary fear.
References
- Islam, M. M., Dutta, P., Rashid, R., Jaffery, S. S., Islam, A., Farag, E., Zughaier, S. M., Bansal, D., & Hassan, M. M. (2023). Pathogenicity and virulence of monkeypox at the human-animal-ecology interface. Virulence, 14(1). https://doi.org/10.1080/21505594.2023.2186357
- Grant, R., Nguyen, L. B. L., & Breban, R. (2020). Modelling human-to-human transmission of monkeypox. Bulletin of the World Health Organization, 98(9), 638–640. https://doi.org/10.2471/blt.19.242347
- Sharma, A., Dudani, P., & Gupta, S. (2022). Patterns of sexual transmission of monkeypox in the current outbreak: An international survey of physicians. Journal of the European Academy of Dermatology and Venereology, 37(5). https://doi.org/10.1111/jdv.18745
- Pan, D., Nazareth, J., Sze, S., Martin, C. A., Decker, J., Fletcher, E., Hollingsworth, T. D., Barer, M. R., Pareek, M., & Tang, J. W. (2023). Transmission of monkeypox/mpox virus: A narrative review of environmental, viral, host, and population factors in relation to the 2022 international outbreak. Journal of Medical Virology, 95(2). https://doi.org/10.1002/jmv.28534
- Saldaña, F., Daza-Torres, M. L., & Aguiar, M. (2023). Data-driven estimation of the instantaneous reproduction number and growth rates for the 2022 monkeypox outbreak in Europe. PLoS ONE, 18(9), e0290387. https://doi.org/10.1371/journal.pone.0290387
- Human monkeypox: secondary attack rates. (1988). PubMed. https://pubmed.ncbi.nlm.nih.gov/2844429/
- Harapan, H., Ophinni, Y., Megawati, D., Frediansyah, A., Mamada, S. S., Salampe, M., Emran, T. B., Winardi, W., Fathima, R., Sirinam, S., Sittikul, P., Stoian, A. M., Nainu, F., & Sallam, M. (2022). Monkeypox: A Comprehensive Review. Viruses, 14(10), 2155. https://doi.org/10.3390/v14102155
- First meeting of the International Health Regulations (2005) Emergency Committee regarding the upsurge of mpox 2024. (2024, August 19). https://www.who.int/news/item/19-08-2024-first-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-upsurge-of-mpox-2024
