Monkeypox
General Information
Monkeypox is caused by monkeypox virus, a member of the Orthopoxvirus genus in the family Poxviridae. Other members of the Orthopoxvirus genus are zoonotic viruses that can also be seen in other living species such as; Camelpox, Cowpox, Variola. Variola, commonly known as smallpox, was eradicated from the world in 1980 with effective vaccination.
Monkeypox is a rare viral zoonotic disease that is primarily endemic in the tropical rainforests of Central and West Africa and occasionally spreads to other parts of the world from there.
Monkeypox is clinically observed by symptoms such as fever, malaise, fatigue, headache, rash, and swollen lymph nodes which can lead to a range of medical complications.
Monkeypox is a self-limiting illness with symptoms that usually last for 2-4 weeks. Severe cases may occur. Recently, the fatality rate has been highest in cases in Central Africa, 10%, in West Africa 1%, and in other geographical areas where the disease is rare, below 1%.
Natural Host
Various animal species susceptible to monkeypox virus have been described. These; string squirrels, wood squirrels, gambian opossums, dormouse, primates, and other species. The natural course of the monkeypox virus has not yet been clearly defined. Its exact reservoir(s) and how the virus circulates in nature are not yet clear.
Transmission Route
Monkeypox is transmitted to humans via close contact with an infected person or animal, or through contaminated materials. The disease can be passed from one person to another through lesions, bodily fluids, respiratory droplets, and contaminated items such as bedding. Droplet transmission often requires prolonged face-to-face contact, which puts healthcare workers, households and close contacts of active cases at risk. The chain of transmission from person to person has increased from 6 to 9 people in recent years. This may be due to the reduced immunity in the community due to the lack of smallpox vaccination. Transmission from mother to baby can occur by close contact during and after pregnancy and childbirth.
Symptoms
The incubation period of monkeypox is usually 6-13 days but can vary from 5-21 days. Infection can be divided into two periods. Initial period 0-5 characterized by fever, headache, enlarged lymph nodes, back pain, muscle pain, weakness. Enlargement of lymph nodes is a prominent feature for this disease and is important in differentiating between measles, smallpox, and chickenpox. Skin rashes begin 1-3 days after having a fever. The rash is more intense on the face, arms, and legs rather than the torso. The face (95%), palms and soles of the feet (75%) are affected. In addition, oral mucosa (70%), genital areas (30%) and conjunctiva (20%) are affected. The rashes first develop as flat-bottomed, slightly raised, then clear, then yellowish, fluid-filled lesions. Lesions may be only a few or thousands. Symptoms are self-limiting within 2-4 weeks. Severe disease can be seen in children. It can also be severe in people with immunodeficiencies. Although smallpox vaccination used to be protective, today people under the age of 40-50 are more susceptible to the disease, depending on the country. Complications include lung infections, sepsis, vision loss and encephalitis (inflammation of the brain).
Treatment
Smallpox vaccine, antivirals, and Intravenous immune globulin (VIG) can be used to control the monkeypox epidemic. However, the original (first generation) smallpox vaccines are no longer available to the public. While a vaccine (MVA-BN) and a specific treatment (tecovirimate) have been approved for monkeypox in 2019 and 2022, respectively, these countermeasures are not yet widely available and populations under 40 or 50 years of age worldwide are more likely to follow previous smallpox vaccination programs.
Is it life threatening?
Monkeypox virus, which has a milder course than smallpox, can cause death in 10% of cases. However, if you encounter any of the symptoms of monkeypox virus, you should see a specialist.
What should be done to reduce the risk of human-to-human transmission?
The World Health Organization (WHO) states that close contact with people showing the symptoms of the disease caused by the virus should not be established and these patients should be isolated.
How effective is sexual contagion for monkeypox transmission?
Monkeypox virus infects people because of "close contact" transmission of droplets. In the statement made by the World Health Organization, monkeypox virus also spreads through sexual intercourse. While it is stated that unprotected sexual intercourse should be avoided for this, it should not be thought that this disease is only a sexually transmitted disease.
How to take precautions against the monkeypox virus
Systematic observations of the virus and rapid identification of new cases are critical to contain the epidemic. During outbreaks, close contact with infected people is the most important risk factor for monkeypox virus infection. Healthcare workers and households are at a greater risk of infection. Healthcare professionals who treat and care for patients with suspected or confirmed infection with the monkeypox virus, or obtain samples from them, should follow standard infection control precautions. If possible, people previously vaccinated against smallpox should be selected for the care of the patient. Personal hygiene measures should be taken into consideration individually. However, care should be taken when using common goods and common areas.
Although the monkeypox virus is rare, it is necessary to take these precautions to minimize the risk of catching it while traveling:
Wash your hands regularly with soap and water or use an alcohol-based hand sanitizer.
Only eat well-cooked meat.
Take care not to touch the towels or clothing of infected people.
Do not come into contact with people who are likely to carry this virus.
What should you do if you think you have contracted monkeypox virus?
First of all, the symptoms must be looked at in order to diagnose the disease. If you have traveled to countries where the monkeypox virus has been seen in the last 1 week, if you have a rash, fever and an intense feeling of illness, you should apply to a health institution without delay. Definitive diagnosis can be made by PCR method, which is performed by taking samples from the rashes on the patient's body in health institutions. After the diagnosis is made, you should isolate yourself and avoid close contact with other people.