What is monkeypox?
Monkeypox is a rare viral infection. It is an endemic disease in parts of Central and West Africa and outbreaks typically occur in populations living in rural areas who hunt, handle and consume bushmeat.
Currently, outbreaks of monkeypox have been seen in several countries outside of Africa – the United Kingdom, other countries in Europe (France, Italy, Spain, Portugal, Sweden) and North America.
This has been concerning as it is not clear how these individuals were exposed to monkeypox. They had no or unknown travel history to monkeypox endemic countries. A few cases from these current outbreaks have occurred in men who have sex with men (MSM). MSM has not been known to be a risk factor for monkeypox transmission.
There are two main types of monkeypox – those arising from the Democratic Republic of Congo (DRC) or from West Africa. The current cases detected are identified as the West African subtype, which is milder infection of the two.
What are the symptoms?
The typical symptoms of monkeypox are:
• Fever
• Body aches / muscle aches
• Swollen lymph nodes
• Chills
• Exhaustion
• Rash – which typically starts from the face before spreading to other parts of the body, including genitalia.
Monkeypox symptoms may last between 2 to 4 weeks.
It is a self-limiting illness, however, there can be serious complications and even death. The mortality rate is around 1% during outbreaks. The mortality rate associated with the milder version of the disease is around 1%, whereas it can be as high as 10% for the more severe form of monkeypox.
How does it spread?
Monkeypox is spread by a bite or scratch from an infected animal, bush meat preparation, or direct contact with blood, body fluids or skin or mucosal lesions of infected animals.
Human-to-human transmission is limited and occurs with contact with clothing / linens of infected persons, direct contact with monkeypox skin lesions or scabs, or coughing / sneezing of an individual with monkeypox rash. The incubation period is between 5 to 21 days.
How is it tested?
Polymerase chain reaction (PCR) test to detect the viral DNA is the ideal way to test for monkeypox. We can obtain the specimens directly from the rash.
How is monkeypox treated?
Monkeypox is a self-limiting illness with symptoms usually improving within 14 to 21 days. Treatment is supportive to manage the symptoms. There is currently no proven medication or vaccine available for monkeypox, however, vaccination against smallpox has shown to be 85% effective in preventing monkeypox. Currently, the smallpox vaccines are no longer available to the general public as by 1981 smallpox was declared to have been eradicated worldwide.
What does this mean for travel?
As of 23rd May 2022 the following countries have reported cases of monkeypox (where they usually would not be expected): Argentina, Australia, Austria, Belgium, Canada, Denmark, France, Germany, Greece, Italy, Israel, Morocco, Netherlands, Portugal, Spain, Sweden, Switzerland, the United Kingdom, the United States of America.
Travellers are advised to remain cautious and follow strictly:
• Maintain a high standard of personal hygiene (frequent hand washing after going to the toilet or when hands are soiled).
• Avoid direct contact with sick or dead animals.
• Ensure all foods containing animal meat or parts are properly cooked before eating.
• Avoid close contact with infected people or their contaminated belongings (including beddings or towels).
Dr Trisha is a British trained doctor based at Osler Health Star Vista.
References
1. Ministry of Health Singapore (MOH) – Monkeypox circular and information.
2. World Health Organisation (WHO) – Monkeypox.
3. National Health Service (NHS) – Monkeypox.
4. Centers for Disease Control and Prevention (CDC) – Monkeypox.
