• Rob Swanda, PhD

Monkeypox: The Past, Present, and Foreseeable Future



This article is available to read in English, Français, Deutsch and Español.


All references to regulatory bodies and medical authorizations / approvals refer to those given by authorities in the United States of America. If you require information about Monkeypox or the available vaccines in your area, speak with your personal doctor / physician or the responsible health department in the country in which you live.


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August 22, 2022


Words & Videos by Dr. Rob Swanda


As the world continues to teeter through the significant impacts of the multi-year long COVID-19 pandemic, the global outbreak of another infectious disease has been hitting headlines and spreading in areas once never detected.

Monkeypox is historically a rare zoonotic disease first discovered in 1958 in research monkeys which is where the original naming came from (Figure 1). It is part of the same virus family as smallpox. This family is known as the vaccinia viruses. Various Monkeypox viruses have and do exist, but it wasn’t until recently (August 2022) that the World Health Organization (WHO) grouped the different sub-types of Monkeypox into clades.


Figure 1 - History of Monkeypox
Figure 1 - History of Monkeypox

Until recently, Monkeypox has been known to spread primarily within central and western African countries. When it has been detected outside these geographic areas, it has been linked to people or animals with recent travel to those affected countries or locations where Monkeypox is known to circulate endemically.


The sheer number of countries that Monkeypox has spread to (beginning summer 2022) in a few months’ time is a distinguishing aspect. For this outbreak Monkeypox was first detected in the United Kingdom in May 2022 and has since spread to at least 94 countries with more than 41,000 confirmed known cases; as of when this was written on August 20, 2022. 87 of these countries had no prior history of local transmission of the disease, but they now make up 99% of the cases. For the United States, with more than 14,000 cases, it currently accounts for 34% of the global case load. Wyoming is the only US state, district or territory known to have no Monkeypox cases recorded.


As mentioned previously, outbreaks outside of the continent of Africa have happened before. For example in the 2003 outbreak in the United States, all known cases were linked to recently imported animals from Ghana. Similarly, in a 2018 outbreak in the United Kingdom, all cases were linked to recent travel to Nigeria. A distinguishing concern during the 2018 outbreak was the first human-to-human transmission occurrence outside of Africa in a healthcare setting. This is thought to have occurred due to contaminated bedding.

Despite these previous outbreaks being contained, the 2022 outbreak has infected more individuals with Monkeypox than ever recorded. Unfortunately, this virus has entered the community while the world is continuing to fight infections caused by SARS-CoV-2. And although these two viruses are spreading at high rates, Monkeypox is different in many ways to COVID-19 (Figure 2) and its impact on the global population should not be extrapolated from the COVID-19 response. While it is understandable that many around the world are fatigued by the unique and ongoing COVID-19 impacts, it would be remiss to view these two very different illnesses within the same lens. It is important to be aware of the various risk profiles within certain communities and to understand the disease etiology of Monkeypox as an additional consideration to mitigate one’s own chance of exposure.


Figure 2 - Infectious Disease Comparison
Figure 2 - Infectious Disease Comparison

Recent reporting has dangerously slanted public perception that Monkeypox is a unique LGBTQIA+ issue. Any infected adult or child can contract and transmit Monkeypox to any number of other individuals. Monkeypox is not gender or age specific, and it can spread beyond only intimate contact. Although Monkeypox can be spread through sexual contact, is not a sexually transmitted disease (STD). Additionally, while the current data supports that sexual contact has been the driving force for the majority of cases, it’s crucial to remember that sexual contact is not the exclusive way that this virus spreads. Monkeypox transmits via close contact with an infected person through skin-on-skin touching, exchange of infectious viral droplets, and/or contact with objects that an infected person has used including linen, clothing, bedding or toys.


Monkeypox can have a very long exposure to symptom onset period of up to 3 weeks, and then another long infectious period of up to an additional 4 weeks. Symptom onset can appear remarkably similar to influenza, COVID-19 or any number of other respiratory illnesses. This includes fever, chills, lethargy, swollen lymph nodes, exhaustion, muscle aches, headache, a sore throat, cough and/or congestion. Each case can be unique, as these symptoms may occur before or after the initial appearance of a rash. This rash can appear on the hands, feet, chest, face and mouth as well as on and around the genitals including the anus. Typically, a very distinguished face rash is one of the key first signs that an individual should be tested for Monkeypox. The rash or ‘pox' can initially appear to be pimples or blisters yet be very itchy and/or painful. Although it can take weeks, the rash(es) will eventually scab before they fall off and a new layer of skin develops which marks the final healing. Only after the skin is fully healed is the infected person no longer considered a carrier-risk to transmit the disease to others.

Fortunately, unlike COVID-19, the world is not starting from a blank slate when it comes to vaccines. The JYNNEOS (IMVANEX in the European Union, IMVAMUNE in Canada) and ACAM2000 vaccines are available for those determined to be at high risk. If aged over 18, both vaccines are available. ACAM2000 is additionally available to all age groups, including pediatrics. Figure 3 provides a comparison between JYNNEOS and ACAM2000 and covers the vaccine type, age suitability, dosage and delivery methods. In brief, JYNNEOS is specifically designated for the use of vaccinating against smallpox & Monkeypox, whereas ACAM2000 is designated for the use in vaccinating against smallpox but is being used against Monkeypox under the FDA’s “Expanded Access Investigational New Drug” or “EA-IND” protocol. For this disease, emerging data supports vaccination as a post-infection treatment plan, which has shown to significantly reduced the severity of symptoms. There is approximately a four-day window from infection where a person can still receive a Monkeypox vaccine. The same post-infection / post-exposure vaccination as first line treatment was used during smallpox eradication with high success.


Figure 3 - Monkeypox Vaccines Comparison
Figure 3 - Monkeypox Vaccines Comparison

To learn how these vaccines work please see the video section at the end of the article


If you are determined to be at high risk of contracting Monkeypox, consider being vaccinated if that option is made available to you. Lastly, make a habit of exchanging and keeping information of close-contacts, including existing or new partners, and/or patients, as well as dates, times and the length of any contact. This will help you and your healthcare team more readily determine a treatment plan if you or your contacts do become infected.







Video: Everything you Need to Know About Monkeypox - with Dr. BCW


Video: How the Monkeypox Vaccine (Jynneos / Imvanex) Works


Video: How the Smallpox Vaccine (ACAM2000 / Dryvax) Works


Data sources:


Centers for Disease Control and Prevention. (2022, 08 19). 2022 Monkeypox Outbreak Global Map.

Retrieved from Centers for Disease Control and Prevention:

https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html


Centers for Disease Control and Prevention. (2022, 08 19). About Monkeypox.

Retrieved from Centers for Disease Control and Prevention:

https://www.cdc.gov/poxvirus/monkeypox/about.html


Centers for Disease Control and Prevention. (2022, 08 19). Monkeypox 2022 U.S. Map & Case Count.

Retrieved from Centers for Disease Control and Prevention:

https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html


National Centre for Biotechnology Information. (2004, 10 17). Monkeypox: A review of the history and emergence in the Western hemisphere.

Retrieved from NCBI:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7129998/


U.S. Food & Drug Administration. (2022, 08 18). FDA Monkeypox Response.

Retrieved from U.S. Food & Drug Administration:

https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/fda-monkeypox-response


World Health Organization. (2022, 08 19). Monkeypox.

Retrieved from World Health Organization:

https://www.who.int/news-room/fact-sheets/detail/monkeypox


 

Author: Rob Swanda, PhD of drswanda.com

Title: Monkeypox: The Past, Present and Foreseeable Future

Date first published: 22 August 2022

Link: https://www.drswanda.com/post/monkeypox-the-past-present-and-foreseeable-future

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