During this spring season, health authorities are investigating more than two dozen confirmed monkeypox cases in Canada as part of an unprecedented outbreak of the rare disease that seldom spreads outside Africa. with twenty-five confirmed cases of infections in Quebec and one in Ontario, so far, the Public Health Agency of Canada is predicting the tally will rise in coming days.
Monkeypox is a rare infectious disease caused by the monkeypox virus. Monkeypox virus is related to, but distinctive from, the viruses that cause smallpox (variola virus) and cowpox. With the eradication of smallpox in year 1980 and subsequent cessation of smallpox vaccination, monkeypox has emerged as the most important orthopoxvirus for public health. Cases of monkeypox are usually found in central and western Africa, often in proximity to tropical rainforests. It is rare to find cases outside of that geographic area, per se.
There are two genetically distinct clades of monkeypox virus:
a. West African clade monkeypox- manifests with limited human-to-human transmission, and a case fatality of 1%, whereas
b. Congo Basin clade monkeypox- associated with human-to-human transmission and case fatalities historically reported of 10%.
While everyone is susceptible to the virus, clusters of cases have been reported among men who have sex with men, officials say. Animal hosts include a range of rodents and non-human primates.
Important facts about monkeypox virus
Monkeypox is caused by monkeypox virus, a member of the Orthopoxvirus genus in the family Poxviridae. Diseases associated with this genus include smallpox, cowpox, horsepox, camelpox, and monkeypox.
Monkeypox occurs largely in tropical rainforest areas of central and west Africa and is occasionally exported to other regions.
Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases can occur, however.
Person-to-person spread of monkeypox is not very common. However, the virus can be transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus.
This virus can be transmitted though infection due to lesions, body fluids, respiratory droplets and contaminated materials like cloths or beds.
Monkeypox is less contagious than smallpox and causes less severe illness.
Monkeypox typically presents symptoms such as fever, rash and swollen lymph nodes, and may lead to a range of medical complications.
An antiviral agent developed for the treatment of smallpox has also been licensed for the treatment of monkeypox.
Vaccines used during the smallpox eradication program also provided protection against monkeypox. Newer vaccines have been developed of which one has been approved for prevention of monkeypox.
Etiology
Various animal species have been identified as susceptible to the monkeypox virus. This includes rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates and other species. Uncertainty remains on the natural history of monkeypox virus, however, and further studies are needed to identify the exact reservoir(s) and how virus circulation happens in nature. Eating inadequately cooked meat and other animal products of infected animals can be a possible risk factor.
Signs and symptoms
The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days.
The infection with monkeypox can be divided into two periods:
a. Invasion period (between 0–5 days) marked by fever, intense headache, lymphadenopathy, back pain, myalgia and intense asthenia (lack of energy). Lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may initially appear similar such as smallpox, measles or chickenpox.
b. Skin eruption usually begins within 1–3 days after fever. The rash tends to be more concentrated on face and extremities. It affects the face (in 95% of cases), and palms of the hands and soles of the feet (in 75% of cases). Also affected are oral mucous membranes (in 70% cases), genitalia (30%), and conjunctivae (20%), as well as the cornea. The rash evolves sequentially from macules (lesions with a flat base) to papules (slightly raised firm lesions), vesicles (lesions containing clear fluid), pustules (lesions containing yellowish fluid), and crusts which dry up and fall off. In severe cases, lesions can coalesce until large sections of skin slough off.
Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and nature of complications. Underlying immune deficiencies may lead to worse outcomes.
Although vaccination against smallpox was protective in the past, today persons younger than 40 to 50 years of age (depending on the country) may be more susceptible to monkeypox due to cessation of smallpox vaccination campaigns globally after eradication of the disease.
Complications of monkeypox
Complications can include-secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision. The extent to which asymptomatic infection may occur is unknown, however.
WHO has developed surveillance case definitions for the current monkeypox outbreak in non-endemic countries. WHO is convening experts to discuss recommendations on vaccination.
References:
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