Should you be worried about Monkeypox?

This blog looks at the recent cases of Monkeypox to answer your questions about whether you need to be worrying about this emergent disease.

Monkeypox first made the news in early May this year, with the WHO reporting that cases of human monkeypox had been reported by 12 member states that are not endemic for the virus.

What that means – in layman’s terms – is that human monkeypox was being reported in countries in which it was not a usual occurrence.  Monkeypox endemic countries are Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan, with the earliest diagnosed case of human monkeypox being that of a child in the DRC in 1970.

The identification of confirmed cases of human monkeypox in countries with no direct travel links to an endemic area represents a highly unusual event, and an increase in the number of cases led to the WHO activating its highest alert level on the 23rd July, declaring the virus a “public health emergency of international concern“.

According to WHO director general Dr Tedros Adhanom Ghebreyesus more than 26,000 cases have now been reported from 75 countries, with five deaths due to the outbreak.

Last week the the US government followed suite and declared the monkeypox outbreak a public health emergency following a spike in US cases. According to health officials, cases have now topped 6,600, with a quarter of all cases appearing New York State, which had already declared its own state of emergency.

Monkeypox in SA

Not to be outdone, SA reported its first case of human monkeypox in Gauteng mid-June, followed shortly by a second case in the Western Cape. The 32-year-old man from Cape Town had no travel history, indicating a high likelihood of local transmission. A third case was reported mid-July in a 42-year-old male tourist from Switzerland, according to the health department of the Limpopo province.

Like me, I’m sure many of you may have greeted this news with an inward groan – and maybe some mild panic. We’re all still reeling from the Coronavirus pandemic, and now this?

Do we really have the mental energy or capacity to be worrying about another public health emergency (while also worrying about load shedding, state capture, and the economy?)
Should we be worried?

Monkeypox is not a new virus

Transmission

Monkeypox is transmitted from person to  person by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding. The incubation period is usually 6 to 13 days,  but can range from 5 to 21 days.

This is very different from Covid-19 as it is not deemed highly transmissible. This means you’re not at risk of catching the virus by having a casual conversation with someone.

However, if you touch their contaminated clothing or their scabs/rashes, or if you have any close physical contact (kissing, hugging, sex), you can get it. Touching or getting bitten by an infected animal may also spread the virus. It’s also important to note that the NICD says there is no risk of monkeypox virus infection from animals in South Africa.

Symptoms and disease progression

Human monkeypox infection is divided into two periods: the first being characterised by general symptoms such as fever, headache, muscle and back pain, and fatigue, and the second by swollen lymph nodes, a skin rash or pus-filled skin lesions. Most people tend to recover within two to four weeks.

Some key facts about treating Monkeypox

• Vaccines used during the smallpox eradication program also provided protection against monkeypox. Newer vaccines have been developed, one of which has been approved for the prevention of monkeypox.
• An antiviral agent developed for the treatment of smallpox has also been licensed for the treatment of monkeypox.
• Monkeypox is usually a self-limited disease with symptoms lasting from 2 to 4 weeks. Severe cases can occur, but in recent times the case fatality ratio has been around 3–6%.

The WHO and national health agencies have decades of experience fighting smallpox, which was declared eradicated in 1980. The successful fight against smallpox, and the tools developed against it, will provide health officials with important knowledge to combat monkeypox.

South African cases

The source of the monkeypox cases in South Africa — as well as the link between the cases — remains under investigation, according to the Department of Health.

The NICD is working with the department to assess the risk of local transmission, in collaboration with the WHO and in line with international health regulations.

“The health officials will continue with contact tracing while closely monitoring the situation and alert clinicians on symptoms to look for, and if [the] clinical picture fits with monkeypox, they are urged to complete a case investigation form and send samples for testing,” said the Health Department.

Why all these cases now?

Scientists are trying to determine what caused the initial cases and if the virus has changed. Increased global travel as well as climate change have generally accelerated the emergence and spread of viruses.

In fact, many new diseases have arisen as humans encroached on new land and encountered wild animals. Deforestation in the rain forests of West and Central Africa was linked to the outbreak of the Ebola virus, bringing fruit bats, the suspected reservoir host, into contact with humans at the edge of forest clearings.

HIV-AIDS and Zika were also linked to human encroachment of natural forest. Three out of four new or emerging infectious diseases originate in animals according to the US Centre for Disease Control and Prevention.

So is it an emergency?

Health officials from several countries had urged the WHO to label monkeypox a public health emergency of international concern because of the quick escalation of cases and concerns it may become endemic in more countries. The emergency declaration is a means to spur global collaboration on everything from testing to the production and distribution of vaccines and treatments.

And in the US the emergency status unleashes funding and gives health agencies regulatory flexibility that could help increase access to vaccines and treatments.

What to do if you think you have Monkeypox

It’s important to seek medical attention promptly if you’re suffering from a rash and you think you may have monkeypox. There are many other things that may cause a rash, most of which can be treated quickly and effectively. It’s important to diagnose monkeypox promptly to aid in the efforts to contain the transmission of the virus and avoid more cases from occurring.

So do we need to worry?

While it is important to be vigilant around any health outbreak in order to monitor the spread, Professor Shabir Madhi, Professor of Vaccinology at the University of the Witwatersrand – in an interview with EWN – said that there’s no need to panic, and that it’s highly unlikely SA will see a human monkeypox outbreak like we saw with COVID-19.

Whilst the NICD says there is no risk of monkeypox infection from animals in South Africa, we still recommend that given that the natural reservoir of monkeypox is hypothesised to be rodents, taking extra rodent-control precautions this winter certainly can’t hurt. If anything, it will protect you and your family from a host of other unpleasant rodent-borne illnesses.