Monkeypox : the next global pandemic ?

What is monkeypox ?

Monkeypox is a viral disease caused by the Monkeypox virus, which is related to the smallpox virus.

Monkeypox is a zoonosis, which means that it is transmitted from animals to humans:

either directly by the animal: like toxoplasmosis by contact with an infected cat;
or indirectly through vectors: such as mosquitoes that can transmit Chikungunya, Dengue, yellow fever or the Zika virus.

Where is monkeypox virus found ?

The monkeypox virus was first isolated in 1958 from monkeys bred for scientific research.

Outbreaks of the virus were initially found in Africa, with the first human case recorded in 1970 in the Democratic Republic of Congo. Since then, epidemics have regularly occurred there without ever spreading to other continents. But in the spring of 2022, the impossible happened and cases were reported in Europe and North America, unrelated to travellers from the risk area.

Transmission and contagion of the Monkeypox virus

Monkeypox virus is transmitted :

from animals to humans: by being bitten or scratched by the animal or by eating contaminated meat. The reservoir animals carrying the virus are rodents (squirrels, rats) and monkeys;
from one human being to another: through prolonged face-to-face contact via respiratory droplets, through direct contact with body fluids (blood, saliva, semen) and through contact with objects that the patient has contaminated.

CAUTION : Protecting sexual intercourse with a condom does not protect against monkeypox transmission!

What are the symptoms of monkeypox ?

The patient is contagious from the time the first symptoms appear until the scabs fall off. The symptoms start with :

High fever;
muscle pain; and
swollen lymph nodes (especially in the neck);
a rash (red patches and itching) on the mouth and tongue;
severe fatigue (asthenia).

Later, the rash will spread to the whole body with macules, papules and pustules from the hands to the soles of the feet. Complications may occur in 10% of cases.

The disease lasts between 2 and 4 weeks. The incubation period (the time before the first symptoms appear) is 5 to 21 days.

The skin lesions eventually heal by forming scabs. These crusts gradually peel off the skin and fall off. They may be responsible for further contamination.

The current form of Monkeypox infection has some peculiarities compared to classical smallpox:

a large proportion of the patients are men who have sex with men;
the patients have anal and genital lesions.

How do you know if you are infected with monkeypox ?

Monkeypox infection is suspected if the person has had possible exposure to the virus within the last three weeks with :

a return from an endemic area in Africa and contact with rodents or monkeys;
contact with an infected person.

Monkeypox should be distinguished from other diseases with similar symptoms:

chickenpox ;
hand-foot-and-mouth syndrome
shingles
measles
scabies
syphilis;
and allergic skin reactions (allergies).

The presence of the virus in a patient is confirmed by a biological test similar to the PCR test performed to confirm the presence of the COVID 2019 SARS virus: a virus-specific nucleic acid amplification test following a nose swab.

The sample can also be taken from :

Throat swab;
genital lesions; and
anal lesions;
skin lesions.

What are the complications of Monkeypox infection ?

Following Monkeypox infection, complications exist and require emergency hospitalisation:

a massive rash: more than 100 blisters all over the body;
eye damage: irreversible damage to the cornea of the eyes, leading to a reduction or even loss of vision;
digestive complications;
neurological complications: a risk of developing fatal encephalitis;
lung damage: the development of pneumopathy.

Currently, the risk of death is 1%. Populations at particular risk of developing a severe form of the disease are

immunocompromised (immune-compromised) individuals;
children;
Pregnant women with transmission of the virus to the newborn.

Monkeypox: which drugs to use to treat it ?

The medical management of monkeypox is limited to alleviating the symptoms present:

the main treatment is to combat the fever. The first-line treatment is to use paracetamol ;
to prevent scratching of the skin, superinfection of the lesions and transmission of the virus, antihistamines may be prescribed;
It is advisable to cover the skin lesions with sterile compresses and dressings to limit infection.

CAUTION : non-steroidal anti-inflammatory drugs are contraindicated because of the possibility of serious infectious complications.

How can the transmission of the Monkeypox virus be avoided ?

To avoid spreading the virus, the sick person should :

isolate themselves until the skin lesions have completely healed (including their pets during the entire period of isolation);
apply barrier measures, including hand washing
wear a surgical mask and protective gloves;
abstain from sexual intercourse until 21 days after the onset of symptoms;
careful cleaning of the home at the end of isolation.

Monkeypox : vaccination

Vaccination after exposure to the virus can be offered to people at risk.

Children and adolescents up to the age of 18, as well as pregnant or breastfeeding women, cannot be vaccinated.

The vaccine is ideally administered within 4 days of the risk contact and no more than 14 days later with a 2-dose schedule (or 3 doses in immunocompromised individuals), spaced 28 days apart.

According to scientific studies, people who have received the smallpox vaccine once in their lifetime (even if the vaccination was given a long time ago) are still partially protected against monkeypox.