All you need to know about the Monkeypox Disease.

Monkeypox disease outbreak has been reported in Agbura, Balyesa State, Nigeria after a man was reportedly said to have killed and eaten a monkey, after which families and neighbors become infected with monkeypox. Similar symptoms observed in smallpox such as skin rash, headache, skin irritation etc was observed.

Below is a breakdown of the monkeypox, the causative agent, mode of transmission, signs, symptoms and prevention.

Introduction

Monkeypox disease is zoonotic in nature, it is transmitted by the monkeypox virus. The disease was first discovered in laboratory monkeys, hence the origin of the name. The virus infects mostly rodents and occasionally primates in its natural state.

It is a disease indigenous to West and Central Africa. An outbreak once occurred in the United States in 2013, which was traced to a pet store which sells imported pouched rats from Gambia.

The monkeypox virus causing the monkeypox disease
Monkeypox virus which causes the monkeypox disease.

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Virus classification;
Group: Double-stranded DNA (dsDNA)

Order: unassigned

Family: Poxviridae

Subfamily: Chordopoxvirinae

Genus: Orthopoxvirus. (this genus also includes variola which causes smallpox, vaccinia virus used in smallpox vaccine and cowpox virus)

Specie: Vaccinia virus.

The first outbreak of monkeypox disease was discovered in 1958 when a pox-like disease was discovered in colonies of monkeys kept for research. The first human infection with monkeypox virus was in 1970 in the Democratic Republic of Congo at a time the country was battling with smallpox. Ever Since there has been rapid spread of the monkeypox disease in humans particularly in central and West Africa. The United States outbreak is the only time humans have been infected with monkeypox disease  outside Africa

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The natural host of the monkeypox virus remains unknown. However, it is strongly believed that the African rodent species play a role in transmission.
Over time, Two distinct genetic groups of the monkeypox virus have been identified; the West African and the central African. The West African is the less severe of the two, it causes fewer deaths and restricted human to human transmission.

Monkeypox

                     Monkeypox rash

Signs and symptoms
Monkeypox symptoms are similar to smallpox but milder, it usually starts with a fever, exhaustion, muscle aches and headache. The main differentiating symptoms of monkeypox and smallpox is that monkeypox cause lymphadenopathy (swelling of the lymph nodes) while small pox does not. The time of infection to the observation of symptoms (incubation period) for monkeypox is usually 7 – 14 days but can extend from 5 – 21days.

The illness begins with;

Fever
Headache
Muscle aches
Backache
Swollen lymph nodes
Chills

After the appearance of the fever, within 1 to 3days, sometimes longer. Patients begin to develop a rash, often starting from the face then a gradual spread to other body parts.

The following are the stages of lession progression before falling off;

Macules
Papules
Vesicles
Pustules

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The disease state last for 2-4weeks. It has been reported that monkeypox cause death in about 1 in 10 people who are infected with the disease.

Transmission
The virus causing monkeypox disease can be transmitted when a person has a direct contact with the virus from another person, animal or materials which have been contaminated with the virus. The virus route into the body is through broken skin (which might not be visible), the mucous membranes (mouth, nose or eyes) or the respiratory tract.

Transmission between animal to humans may occur by scratch, bites, bushmeat delicacy preparation, contact with bodily fluids or lesion, indirect contacts such as through contaminated bedding or linen materials. Transmission between humans mainly occurs through respiratory droplets, which cannot travel more than a few feet, so for infection to occur, there must be a prolonged face to face contact.

Prevention
The following are measures that should be taken to prevent infection with monkeypox disease. 

⛔Avoid animals that have been identified as carriers of the monkeypox virus (including sick animals, dead animals in areas where there is monkeypox outbreak).

⛔Avoid beddings, materials that have been in contact with a sick animal.

⛔Quarantine infected patients from others to prevent the risk of infection.

⛔Time to put your hygiene cap on, wash your hand after coming in contact with infected animals or humans. Wash your hands thoroughly with soap and water and apply an alcohol-based hand sanitizer.

⛔Are you working as a volunteer staff or a nurse caring for infected patients, use personal protective equipment (PPE) when caring for patients.

⛔Avoid crowded places.

References

Multistate outbreak of monkeypox—Illinois, Indiana, and Wisconsin, 2003.
Centers for Disease Control and Prevention (CDC).
Source: MMWR Morb Mortal Wkly Rep. 2003 Jun 13;52(23):537-540.

The detection of monkeypox in humans in the Western Hemisphere.
Reed KD, Melski JW, Graham MB, Regnery RL, Sotir MJ, Wegner MV, Kazmierczak JJ, Stratman EJ, Li Y, Fairley JA, Swain GR, Olson VA, Sargent EK, Kehl SC, Frace MA, Kline R, Foldy SL, Davis JP, Damon IK.
Source: N Engl J Med. 2004 Jan 22;350(4):342-350.

Monkeypox transmission and pathogenesis in prairie dogs.<<br /> Guarner J, Johnson BJ, Paddock CD, Shieh WJ, Goldsmith CS, Reynolds MG, Damon IK, Regnery RL, Zaki SR; Veterinary Monkeypox Virus Working Group.
Source: Emerg Infect Dis. 2004 Mar;10(3):426-431.

Evaluation of human-to-human transmission of monkeypox from infected patients to health care workers.
Fleischauer AT, Kile JC, Davidson M, Fischer M, Karem KL, Teclaw R, Messersmith H, Pontones P, Beard BA, Braden ZH, Cono J, Sejvar JJ, Khan AS, Damon I, Kuehnert MJ.
Source: Clin Infect Dis. 2005 Mar

Clinical characteristics of human monkeypox, and risk factors for severe disease.
Huhn GD, Bauer AM, Yorita K, Graham MB, Sejvar J, Likos A, Damon IK, Reynolds MG, Kuehnert MJ.
Source: Clin Infect Dis. 2005 Dec 15;41(12):1742-1751.

Clinical manifestations of human monkeypox influenced by route of infection.
Reynolds MG, Yorita KL, Kuehnert MJ, Davidson WB, Huhn GD, Holman RC, Damon IK.
Source: J Infect Dis. 2006 Sep 15;194(6):773-780. Epub 2006 Aug 8.

 

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