Monkeypox: What is it and how does it spread?

A growing number of countries, including Canada, the U.S., Spain, Portugal, and the U.K, are reporting an unusual outbreak of monkeypox. What makes these cases notable is the disease is relatively rare and there are no clear links between some of the infections, raising concerns about community spread and undetected cases.

This is what we know about the virus, based on information from Health Canada, the U.S. Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO).

WHAT IS MONKEYPOX?

First discovered in 1958, monkeypox is a rare disease caused by a virus that belongs to the same family as the one that causes smallpox. The disease was first found in colonies of monkeys used for research. The first human case was not recorded until 1970, when it was identified in the Democratic Republic of the Congo in a nine-month-old infant, two years after smallpox had been eradicated in the region.

The disease has primarily been reported in central and western African countries, with the first case outside the continent reported in 2003 in the United States. That outbreak was traced to contact with pet prairie dogs that had been infected after coming in close contact with animals imported from Ghana. Cases outside Africa remain extremely rare, and are typically linked to international travel or imported mammals.

The natural reservoir, or main carrier of the virus is not known, since the virus has only been isolated twice from a wild animal, once in 1985 in an African rodent and another time in 2012 in a non-human primate, but it is believed to occur naturally in tropical jungles around Western and Central Africa.

WHO CAN CATCH IT AND HOW IS IT TRANSMITTED?

The virus is transmitted through contact with an infected animal, human or contaminated material. Transmission between people are thought to primarily occur through large respiratory droplets, which generally do not travel far and would require extended close contact. Transmission from an animal can happen through bites or scratches, contact with an animal’s blood or body fluids.

In both scenarios, infection is also possible through direct contact with body fluids or material like clothing or bedding. Broken skin – even microscopic abrasions, and mucous membranes like the eyes can all be entry points for the virus. Like COVID-19, it can enter through the respiratory tract.

Anyone can catch it, but historically, children under the age of 16 have made up the largest proportion of cases.

Previously, the longest documented chain of infection was four generations of person-to-person transmission, Health Canada notes, suggesting that it has “limited potential for epidemic spread.”

WHAT IS THE INCUBATION PERIOD AND HOW LONG DOES IT LAST?

It usually takes about seven to 17 days from the time a person is infected to when they begin showing symptoms, though it can be as short as five days and as long as 21 days.

The infection usually lasts between two to four weeks.

WHAT ARE THE SIGNS AND SYMPTOMS?

Monkeypox symptoms are similar to those for the smallpox, but generally milder. The first signs are fever, headache, muscle aches, backaches, chills, and exhaustion. One distinguishing feature specific to monkeypox is that an infection also causes lymphadenopathy – the swelling of the lymph nodes.

The “pox” develops after the onset of a fever and usually occurs between one to three days later, sometimes longer. A rash usually begins on the face and spreads to other parts of the body. It starts off as flat patches of skin where the colour has changed (macules) before developing into distinct, raised bumps up to about one centimetre in size (papules). They then become filled with fluid (vesicle) that eventually becomes what is commonly known as “pus” before eventually turning into scabs and falling off.

While most of the lesions are usually around the trunk of the body, it can spread to the palms and soles of the feet, and can also develop in the mouth, tongue and genitalia.

Milder cases may even go undetected.

HOW DO I PREVENT TRANSMISSION?

Transmission can usually be avoided if you do not come in contact with materials or animals that could carry the virus or animals that are sick and found in areas known to have monkeypox.

Good hand hygiene, like handwashing with soap and using hand sanitizer also help, along with wearing protective equipment when caring for someone who is infected.

Patients who are infected should be isolated.

IS THERE TREATMENT OR A VACCINE?

There is no proven treatment for the virus infection, but the smallpox vaccine is known to also protect against monkeypox, with a greater than 85 per cent efficacy. Because the smallpox vaccine eradicated the disease, however, routine smallpox immunization for the general population ended in Canada and the United States in 1972.

Vaccinating with the smallpox vaccine within four days and up to 14 days after initial contact with a confirmed case may help prevent disease.

In Africa, one to 10 per cent of those infected with monkeypox die. Death rates are higher among children. A West African version and Congo Basin version have been identified, with the Congo Basin one considered much deadlier, accounting for the higher fatality rate. The suspected cases in Montreal involve the milder one.

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