MONKEYPOX

PREPARED BY GROUP:

FAIZUL HAFIZZIE DASUKI

NICHOLAS KAMARAU ANAK JOHNNY

DEFINITION OF MONKEYPOX

Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) with symptoms similar to those seen in the past in smallpox patients, although it is clinically less severe. With the eradication of smallpox in 1980 and the subsequent cessation of smallpox vaccination, monkeypox has emerged as the most important orthopoxvirus for public health. Monkeypox primarily occurs in central and west Africa, often in proximity to tropical rainforests, and has been increasingly appearing in urban areas. Animal hosts include a range of rodents and nonhuman primates.

Monkeypox was first brought to the attention of Malaysians in 2019 following the report of a case in Singapore. In an average year, a few thousand cases occur in western and central Africa.

Cases outside Africa have been limited to a handful associated with travel to Africa or with the importation of infected animals.


In the past five years, there have been only eight confirmed cases in which travelers carried monkeypox to countries outside Africa, including two cases in 2021 in the United States. Each of the cases in the US was associated with a person who was in Nigeria, which had seen a resurgence of monkeypox since 2017.

The human-to-human spread was limited in those cases, with two family members infected in one instance. One health care staff that had contact with contaminated bedsheets was infected in another case.

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 can be divided into two periods:

  • The invasion period (lasts between 0–5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle aches) and intense asthenia (lack of energy). Lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may initially appear similar (chickenpox, measles, smallpox)

  • The skin eruption usually begins within 1–3 days of appearance of fever. The rash tends to be more concentrated on the face and extremities rather than on the trunk. 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% of 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 filled with clear fluid), pustules (lesions filled with yellowish fluid), and crusts which dry up and fall off. The number of lesions varies from a few to several thousand. 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 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.

The case fatality ratio of monkeypox has historically ranged from 0 to 11 % in the general population and has been higher among young children. In recent times, the case fatality ratio has been around 3–6%.

VACCINATION

Vaccination against smallpox was demonstrated through several observational studies to be about 85% effective in preventing monkeypox. Thus, prior smallpox vaccination may result in milder illness.

Evidence of prior vaccination against smallpox can usually be found as a scar on the upper arm. At the present time, the original (first-generation) smallpox vaccines are no longer available to the general public.

Some laboratory personnel or health workers may have received a more recent smallpox vaccine to protect them in the event of exposure to orthopoxviruses in the workplace. A still newer vaccine based on a modified attenuated vaccinia virus (Ankara strain) was approved for the prevention of monkeypox in 2019.

This is a two-dose vaccine for which availability remains limited. Smallpox and monkeypox vaccines are developed in formulations based on the vaccinia virus due to cross-protection afforded for the immune response to orthopoxviruses.

PREVENTION

Raising awareness of risk factors and educating people about the measures they can take to reduce exposure to the virus is the main prevention strategy for monkeypox. Scientific studies are now underway to assess the feasibility and appropriateness of vaccination for the prevention and control of monkeypox.

Some countries have, or are developing, policies to offer vaccine to persons who may be at risk such as laboratory personnel, rapid response teams and health workers.

CONCLUSION

Although we have been surprised by the presence of infectious diseases, we should take care of ourselves and continue to follow the SOPs set by the health authorities. In other words, good health care will be able to ward off the transmission of this infectious disease. We should not take this issue lightly.

REFERENCE

  • https://www.cdc.gov/poxvirus/monkeypox/prevention.html. (2022, 7 11). Retrieved from https://www.cdc.gov.

  • https://www.who.int/news-room/questions-and-answers/item/monkeypox. (2022, 7 10). Retrieved from https://www.who.int.

  • Rendall, J. (2022, 7 11). https://www.cnet.com/health/medical/who-needs-a-monkeypoxvaccine/. Retrieved from https://www.cnet.com.

  • reporter, F. (2022, 7 8). https://www.freemalaysiatoday.com/category/nation/2022/07/08/lowrisk-for-14-malaysian-contacts-of-singapore-monkeypox-case/. Retrieved from www.freemalaysiatoday.com.

  • Zainuddin, A. (2022, 5 26). https://codeblue.galencentre.org/2022/05/26/mysejahterareactivated-for-monkeypox-surveillance/. Retrieved from codeblue.galencentre.org