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African Viruses, Flying Monkeys and Monkeypox – Should I Be Worried?

I’ve had at least 15 people ask me about monkeypox today.  So, let me tell you what we actually know and allay your fears of flesh falling off your body and flying monkey nightmares like the Wizard of Oz gone rogue.

Researchers who love a good mystery, have been keeping watch on the appearance of the monkeypox virus that has occurred in a number of countries around the globe.   This outbreak appears to be human to human contact predominantly in the homosexual population.  As of last Friday, May 20, 2022, only twenty cases have been confirmed or are under investigation in the U.S. (Massachusetts and New York), U.K., Spain, Portugal, France, Canada, Sweden, and Italy.

Not all of those infected traveled to West or Central Africa where the disease is most common.  It can jump to people from contact with animals. As was the case in 2003 when 47 humans were infected by pet prairie dog contact that were housed near animals imported from Ghana.

Transmission:

Monkeypox is not easily spread from human to human, unless it occurs in direct contact with body fluids or open lesions contaminating clothing or bedding.  However, it is possible for respiratory droplet transmission based on the data we have.  For droplet transmission, prolonged face-to-face contact may be required for transmission to occur (eg, within a six-foot radius for ≥3 hours).

Incubation:

The incubation phase of the virus is usually 7-14 days from the time of exposure, however, there have been cases ranging 5-21 days.  Persons with a history of an animal bite or scratch may have a shorter incubation period than those with tactile exposures.

Symptoms:

The first symptoms to appear are flu-like symptoms, including fever, aches, and fatigue. Monkeypox infection will also involves swelling of the lymph nodes that will occur once the infection begins. In 2003, with illness in the 47 subjects that were evaluated, the predominant signs and symptoms were:

  • Rash (97 percent)
  • Fever (85 percent)
  • Chills (71 percent)
  • Enlarged lymph nodes (71 percent)
  • Headache (65 percent)
  • Body aches(56 percent)

Then, typically 1 to 3 days later — though sometimes longer – a maculopapular rash occurs that, then, evolved into vesicles, then pustules, which eventually crusted within a two- to three-week period. It often starts on the face before spreading to other parts of the body.

(http://www.uptodate.com/contents/monkeypox)

Illness typically lasts about 2 to 4 weeks.

Fatality Rate:

While the Congo Basin strain of monkey pox is thought to have a fatality rate of 10%, the West African strain — which was confirmed in the U.K. outbreak — has a fatality rate of about 1%.

Treatments:

There’s no proven treatment for monkeypox specifically, but the smallpox vaccine, newer antivirals, and vaccinia immune globulin can be used to help slow it down and prevent severity of infection.

The smallpox vaccine Jynneos (also known as Imvamune or Imvanex) is indicated for monkeypox. It’s an attenuated, live-virus vaccine incapable of replicating in the human body.

The federal government also reportedly has a stockpile of other smallpox virus vaccines that can be used. It is thought that people who received the small pox vaccine likely still have some immunity.

While there are no proven antivirals specific to monkey pox, cidofovir and brincidofovir may be used. According to the CDC, some in vitro and animal studies of these compounds have shown activity against poxviruses in general.

Another drug, tecovirimat (Tpoxx), is FDA approved for treating smallpox in an oral and now intravenous form. In the EU, tecovirimat is now indicated for monkey pox and is the treatment of choice by most physicians. It has been shown in animal studies to be effective in treating orthopoxvirus-induced disease, and human trials involving healthy subjects indicated the drug was safe and well tolerated with only minor side effects.

Needless to say, I’m not worried, and you shouldn’t be either.