MONKEY POX : CHECKOUT THE FACT, SYMPTOMS AND TREATMENT

 Monkeypox is a rare disease that occurs primarily in

remote parts of Central and West Africa, near tropical
rainforests.
The monkeypox virus can cause a fatal illness in
humans and, although it is similar to human smallpox
which has been eradicated, it is much milder.
The monkeypox virus is transmitted to people from
various wild animals but has limited secondary spread
through human-to-human transmission.
Typically, case fatality in monkeypox outbreaks has
been between 1% and 10%, with most deaths
occurring in younger age groups.
There is no treatment or vaccine available although
prior smallpox vaccination was highly effective in
preventing monkeypox as well.
Monkeypox is a rare viral zoonosis (a virus transmitted to
humans from animals) with symptoms in humans similar
to those seen in the past in smallpox patients, although
less severe. Smallpox was eradicated in 1980.However,
monkeypox still occurs sporadically in some parts of
Africa.
Monkeypox is a member of the Orthopoxvirus genus in the
family Poxviridae.
The virus was first identified in the State Serum Institute
in Copenhagen, Denmark, in 1958 during an investigation
into a pox-like disease among monkeys.
Outbreaks
Human monkeypox was first identified in humans in 1970
in the Democratic Republic of Congo (then known as
Zaire) in a 9 year old boy in a region where smallpox had
been eliminated in 1968. Since then, the majority of cases
have been reported in rural, rainforest regions of the
Congo Basin and western Africa, particularly in the
Democratic Republic of Congo, where it is considered to
be endemic. In 1996-97, a major outbreak occurred in the
Democratic Republic of Congo.
In the spring of 2003, monkeypox cases were confirmed in
the Midwest of the United States of America, marking the
first reported occurrence of the disease outside of the
African continent. Most of the patients had had close
contact with pet prairie dogs.
In 2005, a monkeypox outbreak occurred in Unity, Sudan
and sporadic cases have been reported from other parts
of Africa. In 2009, an outreach campaign among refugees
from the Democratic Republic of Congo into the Republic
of Congo identified and confirmed two cases of
monkeypox. Between August and October 2016, a
monkeypox outbreak in the Central African Republic was
contained with 26 cases and two deaths.
Transmission
Infection of index cases results from direct contact with
the blood, bodily fluids, or cutaneous or mucosal lesions
of infected animals. In Africa human infections have been
documented through the handling of infected monkeys,
Gambian giant rats and squirrels, with rodents being the
major reservoir of the virus. Eating inadequately cooked
meat of infected animals is a possible risk factor.
Secondary, or human-to-human, transmission can result
from close contact with infected respiratory tract
secretions, skin lesions of an infected person or objects
recently contaminated by patient fluids or lesion materials.
Transmission occurs primarily via droplet respiratory
particles usually requiring prolonged face-to-face contact,
which puts household members of active cases at greater
risk of infection. Transmission can also occur by
inoculation or via the placenta (congenital monkeypox).
There is no evidence, to date, that person-to-person
transmission alone can sustain monkeypox infections in
the human population.
In recent animal studies of the prairie dog-human
monkeypox model, two distinct clades of the virus were
identified – the Congo Basin and the West African clades
– with the former found to be more virulent.
Signs and symptoms
The incubation period (interval from infection to onset of
symptoms) of monkeypox is usually from 6 to 16 days but
can range from 5 to 21 days.
The infection can be divided into two periods:
I. the invasion period (0-5 days) characterized by fever,
intense headache, lymphadenopathy (swelling of the
lymph node), back pain, myalgia (muscle ache) and
an intense asthenia (lack of energy);
II. the skin eruption period (within 1-3 days after
appearance of fever) where the various stages of the
rash appears, often beginning on the face and then
spreading elsewhere on the body. The face (in 95% of
cases), and palms of the hands and soles of the feet
(75%) are most affected. Evolution of the rash from
maculopapules (lesions with a flat bases) to vesicles
(small fluid-filled blisters), pustules, followed by
crusts occurs in approximately 10 days. Three weeks
might be necessary before the complete
disappearance of the crusts.
The number of the lesions varies from a few to several
thousand, affecting oral mucous membranes (in 70% of
cases), genitalia (30%), and conjunctivae (eyelid) (20%),
as well as the cornea (eyeball).

Some patients develop severe lymphadenopathy (swollen
lymph nodes) before the appearance of the rash, which is
a distinctive feature of monkeypox compared to other
similar diseases.
Monkeypox is usually a self-limited disease with the
symptoms lasting from 14 to 21 days. Severe cases occur
more commonly among children and are related to the
extent of virus exposure, patient health status and severity
of complications.
People living in or near the forested areas may have
indirect or low-level exposure to infected animals, possibly
leading to subclinical (asymptomatic) infection.
The case fatality has varied widely between epidemics but
has been less than 10% in documented events, mostly
among young children. In general, younger age-groups
appear to be more susceptible to monkeypox.
Diagnosis
The differential diagnoses that must be considered
include other rash illnesses, such as, smallpox,
chickenpox, measles, bacterial skin infections, scabies,
syphilis, and medication-associated allergies.
Lymphadenopathy during the prodromal stage of illness
can be a clinical feature to distinguish it from smallpox.
Monkeypox can only be diagnosed definitively in the
laboratory where the virus can be identified by a number
of different tests:
enzyme-linked immunosorbent assay (ELISA)
antigen detection tests
polymerase chain reaction (PCR) assay
virus isolation by cell culture
Treatment and vaccine
There are no specific treatments or vaccines available for
monkeypox infection, but outbreaks can be controlled.
Vaccination against smallpox has been proven to be 85%
effective in preventing monkeypox in the past but the
vaccine is no longer available to the general public after it
was discontinued following global smallpox eradication.
Nevertheless, prior smallpox vaccination will likely result
in a milder disease course.
Natural host of monkeypox virus
In Africa, monkeypox infection has been found in many
animal species: rope squirrels, tree squirrels, Gambian
rats, striped mice, dormice and primates. Doubts persist
on the natural history of the virus and further studies are
needed to identify the exact reservoir of the monkeypox
virus and how it is maintained in nature.
In the USA, the virus is thought to have been transmitted
from African animals to a number of susceptible non-
African species (like prairie dogs) with which they were
co-housed.
Prevention
Preventing monkeypox expansion through restrictions on
animal trade
Restricting or banning the movement of small African
mammals and monkeys may be effective in slowing the
expansion of the virus outside Africa.
Captive animals should not be inoculated against
smallpox. Instead, potentially infected animals should be
isolated from other animals and placed into immediate
quarantine. Any animals that might have come into
contact with an infected animal should be quarantined,
handled with standard precautions and observed for
monkeypox symptoms for 30 days.
Reducing the risk of infection in people
During human monkeypox outbreaks, close contact with
other patients is the most significant risk factor for
monkeypox virus infection. In the absence of specific
treatment or vaccine, the only way to reduce infection in
people is by raising awareness of the risk factors and
educating people about the measures they can take to
reduce exposure to the virus. Surveillance measures and
rapid identification of new cases is critical for outbreak
containment.
Public health educational messages should focus on the
following risks:
Reducing the risk of human-to-human transmission.
Close physical contact with monkeypox infected
people should be avoided. Gloves and protective
equipment should be worn when taking care of ill
people. Regular hand washing should be carried out
after caring for or visiting sick people.
Reducing the risk of animal-to-human transmission.
Efforts to prevent transmission in endemic regions
should focus on thoroughly cooking all animal
products (blood, meat) before eating. Gloves and other
appropriate protective clothing should be worn while
handling sick animals or their infected tissues, and
during slaughtering procedures.

Controlling infection in health-care settings
Health-care workers caring for patients with suspected or
confirmed monkeypox virus infection, or handling
specimens from them, should implement standard
infection control precautions.
Healthcare workers and those treating or exposed to
patients with monkeypox or their samples should consider
being immunized against smallpox via their national health
authorities. Older smallpox vaccines should not be
administered to people with comprised immune systems.
Samples taken from people and animals with suspected
monkeypox virus infection should be handled by trained
staff working in suitably equipped laboratories.