Monkeypox outbreak: preventable and controllable

This is the 4268th article of Da Yi Xiao Hu

Monkeypox outbreaks have been reported in many countries, and for us personally, many confusions and questions have surfaced:

How serious is this virus?

How contagious is it?

Will monkeypox develop into a new pandemic?

Below, we will briefly answer these questions.

1. What is monkeypox?

Monkeypox virus (MPXV) is a member of the genus Orthopoxvirus, which includes the variola virus (which causes smallpox) and the cowpox virus. Human monkeypox (HMPX) is a self-limited zoonotic disease caused by the monkeypox virus (MPXV) that can be transmitted from animals to animals, animals to humans, or humans to humans. Clinical complications of monkeypox include secondary infection, bronchopneumonia, sepsis, encephalitis, and corneal infection with subsequent vision loss. In fact, the clinical manifestations of human monkeypox (HMPX) infection are very complex, and the clinical summary of different monkeypox epidemics often varies significantly. The main symptoms currently known include fever, swollen lymph nodes, and a unique bumpy rash (centrifugal rash).

(Photo source: Internet)

It is reported that the monkeypox virus is mainly transmitted through direct contact with the skin or environmental surfaces, and can also be transmitted through respiratory droplets. There are currently two different subtypes of monkeypox virus: the Congo Basin strain and the West African strain. These two strains also pose different risks to humans:

Congo Basin strain : 1 in 10 people infected with this strain die.

West African strain : About 1 in 100 people infected with this strain die.

2. Where did monkeypox originate?

The monkeypox virus was originally discovered in monkeys raised for research purposes in the Democratic Republic of the Congo in 1958 (hence the name monkeypox). The monkeypox virus has a very wide range of animal hosts in nature, so it has also acquired strong adaptability and is more likely to survive in new environments and new hosts.

(Monkeypox virus, source: World Health Organization official website)

In 1973, six cases of monkeypox virus were first reported in humans, all of which were children. Subsequent studies have also found that the manifestations of monkeypox virus in adolescents and adults are essentially different. The age distribution of HMPX cases has gradually shifted from young children to adolescents and adults, but in general, children <15 years old are still the main group, and children are always the most susceptible to HMPX.

3. Will monkeypox become a new epidemic?

On July 23, 2022, the World Health Organization (WHO) declared the 2022 human monkeypox (HMPX) outbreak a Public Health Emergency of International Concern. In November 2022, the WHO changed the name of the virus to Mpox. Monkeypox is a global health issue. The WHO divides the world into six major regions. The overall global public health risk is medium, the risk assessment in the Americas region is high; the risk assessment in the African region, the Eastern Mediterranean region, the European region and the Southeast Asia region is medium; the risk assessment in the Western Pacific region is low.

Since 1 January 2022, 110 WHO Member States have reported cases of Mpox to WHO. As of 17:00 CET on 13 February 2023, a total of 85 860 laboratory-confirmed cases and 1 381 suspected cases, including 93 deaths, have been reported to WHO. A large proportion of these cases reported since 13 May 2022 are from countries with no previous record of Mpox transmission. Since November, 90% of cases have been reported from the Region of the Americas. This is the first time that cases and ongoing chains of transmission have been reported in countries or areas with no direct or indirect epidemiological links to West or Central Africa.

(Monkeypox virus, source: World Health Organization official website)

Although HMPX can be transmitted from person to person, its ability to spread from person to person is limited and requires close contact between people. Therefore, for certain high-risk susceptible groups such as pregnant women, children, and people with low or missing immunity, personal protection should still be strengthened to reduce the risk of infection. The incubation period of monkeypox is 5-21 days, mostly 6-13 days. People who plan to travel abroad in the near future need to pay close attention to the monkeypox epidemic in the destination country. Learn about the prevention and treatment of monkeypox as soon as possible, enhance personal protection awareness, and do a good job of personal protection.

In the era of COVID-19 prevention and control and beyond, it can be inferred that MPXV will still be an important virus threatening human health for quite some time in the future. At the same time, with the change of human behavior and the deepening of the understanding of HMPX, it may have a certain impact on the HMPX epidemic. As the prevention and control of the epidemic progresses and adjusts, as individuals, we only need to do a good job of daily protection and actively cooperate with relevant prevention and control work. There is no need to panic about the HMPX epidemic.

Author: Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine

Department of Anesthesiology Liu Daoqing