Understand these 4 issues and you don’t have to be afraid of monkeypox

Suddenly, patches of rashes appeared on the smooth skin, followed by pustules that continued to swell up. People screamed and scratched themselves desperately, fell to the ground, convulsed, and then died... Fortunately, this is just a plot in science fiction or horror movies that is often used to show how vicious a certain virus is. The reason is naturally that the symptom of "pustules" is clear enough to understand and has visual impact.

In real life, there are many viruses that can cause pustules in people (of course, the process is never as fast as in the movies). Monkeypox, which has been frequently in the news recently, is one of them. So what exactly is monkeypox? Do we need to worry about it? Let's talk about it briefly today.

01

What exactly is monkeypox? And is it serious?

Monkeypox is a rare zoonosis. The culprit is the monkeypox virus, which belongs to the genus Orthopoxvirus of the subfamily Chordatapoxvirinae under the family Poxviridae. The names of viruses in the same genus are often related to the infected animals, such as rabbitpox, buffalopox, camelpox... and many viruses in the same subfamily are also named in this style, such as fowlpox, swinepox, goatpox...

Monkeypox virus | ImageChong Creative

Symptoms of monkeypox infection include rash, blisters that develop into pustules, fever, fatigue, muscle pain, etc. Monkeypox is a self-limiting disease, which means that as long as there are no serious complications, it will heal on its own even if only symptomatic treatment or no treatment is given, but a few people may have a serious illness, collapse, exhaustion and death.

Human monkeypox: an emerging zoonotic disease

doi:10.2217/17460913.2.1.17

The mortality rate of monkeypox is not low. Depending on the strain and the specific conditions of the patient, the mortality rate is about 1%-10%, which is particularly dangerous for children. However, based on past experience, monkeypox itself is a relatively rare disease, and it is mainly distributed in Central Africa and West Africa, so it does not have a great impact on my country.

02

How is monkeypox transmitted? Is it a sexually transmitted disease?

When we mention monkeypox, we think that monkeys are the main transmitters of the virus, so this name is given, but in fact, monkeys are a bit innocent... Monkeypox virus can indeed be transmitted to humans through many animals (including monkeys), but it is generally believed that rodents are the main transmitters of monkeypox, and monkeys are just unfortunate to bear this blame. The monkeypox virus is transmitted to humans in many cases because humans come into contact with wild animals carrying the virus. In previous cases of cross-border transmission, it is often related to animal transportation. This actually reminds us that we should protect the environment and avoid contact with wild animals.

Monkeypox transmission is related to rodents | Tuchong Creative

Similar to many other infectious diseases caused by viruses, monkeypox virus also needs to rely on animal blood, body fluids and secretions to spread through the respiratory tract, digestive tract and contact. Rodents carrying monkeypox virus, other infected animals and monkeypox patients can all cause transmission.

According to the United Nations report, a large proportion of the recent monkeypox outbreaks occurred in gay, bisexual and other men who have sex with men. Many people may think that monkeypox is a sexually transmitted disease and blame the spread of the disease on these sexual minorities. In fact, this situation occurred because a group of sexual minorities happened to attend the same party. There are many ways for monkeypox to spread. Droplets and objects that patients have touched may spread the monkeypox virus. Therefore, monkeypox is not a sexually transmitted disease and anyone can be infected.

Monkeypox also has an incubation period of about 7-14 days. To be on the safe side, the UK stipulates that close contacts of monkeypox patients need to be quarantined for 21 days.

03

What is the relationship between smallpox and monkeypox?

Does the smallpox vaccine protect against monkeypox?

Smallpox virus and monkeypox virus are often mentioned together. They are indeed closely related, both belonging to the genus Orthopoxvirus. However, in terms of lethality, the two are very different.

Diagram of smallpox virus and its symptoms | TuChong Creative

As mentioned earlier, the mortality rate of monkeypox is currently between 1-10%, while that of smallpox can reach 30%. In addition, the R0 of smallpox can reach 3, which means that without vaccination or protection, one smallpox patient can infect three people. Because of this, smallpox killed about 500 million people in the 100 years before it was completely eradicated by humans.

Fortunately, people discovered methods to fight smallpox, such as human pox and cowpox, very early on, and finally developed a vaccine against smallpox. As a result, smallpox was defeated step by step, and by 1980, the World Health Organization announced that the smallpox virus had been completely eradicated worldwide. Therefore, after 1980, smallpox vaccinations were gradually stopped around the world.

So what is the relationship between smallpox vaccine and monkeypox?

It turns out that because the monkeypox virus is closely related to the smallpox virus, people who have been vaccinated with the smallpox vaccine can also be protected against the monkeypox virus. The current estimated protection rate is about 85%. Some researchers believe that the protection rate is not actually that high, but it still has a certain protective effect.

04

Monkeypox is coming, should we be worried?

In my country, researchers in related fields and disease control experts must of course be cautious, pay attention to the monkeypox epidemic situation, and conduct some research work to prepare for a rainy day. However, for ordinary people, there is no need to be nervous about this. Just be careful not to go to the epidemic area and maintain good hygiene habits.

Why do I say so?

First of all, the transmission efficiency of monkeypox is not high. According to experts' estimates, its R0 is about 1-2, and some experts believe that the R0 of monkeypox virus is even less than 1. In short, the infectiousness of monkeypox is completely not on the same order of magnitude as that of Omicron, and it is much easier to control.

Secondly, as mentioned above, in my country, many people, especially the elderly, have received smallpox vaccines, which also provide considerable protection against monkeypox virus. Conventional disinfection methods can also deal with monkeypox virus, and it is not easy for it to cause any trouble in our current environment where we wear masks every day and wash our hands and disinfect frequently.

Tuchong Creative

In addition, the monkeypox virus has been discovered for decades, and small-scale outbreaks have occurred one after another. This time, when the monkeypox outbreak occurred in Europe and the United States, there were early warnings, and the detection, diagnosis and treatment methods for the monkeypox virus are relatively mature, and we were not caught off guard like when the COVID-19 pandemic first started.

Finally, the monkeypox virus is a double-stranded DNA virus, whose genetic material is relatively stable and less prone to mutation under natural conditions. Compared with the new coronavirus, which has new members popping up every few days, it can be said to be an "honest virus". Because of this, the development of its vaccine has fewer obstacles, and the effect will be better and longer-lasting.

To sum up, although the monkeypox epidemic has spread in the community in Europe and the United States, people in my country do not need to worry about it at present. They just need to avoid going to the epidemic areas and maintain good hygiene habits.

Author | Ding Zong

Review | Jin Dong, Associate Researcher, Institute of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention

Editor | Ding Zong

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