The recent Covid-19 pandemic has certainly highlighted the importance of vigilance and awareness of emerging diseases with public health implications. The monkeypox virus has recently made headlines, after the detection of more than 200 cases in geographically distinct regions.
On May 13, the World Health Organisation (WHO) was notified of human cases of the monkeypox disease in the UK, outside the known endemic region. Exported cases have been detected previously and usually occur sporadically.
In contrast, within the past two weeks, human cases have been confirmed in at least 21 countries, including various European countries, the UK, Israel, the Canary Islands, Canada, the US and Australia.
The initial case appears to have been a traveller from Nigeria. Sequence data may help to determine if there have been multiple exportations from West Africa.
Monkeypox is the name given to a disease caused by the monkeypox virus, a zoonotic pathogen endemic in Central and West Africa, with occasional exported cases in travellers.
The virus was initially identified in 1958 in monkeys housed at a research laboratory in Denmark, and the name monkeypox was derived from the appearance of lesions and the occurrence in monkeys.
The first human case was identified 52 years ago in the Democratic Republic of the Congo. Since then, human monkeypox cases have been reported in several other Central and West African countries: Cameroon, the Central African Republic, Ivory Coast, Gabon, Liberia, Nigeria, Congo-Brazzaville and Sierra Leone.
The first monkeypox outbreak outside Africa was in the US in 2003 and was linked to contact with infected prairie dogs imported as exotic pets.
The virus is related to the smallpox virus, which was eradicated in the 1970s by vaccination. Though belonging to the same family of viruses as the smallpox virus, the disease caused by monkeypox is less severe, with fewer fatalities.
Unlike smallpox, which carries a case fatality rate of 30%, the case fatality rate in monkeypox is low (estimated at 3% to 6% in more recent outbreaks).
Transmission occurs from animal to human, and from human to human, through close contact with lesions, body fluids, and contaminated materials. The virus enters the body through the respiratory tract, mucous membranes or broken skin. The disease begins with non-specific symptoms such as fever, headache, muscle pains and swollen lymph nodes.
This is followed by the typical skin rash, which progresses through stages known as macules, then papules, vesicles, pustules and lastly crusts or scabs. Lesions can also occur on mucous membranes in the mouth, eye and genital area.
The infectious period lasts through all stages of the rash, until all the scabs have fallen off. There are a number of other infectious and non-infectious conditions that need to be differentiated; therefore, individuals presenting with these symptoms will need to consult their doctor to determine whether a diagnosis of monkeypox needs to be considered.
In the current outbreak, a number of the cases in the UK and Europe have been detected in men who have sex with men. This pattern of spread has not previously been described and it remains to be determined whether the spread has occurred through close person-to-person contact or through sexual transmission.
To date, no cases have been detected in SA, but the recent global spread of the severe acute respiratory syndrome coronavirus 2 (SARS_CoV-2) highlights the ability of pathogens to spread. The National Institute for Communicable Diseases (NICD) in Johannesburg offers a specialised diagnostic service for the monkeypox virus, using molecular assays and electron microscopy.
Vaccination against the smallpox virus is believed to offer 85% protection against monkeypox, hence older people should have some protection. However, vaccination against smallpox was phased out globally after the eradication of smallpox in the 1970s. A more recently developed vaccine against monkeypox is available but has limited availability. No specific antivirals are available with proven efficacy in clinical trials.
• Prof Burt is from the Division of Virology in the Faculty of Health Sciences at the University of the Free State (UFS) and the National Health Laboratory Service.
• Prof Goedhals is a clinical virologist at Pathcare Laboratories and the Division of Virology at UFS.
• Dr Kotzé is a registrar working in medical virology at the National Health Laboratory Service lab at Universitas Academic Hospital.
Monkeypox: what is it and what do we need to know?
The virus is related to smallpox, which was eradicated by vaccination in 1970s
Image: Dado Ruvic/
The recent Covid-19 pandemic has certainly highlighted the importance of vigilance and awareness of emerging diseases with public health implications. The monkeypox virus has recently made headlines, after the detection of more than 200 cases in geographically distinct regions.
On May 13, the World Health Organisation (WHO) was notified of human cases of the monkeypox disease in the UK, outside the known endemic region. Exported cases have been detected previously and usually occur sporadically.
In contrast, within the past two weeks, human cases have been confirmed in at least 21 countries, including various European countries, the UK, Israel, the Canary Islands, Canada, the US and Australia.
The initial case appears to have been a traveller from Nigeria. Sequence data may help to determine if there have been multiple exportations from West Africa.
Monkeypox is the name given to a disease caused by the monkeypox virus, a zoonotic pathogen endemic in Central and West Africa, with occasional exported cases in travellers.
The virus was initially identified in 1958 in monkeys housed at a research laboratory in Denmark, and the name monkeypox was derived from the appearance of lesions and the occurrence in monkeys.
The first human case was identified 52 years ago in the Democratic Republic of the Congo. Since then, human monkeypox cases have been reported in several other Central and West African countries: Cameroon, the Central African Republic, Ivory Coast, Gabon, Liberia, Nigeria, Congo-Brazzaville and Sierra Leone.
The first monkeypox outbreak outside Africa was in the US in 2003 and was linked to contact with infected prairie dogs imported as exotic pets.
The virus is related to the smallpox virus, which was eradicated in the 1970s by vaccination. Though belonging to the same family of viruses as the smallpox virus, the disease caused by monkeypox is less severe, with fewer fatalities.
Unlike smallpox, which carries a case fatality rate of 30%, the case fatality rate in monkeypox is low (estimated at 3% to 6% in more recent outbreaks).
Transmission occurs from animal to human, and from human to human, through close contact with lesions, body fluids, and contaminated materials. The virus enters the body through the respiratory tract, mucous membranes or broken skin. The disease begins with non-specific symptoms such as fever, headache, muscle pains and swollen lymph nodes.
This is followed by the typical skin rash, which progresses through stages known as macules, then papules, vesicles, pustules and lastly crusts or scabs. Lesions can also occur on mucous membranes in the mouth, eye and genital area.
The infectious period lasts through all stages of the rash, until all the scabs have fallen off. There are a number of other infectious and non-infectious conditions that need to be differentiated; therefore, individuals presenting with these symptoms will need to consult their doctor to determine whether a diagnosis of monkeypox needs to be considered.
In the current outbreak, a number of the cases in the UK and Europe have been detected in men who have sex with men. This pattern of spread has not previously been described and it remains to be determined whether the spread has occurred through close person-to-person contact or through sexual transmission.
To date, no cases have been detected in SA, but the recent global spread of the severe acute respiratory syndrome coronavirus 2 (SARS_CoV-2) highlights the ability of pathogens to spread. The National Institute for Communicable Diseases (NICD) in Johannesburg offers a specialised diagnostic service for the monkeypox virus, using molecular assays and electron microscopy.
Vaccination against the smallpox virus is believed to offer 85% protection against monkeypox, hence older people should have some protection. However, vaccination against smallpox was phased out globally after the eradication of smallpox in the 1970s. A more recently developed vaccine against monkeypox is available but has limited availability. No specific antivirals are available with proven efficacy in clinical trials.
• Prof Burt is from the Division of Virology in the Faculty of Health Sciences at the University of the Free State (UFS) and the National Health Laboratory Service.
• Prof Goedhals is a clinical virologist at Pathcare Laboratories and the Division of Virology at UFS.
• Dr Kotzé is a registrar working in medical virology at the National Health Laboratory Service lab at Universitas Academic Hospital.
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