So, what’s the monkey business over the news of monkeypox (MP) infections? It really is not funny stuff.
The virus has been known for a long time and has stayed primarily in the Democratic Republic of the Congo, DRC, formerly Zaire, in central Africa and Ghana in West Africa. But since May 7 this year, cases have started showing up in now at least 16 countries, including the U.S. This has induced a panic about a new pandemic. After living through the one we are actually still in, the idea of another such experience would create terror in the most stoic individual.
But, we are told, not to worry. The headline from a May 31 news article says, “World Health Organization: Pox unlikely to become pandemic.” An expert from the WHO said the current 250-plus cases, which seem to be increasing, are not likely to spread like the COVID-19 viral variants, or mutate in the same way. “But she acknowledged there are still many unknowns about the disease.”
A short history of MP is that it was first identified in 1958 in monkeys being used for research in Denmark, hence the name — but monkeys in the wild are not natural reservoirs of the virus from animals studied since then. The first human case identified was in 1970 in a 9-month-old thought to have smallpox. The similarities between the two infections, especially the rash, are striking. But smallpox was on the verge of being eradicated. The search for a source led to a 1985 survey of 385 wild animals in the region, including monkeys, rodents and bats, a favorite reservoir for so many viruses.
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The results yielded MP antibodies in several species of rodents, especially Thomas’s rope squirrel, a rodent caught as bushmeat and consumed, not always fully cooked. Two separate lineages or clades of MP have been defined, the one in central Africa more severe with around a 10% death rate, and the West African one, with a death rate between 1% and 3%, depending on your reference. The smallpox death rate is about 30%, a lot higher.
The typical disease presentation seems to be appearance between 7-14 days after exposure (average 12, range of 5-21) for about a 3-day period of fever, chills, headache, muscle and back pains, feeling rotten/malaise, fatigue, and having enlarged lymph nodes under jaws, back of neck and groins before the typical eruption or rash pops out. It begins centrally and spread out to arms, legs, palms and soles. First seen are flat, red spots, turning to bumps/papules, then becoming the classic blisters, which contain viruses, and pustules, which dimple centrally and turn into scabs. No description details if it scars like smallpox. The photos of the two rashes are almost identical. But smallpox typically doesn’t develop the enlarged lymph nodes, an important point of differentiation.
MP belongs to the group of viruses we have designated as orthopoxviruses. There are 12 species in this genus, which include smallpox, cowpox (vaccinia), horsepox, camelpox, monkeypox and more, almost all in critters. The precise mode of transmission to humans and significant reservoirs isn’t yet clear. It can be airborne to a degree in large air droplets, consumed in not fully cooked meat, and maybe most importantly by close contact with the blisters/pustules, either from hand and skin or from clothing and bedding. That idea has been part of the theory of the current cases sprouting up over the globe. A significant portion of the new cases seem to be in men having sex with men, which would involve direct skin-to-skin transmission.
That mode of infection is known for cold sore virus if blisters are on wrestlers’ skin when they grind each other mercilessly into the ground, and inoculate it into their opponent, called herpes gladiatorum (of the gladiators). We’ll leave the present mystery’s deciphering to the public health detectives. As of this writing, Georgia just became the seventh state to sprout a case, with a tally of 18 so far.
One speculation of the 10-fold global rise of MP cases is the cessation of smallpox vaccinations years ago. They were discontinued here in 1972. That vaccine provided 85% protection against MP, but has some adverse reactions. One vaccine called Jynneosis, a weakened cowpox virus, which cannot replicate once injected, is used for MP prevention. It is approved for some orthopox viruses, including MP. It is being offered to health workers exposed to MP.
The good news to end with is the orthopox viruses have DNA genetic material, not RNA, like the coronaviruses, and do not mutate much. That angle is being studied among the current specimens, comparing them to prior MP viral strains They’ve been found to be quite similar, but not mutated.
So, monkeypox is not an infection to be feared to the same degree as COVID-19, but we should still respect it. Whether it is acquired through monkey business or monkey shines is yet to be determined. But it doesn’t look like a “pox on thee” will become a pox on we. As with COVID, the virus is still teaching us.
Dr. Bures, a semi-retired dermatologist, since 1978 has worked Winona, La Crosse, Viroqua and Red Wing. He also plays clarinet in the Winona Municipal Band and a couple dixieland groups. And he does enjoy a good pun.