A professor of Medical Virology and Microbiology, College of Medical Sciences, University of Maiduguri, Marycelin Baba, tells EMMANUEL OJO about the symptoms, causes and management of monkeypox and how to curb the outbreak
What is monkeypox, and how can you describe it?
Monkeypox is pox and looks like measles. The rash there is called maculopapular rash. It starts like measles, then it gets into the next stage, which is the vesicular stage, then to the pustular stage, after which it develops into very thick scabs on the skin. That’s what is called monkeypox, but pox is a pox, either it’s caused by smallpox, chickenpox or others. Pox is pox. The way it is transmitted differentiates it.
Monkey pox originated in 1958. The first case was reported when there was a monkey display. So it was transmitted by monkeys but note that even though it’s called monkeypox, because it was first detected in monkeys, monkeys are not really the major carriers. It’s called monkeypox because the first case was detected in monkeys and there was research on monkeys, but it doesn’t mean that monkeys are the only carriers of the virus.
Where did it originate from?
It is endemic in the Democratic Republic of Congo, Liberia, Nigeria and Sierra Leone. Mainly in West Africa, but it was discovered in 1958.
What are the signs and symptoms?
It is malaria-like. The way malaria comes with fever, headache, general body weakness and feeling of exhaustion. It begins with the malaria-like or flu-like symptoms, then one to three days later, there will be more specific symptoms. The person will start developing a rash. The rash starts like that of measles, which is maculopapular; then, it starts developing vesicles and thereafter pus. At that stage, it develops a scab, a hard one on the skin.
The symptoms may last between two to four weeks. This depends on the immunity of the infected person. Generally, it is not expected to be fatal. It is a self-limiting disease. It comes and heals on its own, but there may be a case of one death out of 10, but now the mortality rate lies between three to six per cent. It can cause death but it is not as bad as COVID. One death may occur in 10 cases.
What causes monkeypox?
It is caused by the pox virus, which is a DNA virus, while COVID is caused by an RNA virus. Viruses can never have both DNA and RNA like all other organisms. So, viruses can only be RNA or DNA just like a human being must be a male or a female. This DNA virus belongs to the family, poxviridae. It belongs to the same family as smallpox, chickenpox and cowpox.
Who is vulnerable to the infection?
Both animals and humans are vulnerable. It’s a zoonotic disease and can be transmitted between animals. It was first detected in monkeys. The primary reservoir is rat. Rats are really implicated – different species of rats and rodents. It can be transmitted from rat bites, blood, fluids, or tissues of infected animals. These can be a source of infection for humans. It can also be human to human through respiratory droplets just like that of COVID. Also, direct contact with people that have scabs or pus on their bodies. If the pus coming out of the scabs gets in contact with another person’s body, it is usually transmitted when the skin of the new contact person is broken, but if the skin is not broken, there won’t be transmission.
Sometimes, a broken skin may be visible and some other times it may not be visible. It’s only in a situation where there is a direct contact whereby the vesicle or pus from the infected person gets in contact with the part of the skin that is broken or any other medium through which it can get into the body fluid that there will be a transmission of the infection.
Can pets be the vectors to transmit the infection too?
Yes. Right now, an established natural animal reservoir is not yet known. So, animals and pets can be vectors. Dogs, cats and so on. Right now with this outbreak, any animal that is sick can be a suspect and the handler of the animal should handle the situation well. They should make sure that they use personal protective equipment, face masks, constant washing of hands, and disinfect with alcohol-based sanitizers. Also, materials that are used in treating animals can be a source of infection to the human handler.
What major difference or similarity does monkeypox have with COVID-19?
Like I said earlier, monkeypox is caused by a DNA virus. DNA viruses are not as ruthless as RNA viruses. COVID is caused by an RNA virus. For COVID, the animal reservoir host of the virus is not established. For monkeypox, it is known that rodents, monkeys and many other animals are implicated. Monkeypox in most cases is self-limiting. The fatality rate of monkeypox is lower than COVID. With COVID, there may be no rash, but with monkeypox, the primary symptom is the rash, which develops into dry scabs. COVID might not be transmitted through fomites, or through the bathing of infected persons. COVID can also not stand very high temperatures, but pox can stand it. It is a DNA virus.
How does it affect the body and special organs?
There might be complications, but the real problem lies on the skin. That’s the major complication of monkeypox. It is usually on the skin. Unlike COVID, which results in respiratory distress, no form of respiratory distress is seen in this. It is majorly an infection on the skin. The complications may be bacterial-based. There may be other bacterial infections with pox because it lowers immunity and when immunity is lowered, many other infections can set in.
Are there risk factors that come with monkeypox?
The main risk factor is the handling of animals, especially with this current outbreak. Animal bites or scratches also should be avoided. Care should also be taken when attending to sick people at the moment. The person may just be having the virus as well. In general, handling animals, especially those that are sick, is a major risk factor that should be avoided.
How is it diagnosed?
Diagnosis is almost like that of COVID. For COVID, because it’s an RNA virus, we take samples from the mouth or the nose, but for monkeypox we take the vesicle or scrape the scabs, then carry out Polymerase Chain Reaction test. The PCR is a test of choice for monkeypox.
How can it be treated?
For now, there is no treatment. In 1798, when Edward Jenner discovered vaccination, the first thing he did was to use extracts of cowpox from cows and exposed them close to the nostrils of humans. That was being used to vaccinate people against smallpox. If anyone has the smallpox vaccine, that gives 85 per cent protection against monkeypox. Right now, there are bacterial pox-based vaccines for monkeypox. I’m not sure that the new vaccine we are talking about has reached Africa yet. Even some parts of the developed world have not got it. So, for now, let the sickness just have its natural course. As it comes, so it heals. There is no established drug for it. Antibiotics can be taken to suppress what we call secondary infection by bacteria.
How can it be managed for someone who has been infected?
First of all, the person should go into isolation just as we had for COVID. While the person is in isolation, antibiotics should be administered to suppress secondary infection and the person should be supported with a lot of fluids. The person should take a lot of water, juice, fluids and so on to sustain hydration.
How can it be prevented?
For prevention, avoid contact with animals, especially the sick ones. Avoid bathing of sick animals and sick people, especially those taking care of patients in the hospital and health workers. Health workers should use adequate personal protective equipment when attending to patients, especially during this outbreak, knowing the mode of transmission. They have to be careful. Then people identified as monkeypox patients should be in isolation just as it was done for COVID. Everyone should also maintain good hygienic practices.
Does it leave a scar on the skin after recovery?
Scars may be there but there are creams that can be used to completely wipe out the traces of the scars.
Is the infection once in a lifetime or someone that has recovered from it can get infected again?
I don’t believe it. What I know in virology is that once a person has a natural infection and has been vaccinated, the vaccine has induced immunity. The person is protected for life except it’s not a virus. Once the person is infected and recovers from it, the person is protected for life and even protected against other viruses of the same family like cowpox, chickenpox, smallpox and so on. This is because there is a kind of cross-protection within the family.
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