Monkeypox, a rare viral disease, has captured global attention due to its emergence and spread in various parts of the world. Although it is not a new disease, the recent outbreaks have raised concerns among health authorities and the general public. This article provides an in-depth understanding of monkeypox, its origins, symptoms, transmission, and comparison with the COVID-19 pandemic. Additionally, we will explore the response of the World Health Organization (WHO) and other health bodies to this disease, and whether it poses a greater threat than COVID-19.
What is Monkeypox?
Monkeypox is a viral zoonosis, meaning it is a disease transmitted from animals to humans. It is caused by the monkeypox virus, a member of the Orthopoxvirus genus, which also includes the variola virus (which causes smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus. The monkeypox virus was first identified in 1958 in laboratory monkeys, hence the name. However, the primary carriers of the virus in nature are rodents, not monkeys.
The first human case of monkeypox was reported in 1970 in the Democratic Republic of Congo (DRC). Since then, the disease has been reported in several Central and West African countries. Until recently, monkeypox was largely confined to these regions, with sporadic cases in other parts of the world linked to travel or imported animals. However, the 2022-2023 outbreaks saw a significant increase in cases in non-endemic countries, prompting global concern.
Symptoms and Clinical Presentation
Monkeypox symptoms in humans are similar to those of smallpox, though generally less severe. The incubation period, which is the time from exposure to the virus to the onset of symptoms, typically ranges from 6 to 13 days but can be as long as 21 days.
The illness begins with a fever, headache, muscle aches, and exhaustion. A key difference between smallpox and monkeypox is that monkeypox causes swelling of the lymph nodes (lymphadenopathy), whereas smallpox does not. This symptom usually precedes the rash that characterizes the disease.
The monkeypox rash typically starts on the face and then spreads to other parts of the body, including the palms of the hands and the soles of the feet. The rash progresses through several stages before eventually forming scabs, which later fall off. The rash can vary from a few lesions to several thousand, depending on the severity of the case.
Transmission of Monkeypox
Monkeypox can be transmitted to humans through direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. In Africa, infection has been documented through the handling of infected monkeys, Gambian giant rats, and squirrels, among other animals. Consuming undercooked meat from infected animals is another potential risk factor.
Human-to-human transmission occurs primarily through large respiratory droplets. However, since these droplets cannot travel far, prolonged face-to-face contact is generally required. This is different from more highly transmissible respiratory viruses like COVID-19. Transmission can also occur through direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens.
Current Outbreaks and Global Spread
In 2022, monkeypox cases began to appear in countries where the virus had not been endemic. This was unusual and alarming because, until then, the disease had been mostly restricted to parts of Africa. Cases were reported in Europe, North America, and other regions, often with no clear links to travel from endemic areas.
The global spread of monkeypox in 2022-2023 marked a significant shift in the epidemiology of the disease. While the number of cases was much smaller compared to COVID-19, the fact that the virus was spreading in new regions prompted a coordinated international response.
WHO’s Response and Public Health Measures
The World Health Organization (WHO) and other public health bodies quickly responded to the global spread of monkeypox. In July 2022, the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC). This is the highest level of alert that the WHO can issue, and it is used to coordinate a global response to significant public health threats.
However, it’s important to note that declaring a PHEIC does not equate to declaring a pandemic. A pandemic is defined as the worldwide spread of a new disease, whereas a PHEIC is a broader term that refers to an extraordinary event that poses a public health risk through the international spread of disease and potentially requires a coordinated international response.
The WHO’s declaration of a PHEIC for monkeypox underscored the need for heightened surveillance, public awareness, and vaccination efforts, particularly in non-endemic countries. The organization also emphasized the importance of avoiding stigmatization of affected communities and ensuring equitable access to vaccines and treatments.
Is Monkeypox Worse Than COVID-19?
To assess whether monkeypox is worse than COVID-19, it’s essential to consider several factors, including transmissibility, severity, global impact, and public health response.
- Transmissibility: COVID-19 is far more transmissible than monkeypox. The SARS-CoV-2 virus, which causes COVID-19, spreads easily through respiratory droplets and aerosols, making it highly contagious. Monkeypox, on the other hand, requires closer and more prolonged contact for transmission. This difference in transmissibility is a key reason why COVID-19 spread so rapidly worldwide, while monkeypox has been more contained.
- Severity: The severity of monkeypox cases varies, but the case fatality rate (CFR) in most outbreaks is between 1% and 10%, depending on the strain and access to medical care. The strain involved in the 2022-2023 outbreaks has a lower CFR, estimated to be less than 1%. In contrast, COVID-19’s CFR has varied significantly depending on the variant, healthcare access, and population demographics, with global averages around 1% to 3% but much higher in vulnerable populations.
- Global Impact: COVID-19 has had a profound and far-reaching impact on global health, economies, and societies. The pandemic has caused millions of deaths, overwhelmed healthcare systems, disrupted global supply chains, and led to widespread lockdowns and economic recessions. While monkeypox has caused concern, its impact has been much more localized and less disruptive on a global scale.
- Public Health Response: The global response to monkeypox has been more measured compared to the response to COVID-19, partly because of lessons learned from the COVID-19 pandemic. Vaccines for monkeypox already exist, and there is experience in dealing with similar viruses like smallpox. This has allowed for a more targeted response, with vaccination efforts focusing on high-risk populations.
Vaccination and Treatment
Vaccination plays a critical role in controlling monkeypox outbreaks. The smallpox vaccine, which was widely used until smallpox was eradicated in 1980, provides some protection against monkeypox due to the genetic similarities between the two viruses. In fact, countries with strong smallpox vaccination programs saw lower incidence rates of monkeypox after the cessation of smallpox vaccination.
In response to the 2022-2023 outbreaks, several countries have initiated vaccination campaigns targeting high-risk populations, such as healthcare workers and close contacts of confirmed cases. The JYNNEOS (also known as Imvamune or Imvanex) vaccine, which was initially developed for smallpox, has been approved for use against monkeypox and is being deployed in these efforts.
Treatment for monkeypox is primarily supportive, addressing symptoms such as fever, pain, and skin lesions. Antiviral drugs like tecovirimat (TPOXX), which were developed to treat smallpox, have shown promise in treating monkeypox as well, particularly in severe cases.
The Role of Public Awareness and Education
Public awareness and education are crucial in preventing the spread of monkeypox. Given the zoonotic nature of the virus, understanding how to minimize the risk of transmission from animals to humans is essential, particularly in regions where monkeypox is endemic. Public health campaigns should focus on educating people about safe practices when handling animals, recognizing early symptoms, and seeking medical attention promptly.
In non-endemic regions, where the risk of human-to-human transmission is more significant, public health messaging should emphasize the importance of avoiding close contact with infected individuals, practicing good hygiene, and following guidelines for quarantine and isolation when necessary.
Monkeypox, while a serious and concerning disease, is not likely to reach the same level of global impact as COVID-19. The differences in transmissibility, severity, and the availability of vaccines and treatments mean that the public health response can be more targeted and effective. However, the emergence of monkeypox in non-endemic regions highlights the importance of global health vigilance and preparedness for emerging infectious diseases.
The WHO’s declaration of a Public Health Emergency of International Concern for monkeypox underscores the need for continued surveillance, research, and public health measures to control the spread of the virus. By learning from the COVID-19 pandemic, the global community can better respond to monkeypox and other emerging health threats, ensuring that public health systems are equipped to protect populations worldwide.
As the world continues to navigate the challenges of emerging infectious diseases, the experience with monkeypox serves as a reminder of the importance of global cooperation, scientific research, and public health preparedness in safeguarding public health and preventing future pandemics.