Monkeypox: The Latest In The Long List Of Dreaded Viruses

August 28, 2022 at 7:47 p.m.


Does it seem like there has been a continuous string of deadly viruses to plague us in the past two decades? The list would include, in no particular order: Dengue Fever, Machupo, Junin, Hantavirus, Ebola, Marburg, Zika, MERS, SARS-Cov-2, HIV/AIDS and COVID-19 and associated mutations.  

There have also been reports of new Polio virus cases. Most  emerging and re-emerging infectious diseases are RNA viruses with high mutation rates. This leads to their rapid evolution and environmental adaptability.

Monkeypox is the latest global health risk in the series.  This virus, first discovered in monkeys in 1958 and that spread to humans in 1970, is now being seen in small but rising numbers in Western Europe and North America. Case numbers are rising daily.

Incidence

Monkeypox has infected more than 32,000 people since the beginning of August, according to the World Health Organization. This encompasses 82 nonendemic countries.  The first U.S. case was reported on May 7 and now there are more than 9,500 confirmed cases. On Aug. 4, the Biden administration declared monkeypox a public health emergency, giving federal agencies the ability to quickly direct funds toward vaccines, therapeutics and other immediate needs.  

Spread

Monkeypox is transmitted primarily through direct skin-to-skin contact with infectious lesions. Most cases have occurred among men who acquired the infection through sexual or intimate contact with other men.  Contact with materials used by persons with monkeypox including clothing, bedding or sex toys may lead to transmission.  

While monkeypox can be transmitted during sexual contact, it is not considered a sexually transmitted disease because the virus can be acquired without having sex. It remains unclear if monkeypox can be transmitted through semen, vaginal secretions, urine or feces. It is also unknown if the virus is transmissible by individuals without skin lesions or how often the virus is spread through respiratory secretions. It is not spread by casual contact.

Clinical Characteristics

As of July 25, the U.S. Centers for Disease Control and Prevention (CDC) reported that 99.1% of U.S. cases are among individuals assigned male sex at birth, with a median age of 35 years (range 18-76 years). The mean incubation period from time of exposure has been estimated at 7.6 days (range 6.2-9.7). Ninety-five percent of individuals develop symptoms within 17.1 days.

The initial symptoms are those of a flu-like illness with fever, malaise, headache and fatigue often accompanied with swollen lymph glands.  A rash appears shortly thereafter, starting as macules that progress to papules, vesicles and then pustules before scabs form.  In the current outbreak, common symptoms also include anorectal pain, proctitis with bleeding, and penile edema.  Sore throat, painful swallowing of food, tonsillitis and inflammation of the epiglottis.  For most individuals, monkeypox is not life threatening but it is disruptive and painful and could generate social stigma.  

Hospitalization is uncommon and the major reason is pain control, typically from anorectal or oral pain. People with monkeypox should remain in isolation for the duration of the illness, which typically lasts two to four weeks.  Mortality is rare, but so far at least four people in nonedemic countries have died.

Testing And Treatment

An unusual skin lesion, particularly in the anogenital area, should be investigated. The rash may be limited to a few lesions or only a single lesion. There is a PCR (polymerase chain reaction) test that can detect monkeypox and is the test currently being used. With testing expanded to five commercial laboratories, access to testing has increased; however, results still take two to three days in many places.

Treatment

For most patients, management is symptomatic, including pain treatment.  Monkeypox is a member of the Orthopoxvirus genus.  Another member of the genus is the variola virus which causes smallpox. As a result, while there are no antivirals currently approved for monkeypox, tecovirimat, an antiviral drug approved for the treatment of smallpox based on animal data, have been made available to treat monkeypox via an expanded access Investigational New Drug protocol. Tecovirimat is available as an oral capsule and as an injectable for intravenous administration.

Preventing Spread

With appropriate use of person protective equipment, the risk of transmission of monkeypox in the healthcare setting is low.  However, a person with monkeypox should avoid close contact with others until the skin lesions are completely healed, which can take several weeks.

Final Thoughts

Being infected with a virus is no surprise.  The fact is that we live in a world of viruses — viruses that are unfathomably diverse and immeasurably abundant.  

According to a recent National Geographic issue, the oceans alone may contain more viral particles than the stars in the observable universe.  Mammals may contain at least 320,000 different species of viruses.  When you add the viruses infecting nonmammalian animals, plants, terrestrial bacteria and every other possible host, the total is uncountable and unimaginable.

Max Sherman is a medical writer and pharmacist retired from the medical device industry.  His new book “Science Snippets” is available from Amazon and other book sellers. It contains a number of previously published columns.  He can be reached by email at  [email protected].  



Does it seem like there has been a continuous string of deadly viruses to plague us in the past two decades? The list would include, in no particular order: Dengue Fever, Machupo, Junin, Hantavirus, Ebola, Marburg, Zika, MERS, SARS-Cov-2, HIV/AIDS and COVID-19 and associated mutations.  

There have also been reports of new Polio virus cases. Most  emerging and re-emerging infectious diseases are RNA viruses with high mutation rates. This leads to their rapid evolution and environmental adaptability.

Monkeypox is the latest global health risk in the series.  This virus, first discovered in monkeys in 1958 and that spread to humans in 1970, is now being seen in small but rising numbers in Western Europe and North America. Case numbers are rising daily.

Incidence

Monkeypox has infected more than 32,000 people since the beginning of August, according to the World Health Organization. This encompasses 82 nonendemic countries.  The first U.S. case was reported on May 7 and now there are more than 9,500 confirmed cases. On Aug. 4, the Biden administration declared monkeypox a public health emergency, giving federal agencies the ability to quickly direct funds toward vaccines, therapeutics and other immediate needs.  

Spread

Monkeypox is transmitted primarily through direct skin-to-skin contact with infectious lesions. Most cases have occurred among men who acquired the infection through sexual or intimate contact with other men.  Contact with materials used by persons with monkeypox including clothing, bedding or sex toys may lead to transmission.  

While monkeypox can be transmitted during sexual contact, it is not considered a sexually transmitted disease because the virus can be acquired without having sex. It remains unclear if monkeypox can be transmitted through semen, vaginal secretions, urine or feces. It is also unknown if the virus is transmissible by individuals without skin lesions or how often the virus is spread through respiratory secretions. It is not spread by casual contact.

Clinical Characteristics

As of July 25, the U.S. Centers for Disease Control and Prevention (CDC) reported that 99.1% of U.S. cases are among individuals assigned male sex at birth, with a median age of 35 years (range 18-76 years). The mean incubation period from time of exposure has been estimated at 7.6 days (range 6.2-9.7). Ninety-five percent of individuals develop symptoms within 17.1 days.

The initial symptoms are those of a flu-like illness with fever, malaise, headache and fatigue often accompanied with swollen lymph glands.  A rash appears shortly thereafter, starting as macules that progress to papules, vesicles and then pustules before scabs form.  In the current outbreak, common symptoms also include anorectal pain, proctitis with bleeding, and penile edema.  Sore throat, painful swallowing of food, tonsillitis and inflammation of the epiglottis.  For most individuals, monkeypox is not life threatening but it is disruptive and painful and could generate social stigma.  

Hospitalization is uncommon and the major reason is pain control, typically from anorectal or oral pain. People with monkeypox should remain in isolation for the duration of the illness, which typically lasts two to four weeks.  Mortality is rare, but so far at least four people in nonedemic countries have died.

Testing And Treatment

An unusual skin lesion, particularly in the anogenital area, should be investigated. The rash may be limited to a few lesions or only a single lesion. There is a PCR (polymerase chain reaction) test that can detect monkeypox and is the test currently being used. With testing expanded to five commercial laboratories, access to testing has increased; however, results still take two to three days in many places.

Treatment

For most patients, management is symptomatic, including pain treatment.  Monkeypox is a member of the Orthopoxvirus genus.  Another member of the genus is the variola virus which causes smallpox. As a result, while there are no antivirals currently approved for monkeypox, tecovirimat, an antiviral drug approved for the treatment of smallpox based on animal data, have been made available to treat monkeypox via an expanded access Investigational New Drug protocol. Tecovirimat is available as an oral capsule and as an injectable for intravenous administration.

Preventing Spread

With appropriate use of person protective equipment, the risk of transmission of monkeypox in the healthcare setting is low.  However, a person with monkeypox should avoid close contact with others until the skin lesions are completely healed, which can take several weeks.

Final Thoughts

Being infected with a virus is no surprise.  The fact is that we live in a world of viruses — viruses that are unfathomably diverse and immeasurably abundant.  

According to a recent National Geographic issue, the oceans alone may contain more viral particles than the stars in the observable universe.  Mammals may contain at least 320,000 different species of viruses.  When you add the viruses infecting nonmammalian animals, plants, terrestrial bacteria and every other possible host, the total is uncountable and unimaginable.

Max Sherman is a medical writer and pharmacist retired from the medical device industry.  His new book “Science Snippets” is available from Amazon and other book sellers. It contains a number of previously published columns.  He can be reached by email at  [email protected].  



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