Tuesday, June 14, 2022


Does it appear as if we are beginning the plagues that struck Egypt in the Bible? Just as we seem to be learning to live with COVID (though that virus may not be done with us just yet), along comes monkeypox. What is it? How worried should you be?

The most notable poxvirus is the life-threatening smallpox, which has been vanquished after millennia in which it was a leading cause of death. Related viruses are the cowpox virus that Jenner used to make the first vaccines and the vaccinia virus used to make modern smallpox vaccines.

Monkeypox is a similar virus, and has probably been around for a long time, but was largely confined to central and western Africa, so was not studied by western scientists. It is so-called because it was first detected in laboratory monkeys (in Denmark), but its usual hosts are small African rodents and other small mammals. There are two forms of the virus; the one seen in the Congo basin causes more severe illness, with about a 1-2% death rate in humans, and is more transmissible. The current outbreak appears to be of the less severe West Africa strain. No deaths have yet been reported in the current outbreak.

Before this year, cases outside Africa were rare, and usually seen in returning travelers. The U.S. had an outbreak in 2003. A shipment of Gambian pouched rats infected prairie dogs housed in the same facility, and these were then bought as pets and infected their owners.

2022 is different. As of this writing, some 1500 confirmed cases have been reported from 31 countries around the world, with 60% of these in Spain, Portugal and the United Kingdom. Most of these have been traced to large gatherings such as raves, where people mingled closely. Some 50 cases have been verified in the U.S. and over 110 in Canada (most in Quebec). The virus is primarily spread by direct contact with skin lesions but can also be spread by contact with sheets or clothing that have been in contact with skin lesions. While still debated, it may be spread by large respiratory droplets.

The usual illness is fever, chills, muscle aches, sore throat and swollen lymph glands, and then comes the rash. The rash begins as flat moles, which then form blisters and then pustules. It can be all over or confined to a small area.

In the current outbreak, most cases have been in men who have sex with men, and the rash has been in the genital and rectal area. Unless the doctor treating such a patient thinks of monkeypox, they are more likely to diagnose a more common sexually transmitted disease such as herpes.

Should you be worried? Probably not yet. Unlike Covid-19, which spreads primarily through small respiratory droplets and can easily be spread even when the carrier is not sick, monkeypox is mostly spread by direct contact with a sick person, so you do not need to worry about catching it in stores or concerts. Casual contact is not a high risk.

Treatment is focused on treating symptoms. Some vaccines and antiviral medicines are available that help, but these can only be obtained from the CDC.

My biggest concern is that if private doctors and public health officials are not vigilant, the virus may become established world-wide and no longer be confined to Africa.

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