Monkeypox is a virus that causes a disease in humans that is similar to smallpox but not as deadly. Although most cases occur in Africa, outbreaks in other countries have occurred from international travel and the exotic pet trade.
Monkeypox was first identified in 1958 when monkeys shipped from Singapore to a research facility in Denmark got sick. The first human case was not confirmed until 1970 — a child in the Democratic Republic of Congo suspected of having smallpox.
Monkeypox is edemic to Africa, with most of the cases occurring in the Democratic Republic of the Congo. Since 2016, cases in other African countries have been increasing, and as most cases occur in rural areas, the number is likely drastically underreported.
Although there are many complex reasons for this increase, eradicating smallpox likely increased the number of monkeypox cases as it eliminated the virus's natural competition.
Although monkeypox is endemic to Africa, cases have sporadically occurred in other places. In 2003, rats imported from Ghana infected prairie dogs, spreading the virus around the American midwest, leading to more than 50 human cases. Cases of people traveling to Africa and getting infected were reported in 2018, 2019, and 2021.
According to the World Health Organization, cases of monkeypox in countries where it is not endemic have spread significantly since May 2022. Although some of the people who developed the disease had a confirmed travel history, this travel was to North American and European countries.
This is the first time clusters have been widely reported outside Africa.
There are two strains of monkeypox: one that circulates in the Congo basin and one that spreads in West Africa.
The type that occurs in the Congo basin is more severe than the one in West Africa. The strain involved in the 2022 outbreak seems to be more closely related to the milder West African strain.
Monkeypox primarily spreads through direct contact. Some cases come from contact with animals and are spread through scratches, bites, or eating wild game, but monkeypox can also spread from person to person.
Human-to-human transmission can occur from direct contact with body fluids or sheets, blankets, or clothes that came in contact with an infected person.
Monkeypox has a long incubation period. It can take up to three weeks after exposure for symptoms to appear, though they can start in as little as four days.
The first signs of infection are a general feeling of being unwell, followed by muscle aches, fever, swollen lymph nodes, and other flu-like symptoms. A few days later, a blister-like rash forms. It usually first appears on the face, but if the person acquired the virus from sexual contact, it might begin on or near the genitals. The rash spreads all over the body and dries up after a week or two.
Most monkeypox infections last between two and four weeks.
Monkeypox is generally rare, so health care professionals may first rule out other rash-producing infections like syphilis, chickenpox, and measles if the person does not live in an area with significant exposure risk.
They may use blood tests or swabs from the rash to confirm a diagnosis. Under a microscope, the monkeypox virus has a few distinct features that make it easily identifiable, including its large brick-like shape.
There is no specific medication approved for monkeypox. Treatment focuses on comfort and symptom management. People with active monkeypox infections should remain isolated, wear a surgical mask, and cover lesions as much as possible until they have healed completely.
Researchers are looking at some smallpox drugs as possible treatments for monkeypox, but these are currently under investigational use and only considered for people with severe cases.
Prognosis largely depends on the strain of the monkeypox virus causing the infection. The strain from West Africa has a mortality rate below one percent, while the strain from the Congo Basin is significantly higher, at up to 11 percent in unvaccinated children.
Most people recover from monkeypox within four weeks of when the symptoms appear, though they may be left with scarring and skin discoloration from the rash.
Vaccines for monkeypox are available, and the CDC recommends vaccination for anyone who is at higher risk of getting monkeypox or has had a recent exposure.
People who get vaccinated within four days of exposure may prevent the disease from developing, and getting vaccinated within 14 days of exposure can reduce the severity of the infection.
The best way to prevent a monkeypox infection is to decrease contact with infected animals and limit person-to-person spread. Wash your hands frequently with soap and water, disinfect regularly touched surfaces, and avoid contact with clothing, bedding, and other materials that may be contaminated with the virus.
Stay away from people who may be infected with monkeypox, and practice safe sex. In healthcare settings, people who care for patients infected with monkeypox should wear gloves, masks, and gowns, and patients may be kept in negative air pressure rooms.
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