Monkeypox Case Reported in the US as Virus Spreads Across Europe and North America

Battling infectious diseases may not be the same anymore after COVID-19, and global infectious disease centers are now on alert over cases of monkeypox popping up around the world.

So far, cases of monkeypox have been found in the US, Canada, Australia and several countries in Europe, including the UK, France, Italy, Sweden, Portugal and Spain. There are currently two confirmed cases in Quebec, Canada and 17 suspected cases in the Montreal region in the province. Spain and Portugal have now reported over 40 cases. The US has one confirmed case reported in Massachusetts, which has been linked to travel from Canada via private transportation.

Monkeypox is a rare zoonotic disease. There are two main strains of the monkeypox virus — the West African strain, which has a mortality rate of around one percent and the more severe Congo strain that has a mortality rate up to ten percent.

The more positive news is that most of the monkeypox cases being reported are presenting with mild symptoms. This is why health officials are saying not to panic but are closely watching its epidemiological trajectory.

In light of the more than dozen cases reported in the Montreal area, the Public Health Agency of Canada (PHAC) said in a statement that, “this is an evolving and ongoing investigation, both in Canada and around the world.”

Up until now, monkeypox outbreaks have mostly been limited to central and western Africa.

Britain recently announced it will be offering the smallpox vaccine, which is 85 percent effective against monkeypox according to the World Health Organization (WHO), to healthcare workers in the country due to the handfuls of cases being reported across Europe.

What is Monkeypox?

Monkeypox is a viral infection caused by the monkeypox virus. It is similar to smallpox and can jump from animals to humans.

The monkeypox virus is part of the Orthopoxvirus genus in the family Poxviridae. The Orthopoxvirus genus also includes the cowpox virus, the virus that causes smallpox (variola virus) and the virus used in the smallpox vaccine (vaccinia virus).

Monkeypox was first discovered in a colony of monkeys in a research lab in 1958. Two outbreaks of a pox-like disease occurred among the monkeys, and is why the virus was named after the animals. According to the Centers for Disease Control and Prevention (CDC), the first human case of monkeypox was identified in 1970 in the Democratic Republic of the Congo (DRC) in a period when there were intense efforts to eradicate smallpox.

While African rodents and non-human primates such as monkeys may play host to the virus and infect humans, the natural reservoir of monkeypox is not known.

What are the Symptoms of Monkeypox?

According to the CDC, the symptoms of monkeypox are similar to smallpox but milder. The symptoms of monkeypox include a rash, fever, headache, muscle aches, backache, swollen lymph nodes, chills and fatigue. The main difference between the symptoms of smallpox versus those of monkeypox is that monkeypox causes lymphadenopathy (swelling of the lymph nodes) while smallpox does not.

The time from infection to the appearance of symptoms for monkeypox is typically between seven to 14 days but can range from five to 21 days.

The illness usually lasts for two to four weeks.

According to the CDC, despite the mildness of most cases, monkeypox has been shown to cause death in as many as one in ten people who contract the disease.

How is Monkeypox Transmitted?

Person-to-person transmission is not common for monkeypox, but it is transmitted through close contact. The first three cases of monkeypox reported by the UK to the WHO on May 13 were among individuals who were family members living together.

Recent cases of monkeypox in different parts of the world are attributed to international travel, as monkeypox is not typically reported outside of Africa.

According to health officials in Spain, some of the infections they are seeing may have been through sexual contact, namely among gay or bisexual men. However, Montreal’s top public health official Dr. Mylène Drouin said the monkeypox virus is not sexually transmitted and is mainly spread “by close contact and [respiratory] droplets.”

She said it is also spread through open sores, contact with bodily fluids or by touching contaminated clothes or bedding.

Treatments

Currently, the CDC says that there is “no proven, safe treatment” for infection with the monkeypox virus. However, to help treat the infection and prevent outbreaks, the health agency says antivirals, the smallpox vaccine and vaccinia immune globulin (VIG) can be used.

In the US, JYNNEOS (also known as Imvamune or Imvanex) is a vaccine that is licensed to prevent both monkeypox and smallpox.

Outbreaks Outside Africa

In 2003, the first outbreak of monkeypox outside Africa occurred in the US. The outbreak involved six states (Illinois, Indiana, Kanas, Missouri, Ohio and Wisconsin) and 47 confirmed and probable cases. According to the CDC, the cases were linked to contact with pet prairie dogs. The dogs were infected after being housed near small mammals imported from Ghana.

The CDC says the outbreak was contained through measures that included extensive laboratory testing; deployment of smallpox vaccine and treatments; development of guidance for patients, healthcare providers, veterinarians and other animal handlers; tracking potentially infected animals; and investigation into possible human cases. Response partners also issued an immediate embargo and ban on the import, interstate transport, sale and release into the environment of certain species of rodents including prairie dogs.

While the FDA later removed the ban, the CDC’s restriction on the importation of African rodents is still in place.