Florian Lienert
Product Lead Medical Affairs, Bavarian Nordic
COVID-19 has brought infectious diseases to the forefront and now monkeypox is a condition which needs wider visibility and attention globally.
Experts are looking to raise awareness of the rare viral infection monkeypox amid concerns that cases of the condition could rise in western countries as COVID-19 travel restrictions are eased.
The disease was discovered in monkeys in the late 1950s, and the first human case was detected in 1970.
In the last few years there have been outbreaks in Nigeria and the Democratic Republic of the Congo, with cases subsequently exported to the United Kingdom, the United States, Israel and Singapore.
Governments, public health officials and clinicians are now being urged to be more vigilant of the condition amid concerns that more cases may be observed.
Less severe
Dr Florian Lienert, Product Lead Medical Affairs at Bavarian Nordic, explains that the symptoms of monkeypox are similar to those observed in smallpox patients, before the eradication of smallpox in 1980. The similarity of clinical symptoms is due to the close relatedness of the viruses that are causing these two diseases.
“The disease is usually less severe than smallpox, but it can still have a mortality of 1-10%,” he states.
Milder cases of monkeypox may go undetected and represent a risk of person-to-person transmission. The time between the exposure to monkeypox and first signs of symptoms can range between 5 to 21 days.
Initial symptoms are fever and headache but with monkeypox there is also a swelling of the lymph nodes in many patients, which was not observed for smallpox.
Typical skin symptoms with monkeypox include pustules and fluid-filled blisters, which generally disappear within 2-4 weeks.
In most cases, people recover though there can be long-term sequelae and severity of the disease is higher in people with immune-compromised conditions.
However, experts are concerned that “monkeypox might at some point occupy the epidemiological niche that was created because of the eradication of smallpox”.
Initial symptoms are fever and headache but with monkeypox there is also a swelling of the lymph nodes in many patients, which was not observed for smallpox.
Travel restrictions
Monkeypox, prevalent in central and western African countries, can spread from animal to humans and then be transmitted between people mainly through respiratory droplets, direct contact with infected secretions and from being in a contaminated patient environment.
Recently, a person travelled from Nigeria to the UK this summer with monkeypox, which was subsequently transmitted to two other family members. Similarly, there was another case found in the US. Yet, with no clear picture of the extent of the disease in African countries, particularly in Nigeria, what is causing experts particular concern is the changing epidemiology of the condition.
They are concerned that monkeypox has the potential to become a bigger problem.
Vulnerable populations
Smallpox vaccines are known to be effective against monkeypox, which may explain the small number of monkeypox cases before and in the years after smallpox was first eradicated.
But since smallpox vaccination programmes were phased out, immunity within vulnerable populations to monkeypox is now less than before, explains Dr Lienert, leaving a population that has never been vaccinated against smallpox or only many decades age more susceptible to monkeypox.
“With less immunity in populations against smallpox and other related viruses, this might explain this increase in monkeypox cases in these African countries and export to countries outside of Africa,” he says.
There is also a growing generation of clinicians who will not be familiar with symptoms of smallpox or monkeypox.
It is now imperative to raise awareness of the condition and support surveillance efforts, particularly as global travel becomes easier while COVID-19 restrictions continue to be eased.
GL-ODA-2100001 – Date of preparation: September 2021
