Monkeypox is a zoonotic disease typically found in central and western Africa caused by infection with the monkeypox virus. The disease was originally discovered in a group of monkeys used for research in 1958. The virus was later found to be transmitted to the human population in 1970. The monkeypox virus has since evolved into two separate variants: one primarily located in central Africa and one primarily located in western Africa, the dividing location between the two clades located in Cameroon, the only location where both variants have been found. Prior to the 2022 outbreak, most cases of monkeypox outside of central and western Africa were linked to travel to one of these hotspot locations or to animals imported from one of these locations. The first outbreak of monkeypox outside of Africa occurred in 2003 in the United States, when over 70 cases of monkeypox were reported after prairie dogs were imported from an endemic country. There was not another outbreak in a non-endemic country until September 2018, and eight outbreaks occurred between then and May of 2022. However, as of July 23 2022, there were over 16,000 people infected from 75 countries and territories with 5 total fatalities. On July 23, 2022, the World Health Organization (WHO) declared the 2022 monkeypox outbreak a public health emergency of international concern. See also: Africa; Animal virus; Disease ecology; Epidemic; Epidemiology
The 2022 monkeypox outbreak is the western African variant, which has shown to have milder symptoms. The lesser symptoms increase the probability that those infected may not know they are infected, and therefore will not take actions to prevent viral spread. Although symptoms of monkeypox are similar to those of smallpox, symptoms are milder and the disease is rarely fatal. These can include fever, headache, muscle and back aches, swollen lymph nodes, chills, exhaustion, and most commonly a rash resembling pimples or blisters appearing on the face, inside the mouth, and other places on the body such as the hands, feet, genitals, and anus. The incubation period, or period from infection to the onset of symptoms, typically ranges from 6–13 days, but can last anywhere from 5–21 days. Before healing completely, the rash goes through different stages, and the illness typically ranges from 2–4 weeks. See also: Fever; Headache; Lymphatic system; Smallpox
Despite its name, the source of monkeypox remains unknown. However, African rodents and non-human primates (such as monkeys) might harbor the virus and infect people through bites, scratches, blood, lesions, or body fluids, whether through direct contact or through human use or consumption of animal products or byproducts. Monkeypox can also be spread from human to human through direct physical contact with sores, scars, oral fluid, or respiratory droplets of someone infected with monkeypox usually through prolonged periods of close contact or in intimate situations. The disease has been found to be concentrated among men who have sex with men, and typically men who have multiple male sexual partners, due to the exchange of bodily fluids in prolonged intimate situations. Further, monkeypox can be transmitted via direct physical contact with materials recently contaminated with the virus, such as bed sheets or towels. As some new modes of transmission remain unknown, and the population infected continues to skyrocket, the WHO Director-General concluded that the label of a "public health emergency of international concern" would be suitable, and that global recommendations must be put in place to prevent transmission. These recommendations include providing information and services to communities of men who have sex with men while reducing stigma and discrimination against this group. Other recommendations depend on the state of the outbreak in the country or territory, or that country or territory's resources. See also: Animal virus; Disease ecology; Infection; Infectious disease; Virus; Zoonoses
To diagnose monkeypox, a healthcare provider will take a tissue sample from a lesion and send it to a lab for a polymerase chain reaction (PCR) test. Doctors can usually distinguish between monkeypox and measles or chickenpox by a patient’s swollen lymph nodes, which rarely occurs in the presence of one of the other viruses. Monkeypox will typically alleviate without treatment within the 2- to 4-week period. Doctors will monitor and try to relieve symptoms that occur. Antivirals and vaccinations can also be used to prevent and treat infection. Tecovirimat, an antiviral medication sold under the name TPOXX, may be used for those with weakened immune systems or who are more likely to become severely ill with the infection. People who have been vaccinated against smallpox will have some protection against monkeypox, as both are members of the orthopoxvirus family. This may lead to lower chance of infection and milder symptoms if infected. See also: Chickenpox and shingles; Immunology; Measles; Polymerase chain reaction (PCR); Vaccination; Virus classification
Even though monkeypox cases are increasing worldwide, including in the United States, the risk of the virus mutating is low. The virus that causes monkeypox is generally very stable because—unlike the coronavirus or Ebola—monkeypox is an enveloped double-stranded DNA virus, and not an RNA virus. Nevertheless, it is advisable to limit contact with people and animals infected or with the possibility of being infected with the monkeypox virus, as well as avoiding contact with contaminated materials. Anyone with close physical contact with a human or animal with symptoms of monkeypox is at risk of infection. It is advisable to isolate yourself from others if you believe you may have come in contact with someone infected, or if you begin to develop symptoms of monkeypox. The WHO Director-General believes that by implementing his recommendations, the global community has the power to stop transmission and bring the outbreak under control. See also: Animal virus; Coronavirus; Deoxyribonucleic acid (DNA); Ebola virus; Mutation; Ribonucleic acid (RNA)
