Monkeypox is a viral zoonotic (zoonosis) disease that occurs primarily in topical rainforest area of Central and West Africa, and is occasionally exported to other regions. Monkeypox typically presents clinically with fever, rash and swollen lymph nodes and may lead to a range of medical complications.
Key facts,
- Monkeypox is caused by monkeypox virus a member of the Orthopox virus genus in the family poxviridae.
- Monkeypox is usually a self limited disease with the symptoms lasting from 2 to 4 weeks severe cases can occur. in recent times the case fatality ratio has been around 3-6%.
- Monkeypox is transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus.
- Monkeypox virus is transmitted from one person to another by close contact with lesions, body Fluids, respiratory droplets and contaminated materials bedding.
- The clinical presentation of Monkeypox resembles date of smallpox a related orthopoxvirus infection which was declared eradicated worldwide in 1980. Monkeypox is less contagious than smallpox and causes less severe illness.
- Vaccines used during the smallpox eradication programme also provided protection against monkeypox. Newer vaccines have been developed of which one has been approved for prevention of Monkeypox.
- An antiviral agent developed for the treatment of smallpox has also been licensed for the treatment of Monkeypox.
Introduction:-
Monkeypox is a viral zoonosis (a virus transmitted to humans from animals), with symptoms very similar to those seen in the past in smallpox patients, although it is clinically less severe. With the eradication of smallpox in 1980 and subsequent cessation of smallpox vaccination, monkeypox has emerged, age the most important orthopoxvirus for public health. Monkeypox primarily occurs in Central and West Africa, often in proximity to tropical rainforest and has been increasingly appearing in urban areas. Animal hosts include a range of rodents and non-human primates.
The pathogen:-
Monkeypox virus in an enveloped double stranded DNA virus that belongs to the Orthopoxvirus genus of the poxviridae family. There are two distinct genectic clades of the monkeypox virus– the central African (Congo Basin) clade and the west African clade. The Congo Basin clade has historically caused more severe disease and was through to be more transmissible. The geographical division between the two clades has so far been in Cameroon – the only country where both virus clades have been found.
Natural host of Monkeypox virus:-
Various animal species have been identified as susceptible to monkeypox virus. The includes rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates and other species. Uncertainty remains on the natural history of Monkeypox virus and further studies are needed to identify the exact reservoir, and how virus circulation is maintained in nature.
Transmission:-
Animal to human (zoonotic) transmission can occur from direct contact with the blood bodily floods, or cutaneous or mucosal lesions of infected animals. in Africa evidence of Monkey Pox virus infection has been found in many animals including rope squirrels, tree squirrels, Gambian poached rats, dormice, different species of monkeys and others. The natural reservoir of Monkeypox has not yet been identified through rodents are the most likely. Eating inadequately cooked meat and other animal products of infected animals is a possible risk factor. People living in or near forested areas may have indirect or low-level exposure to infected animals.
Signs and symptoms:-
The incubation period ( interval from infection to onset of symptoms) of Monkey Pox is usually from 6 to 13 days but can rent from 5 to 21 days.
The infection can be divided into two periods.
- The invasion period (lasts between 0-5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscles pain), and intense asthenia (lack of energy). lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may initially appear similar ( chickenpox, measles, smallpox)
- The skin eruption usually begins within 1-3 days of appearance of fever. The rash tends to be more concentrate on the face and extremities rather than on the trunk. It effects the face (in 90% of cases), and palms of the hands and soles of the feet ( in 70% of cases) , genitalia (30%), and conjunctivae ( 20%) as well as the cornea. The rash evolves sequentially from macules (slightly raised firm lesions), vesicles (lesions filled with clear fluid), pustules (lesions filled with yellowish fluid), and crusts which dry up and fall off. The number of lesions varies from a few to severe thousand. In severe cases, lesions can coalesce until large sections of skin Slough off.
Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. severe cases occur More commonly among children and are related to the extend of virus exposure, patient health status and nature of complications. Underlying immune deficiencies may lead to worse outcomes. Although vaccination against smallpox was protective in the past today, person younger than 42 to 50 years of age ( depending on the country) may be more susceptible to monkeypox due to cessation of smallpox vaccination campaigns globally after eradication of the disease. Complication of Monkeypox can include secondary infection, bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision. The extent or two which asymptomatic infection may occurs in unknown.
Diagnosis:-
The clinical differential diagnosis that must be considered includes other resh illnesses, such as chickenpox, measles, bacteria skin, infection scabies, syphilis, and medication – associated allergies. Lymphadenopathy during the prodromal stage of illness can be a clinical feature to distinguish monkeypox from chickenpox or smallpox.
If monkeypox is suspected, health workers should callect an appropriate sample and have it transported safety to a laboratory with appropriate capability. Confirmation of Monkeypox depends on the type of laboratory test. Thus the specimen should be packaged and shipped in accordance with National and international requirements. Polymerase chain reaction (PCR) is the referred laboratory test given its accuracy and sensitivity.
Vaccination:-
Vaccination against smallpox was demonstrate through several observation studies to be about 85% effective in preventing monkeypox. Thus prior smallpox vaccination may result in milder illness. Evidence of prior vaccination against smallpox can usually be found as a scar on the upper arm. At the present time the original ( first-generation) smallpox vaccines are no longer available to the general public. Some laboratory personnel or health workers may have received a more recent smallpox vaccine to protect them in the event of exposure to orthopoxvirus in the workplace. A still newer vaccine based on a modified attenuated vaccinia virus (Ankara strain) was approved for the prevention of Monkeypox in 2019.
Prevention:-
Raising awareness of risk factors and educating people about the measures they can take to reduce exposure to the virus is the main prevention strategy for monkeypox. Scientific studies aur now underway to assess the feasibility and appropriateness of vaccination for the prevention and control of Monkeypox. Some countries have or are developing, policies to offer vaccine to persons who may be at risk such as laboratory personnel rapid response team and health workers.
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By GS India Nursing, (Lucknow), India!!