What Is Monkeypox And Is It More Dangerous Than Covid?

Mpox (monkeypox) is a viral illness caused by the monkeypox virus, a species of the genus Orthopoxvirus. Two different clades exist: clade I and clade II. Both clades can spread through direct contact with infected wild animals, through close contact (including intimate or sexual contact) with a person with mpox, and through contact with contaminated materials.

Is Monkeypox Different To COVID-19?

Yes Monkeypox is different to Covid-19 And here are some of the differences:

  • It is highly unlikely to have the global healthcare and economic consequences of COVID-19.
  • Monkeypox is a well-known, typically rare viral disease that has been around for a long time. COVID-19 developed from a novel (newly identified) Coronavirus that quickly became ubiquitous globally.
  • Monkeypox is significantly less contagious than the SARS-CoV-2 virus, which causes COVID-19. Importantly, to date, this outbreak of Monkeypox appears to be transmitted through direct bodily fluid contact, whereas COVID-19 spread posed a much higher person-to-person transmission risk through proximity to an infected individual. That said, more needs to be understood about Monkeypox’s mode of transmission which seems to have changed, resulting in the current outbreak.
  • Monkeypox is almost never fatal, and typically resolves spontaneously, consequently posing a low threat to healthcare systems. We are not at all likely to witness healthcare professionals and the healthcare system being severely impacted by this Monkeypox outbreak, to the same extent as COVID-19.

How Does Monkeypox Spread?

According to WHO Person-to-person transmission of Monkeypox can occur through direct contact with infectious skin or other lesions such as in the mouth or on genitals; this includes contact which is

  • face-to-face (talking or breathing)
  • skin-to-skin (touching or vaginal/anal sex)
  • mouth-to-mouth (kissing)
  • mouth-to-skin contact (oral sex or kissing the skin)
  • respiratory droplets or short-range aerosols from prolonged close contact

The virus then enters the body through broken skin, mucosal surfaces (e g oral, pharyngeal, ocular, genital, anorectal), or via the respiratory tract. Monkeypox can spread to other members of the household and to sex partners. People with multiple sexual partners are at higher risk.

Animal to human transmission of Monkeypox occurs from infected animals to humans from bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses, or eating animals. The extent of viral circulation in animal populations is not entirely known and further studies are underway.

People can contract Monkeypox from contaminated objects such as clothing or linens, through sharps injuries in health care, or in community setting such as tattoo parlours.


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What Are The Signs and Symptoms Of Monkeypox?

Monkeypox causes signs and symptoms which usually begin within a week but can start 1–21 days after exposure. Symptoms typically last 2–4 weeks but may last longer in someone with a weakened immune system.

Common symptoms of Monkeypox are:

  • rash
  • fever
  • sore throat
  • headache
  • muscle aches
  • back pain
  • low energy
  • swollen lymph nodes. 

For some people, the first symptom of Monkeypox is a rash, while others may have different symptoms first. 

The rash begins as a flat sore which develops into a blister filled with liquid and may be itchy or painful. As the rash heals, the lesions dry up, crust over and fall off. 

Some people may have one or a few skin lesions and others have hundreds or more. These can appear  anywhere on the body such as the:

  • palms of hands and soles of feet
  • face, mouth and throat
  • groin and genital areas
  • anus.

Some people also have painful swelling of their rectum or pain and difficulty when peeing.

People with Monkeypox are infectious and can pass the disease on to others until all sores have healed and a new layer of skin has formed. 

Children, pregnant people and people with weak immune systems are at risk for complications from Monkeypox.

Typically for Monkeypox, fever, muscle aches and sore throat appear first. The Monkeypox rash begins on the face and spreads over the body, extending to the palms of the hands and soles of the feet and evolves over 2-4 weeks in stages – macules, papules, vesicles, pustules. Lesions dip in the centre before crusting over. Scabs then fall off. Lymphadenopathy (swollen lymph nodes) is a classic feature of mpox. Some people can be infected without developing any symptoms.

In the context of the global outbreak of Monkeypox which began in 2022 (caused mostly by Clade IIb virus), the illness begins differently in some people. In just over a half of cases, a rash may appear before or at the same time as other symptoms and does not always progress over the body. The first lesion can be in the groin, anus, or in or around the mouth.

People with Monkeypox can become very sick. For example, the skin can become infected with bacteria leading to abscesses or serious skin damage. Other complications include pneumonia, corneal infection with loss of vision; pain or difficulty swallowing, vomiting and diarrhoea causing severe dehydration or malnutrition; sepsis (infection of the blood with a widespread inflammatory response in the body), inflammation of the brain (encephalitis), heart (myocarditis), rectum (proctitis), genital organs (balanitis) or urinary passages (urethritis), or death. Persons with immune suppression due to medication or medical conditions are at higher risk of serious illness and death due to Monkeypox. People living with HIV that is not well-controlled or treated more often develop severe disease.

Diagnosis Of Monkeypox

Identifying Monkeypox can be difficult as other infections and conditions can look similar. It is important to distinguish Monkeypox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmissible infections, and medication-associated allergies. Someone with Monkeypox may also have another sexually transmissible infection such as herpes. Alternatively, a child with suspected Monkeypox may also have chickenpox. For these reasons, testing is key for people to get treatment as early as possible and prevent further spread.

Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for Monkeypox. The best diagnostic specimens are taken directly from the rash – skin, fluid or crusts – collected by vigorous swabbing. In the absence of skin lesions, testing can be done on oropharyngeal, anal or rectal swabs. Testing blood is not recommended. Antibody detection methods may not be useful as they do not distinguish between different orthopoxviruses.

Monkeypox

Treatment And Vaccination Of Monkeypox

The goal of treating Monkeypox is to take care of the rash, manage pain and prevent complications. Early and supportive care is important to help manage symptoms and avoid further problems.

Getting a Monkeypox vaccine can help prevent infection. The vaccine should be given within 4 days of contact with someone who has Monkeypox (or within up to 14 days if there are no symptoms). 

It is recommended for people at high risk to get vaccinated to prevent infection with Monkeypox, especially during an outbreak. This includes:

  • health workers at risk of exposure
  • men who have sex with men
  • people with multiple sex partners
  • sex workers.

Persons who have Monkeypox should be cared for away from other people.

Several antivirals, such as tecovirimat, originally developed to treat smallpox have been used to treat Monkeypox and further studies are underway. Further information is available on Monkeypox vaccination and case management.

Self-care and prevention

Most people with mpox will recover within 2–4 weeks. Things to do to help the symptoms and prevent infecting others:

Do

  • stay home and in your own room if possible
  • wash hands often with soap and water or hand sanitizer, especially before or after touching sores
  • wear a mask and cover lesions when around other people until your rash heals
  • keep skin dry and uncovered (unless in a room with someone else)
  • avoid touching items in shared spaces and disinfect shared spaces frequently 
  • use saltwater rinses for sores in the mouth
  • take sitz baths or warm baths with baking soda or Epsom salts for body sores
  • take over-the-counter medications for pain like paracetamol (acetaminophen) or ibuprofen.

Do not

  • pop blisters or scratch sores, which can slow healing, spread the rash to other parts of the body, and cause sores to become infected; or
  • shave areas with sores until scabs have healed and you have new skin underneath (this can spread the rash to other parts of the body).

To prevent spread of mpox to others, persons with mpox should isolate at home, or in hospital if needed, for the duration of the infectious period (from onset of symptoms until lesions have healed and scabs fall off). Covering lesions and wearing a medical mask when in the presence of others may help prevent spread. Using condoms during sex will help reduce the risk getting mpox but will not prevent spread from skin-to-skin or mouth-to-skin contact.

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