What you need to know about monkeypox

According to Wikipedia.org, an outbreak of monkeypox was confirmed on May 6, beginning with a British resident who, after travelling to Nigeria (where the disease is endemic), presented symptoms consistent with monkeypox on April 29. The resident returned to the United Kingdom on May 4, creating the country’s index case of the outbreak.
According to the World Health Organisation (WHO), monkeypox is a zoonotic (spread from animals to humans) disease caused by an orthopoxvirus. The virus belongs to the same family as that which causes smallpox and cowpox. However, smallpox is considered to be more clinically severe than monkey pox.

Monkeypox has become an endemic in West and Central Africa with the first case, according to WHO, having been discovered in 1950 among monkeys and later among humans in 1970. Apart from monkeys, the virus can also be found among rope squirrels, tree squirrels, Gambian poached rats, dormice, different species of monkeys and others. The health body says the natural reservoir of monkeypox has not yet been identified, though rodents are the most likely.
In the US, according to WHO, the first outbreak was in 2003 among pet prairie dogs that were being kept with Gambian pouched rats and dormice that had been imported from Ghana. This registered 47 cases, according to Centres for Disease Control and Prevention (CDC).

READ: Monkeypox: Govt should increase surveillance
Clade types
According to WHO, there are two ‘clades’ of monkey pox. There is the West African clade which is responsible for the recent cases of monkeypox and has a fatality rate of less than one percent. There is also the Congo Basin clade, which has a higher mortality rate of up to 10 percent. 

Save USA, West and Central Africa, the disease has been detected in Canada, Australia, the United Kingdom (UK) and other European countries. According to cnet.com, health officials are monitoring the newer clusters of cases, more so in UK because some of the cases are not linked to travel. That shows an unusual community spread in countries that have not previously been impacted by the disease.
Transmission
According to WHO, zoonotic transmissions can occur from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. 
Eating inadequately cooked meat and other animal products of infected animals is also a possible risk factor. 
People living in or near forested areas may have indirect or low-level exposure to infected animals.
On the other hand, WHO says human-to-human transmission can result from close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects. 

Transmission via droplet respiratory particles usually requires prolonged face-to-face contact, which puts health workers, household members and other close contacts of active cases at greater risk. However, the longest documented chain of transmission in a community has risen in recent years from six to nine successive person-to-person infections. That may highlight declining immunity in communities due to cessation of smallpox vaccination. 
Transmission can also occur via the placenta from mother to foetus (which can lead to congenital monkeypox) or close contact during and after birth. 
While close physical contact is a well-known risk factor for transmission, WHO says research is still being done to ascertain if it can be transmitted specifically through sexual transmission. 
Signs and symptoms
While WHO puts the incubation period (interval from infection to onset of symptoms) of monkeypox at six to 13 days, they say it can also range from five to 21 days. That said, the symptoms include:
● The invasion period (between 0–five days)
The phase is characterised by fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle aches) 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 (within one to three days)
It is characterised by the appearance of fever in the first three days and the rash tends to be more concentrated on the face and extremities (palms and foot soles) rather than on the trunk. Others may have it on the oral mucous membranes, genitalia, conjunctivae and the cornea. The rash evolves with time from macules (lesions with a flat base) to papules (slightly raised firm lesions), vesicles (lesions filled with clear fluid), pustules (lesions filled with yellowish fluid), and crusts which dry up and fall off. In severe cases, lesions can come together until large sections of skin slough off. The number of lesions varies from a few to several thousand. 

The symptoms last between two to four weeks and cases are more severe in children and those with low immunity.
While vaccination helped with smallpox, it was eradicated. Therefore, people below 40 to 50 years who never got the vaccine are more susceptible to monkeypox.

Complications 
These include secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision. The extent to which asymptomatic infection may occur is unknown.
Diagnosis
WHO says the signs that must be looked out for include chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies. Lymphadenopathy during the prodromal stage of illness can also be a clinical feature to distinguish monkeypox from chickenpox or smallpox.

If monkeypox is suspected, WHO advises health workers to collect an appropriate sample and have it transported safely to a laboratory with appropriate capabilities to test for the disease. Confirmation of monkeypox depends on the type and quality of the specimen and the type of laboratory test. Thus, specimens should be packaged and shipped in accordance with national and international requirements. 

Case of Uganda 
Dr Charles Olaro, the director curative services at Ministry of Health, says there are currently no known cases of monkeypox in Uganda but antibodies from people who move from Democratic Republic of Congo (DRC) and the Albertine region. 

“We, however, have the capacity to test for it through UVRI and will include it to our surveillance list, which previously had only Ebola and Covid-19. And since DRC is close to Uganda, we need to be on high alert,” he says.

Dr Julius Lutwama, the head of arbovirology department at the Uganda Virus Research Institute, says while there are no cases of monkeypox in Uganda, studies done have shown the presence of monkeypox antibodies in Bunyoro around Lake Albert. 

“The antibodies point to people who have periodically been affected although not to the scale of an epidemic,” he says. 

Dr Lutwama adds that the last case of monkeypox antibodies was seen approximately four years ago but with the condition becoming a global threat, there is need for vigilance. “We advise health workers, more so those in the Albertine region to lookout for the symptoms,” he says.