Monkeypox explained: What we know so far about the outbreak

Health authorities are investigating a recent outbreak of monkeypox cases that have been reported in countries outside of central and west Africa, where the rare disease is endemic.
As of 21 May, the World Health Organization (WHO) reported 92 confirmed monkeypox cases and 28 suspected cases from 12 non-endemic countries, including several European nations, the United States, Canada and Australia.
Two cases have been identified in Australia – the first being a man in his 30s in Victoria, announced by the state’s health department on 19 May.

A second case – a man in his 40s – was confirmed in NSW the following day. Both had recently travelled to Europe and are now isolating.


Officials are investigating the likely source of this outbreak as reported cases so far have no established travel links to central and west Africa, where the virus is endemic. The WHO expects there to be more cases in the coming weeks, as surveillance expands in non-endemic countries.
Experts say monkeypox is usually a mild viral infection that spreads through close contact.
While the risk to the general population is low – and the outbreak “containable”, they say awareness is important as investigations continue.

Here’s what you need to know.

What is monkeypox?

Monkeypox is a viral zoonosis, meaning it is a virus transmitted to humans from animals, including a range of rodents and non-human primates.
According to University of NSW epidemiologist Professor Raina MacIntyre, it is closely related to the virus that causes smallpox, but is clinically less severe.

“It is usually found in animals, including monkeys, but other animals as well, and occasionally it can spread from animals to humans, and very occasionally from human to human,” Professor MacIntyre told SBS News.

With the eradication of smallpox in 1980 and the subsequent ending of smallpox vaccination, the WHO says monkeypox has emerged as the “most important orthopoxvirus for public health”.
The first case of monkeypox in humans was identified in 1970 in the Democratic Republic of Congo in a nine-year-old boy, according to the WHO. Smallpox had been eliminated in the region two years earlier.
There are two main strains of the monkeypox virus in central and west Africa.
“One [strain] has about a one per cent fatality rate, which is similar to COVID-19. And the other has about a 10 per cent fatality rate, which is similar to the first SARS,” Professor MacIntyre said.

The current outbreak in non-endemic countries appears to be the less severe strain.

How is it spread and what are the symptoms?

Monkeypox can spread to humans through close contact with an infected person or animal, the WHO says. It is transmitted from one person to another by close contact with lesions, body fluids or with material contaminated with the virus.
Australian Medical Association (AMA) Vice President Dr Chris Moy said that unlike viruses such as COVID-19, it requires a “fair bit of contact, so it’s not something that will spread like wildfire”.
“It’s actually quite hard to catch. Generally, it requires very close physical contact with somebody else who is infected with it and it goes through your skin, broken skin or through your eyes or nose,” he told SBS News.
Dr Moy said that most cases are mild and include symptoms of a high fever, headaches, swollen lymph nodes, muscle and body aches and a blistery pox-type rash on the body.

People with monkeypox are generally infectious for up to 21 days, until the lesions are healed and symptoms no longer persist.


Who is at risk?

People at risk are those who have had close physical contact with someone infected, while they are symptomatic.
Associate Professor John Blakey, a respiratory physician at Sir Charles Gairdner Hospital, told SBS News, “we’re all at risk of contracting a virus to which we don’t have that kind of natural immunity”.
According to the WHO, several of the cases that have been reported from non-endemic countries have been identified in men who have sex with men.
“The reason we are currently hearing more reports of cases of monkeypox in communities of men who have sex with men may be because of positive health-seeking behaviour in this demographic,” it says.
Professor Blakey said this was likely due to the mode of transmission rather than this community being more or less vulnerable to catching the virus.
“It seems as though there was a large spreader event … so that’s why there seems to be a lot of reports of transmission between men who have sex with men,” he said.
The United Nations’ AIDS agency (UNAIDS) on Sunday that some reporting on monkeypox has used language and imagery that “reinforce homophobic and racist stereotypes,” warning of exacerbating stigma and undermining the response to the growing outbreak.


“Stigma and blame undermine trust and capacity to respond effectively during outbreaks like this one,” UNAIDS deputy executive director Matthew Kavanagh said.
Thorne Harbour Health is a community organisation which supports LGBTIQ+ communities in Victoria.
Its Promotion Policy and Communications Director, Colin Batrouney, said these narratives were “espoused during the first decades of the epidemic of HIV and AIDS with catastrophic effects both to gay men, their loved ones, and the community at large”.
“One would hope that we are beyond that now,” he said.
He said the impacts of stigmatising language are many.
“For some, it reinforces both internalised and externalised homophobia which can have devastating consequences to the mental health and wellbeing of gay men,” he said.
“In addition, it can lead to gay men not seeking out diagnosis or treatment when they need it, leading to increased transmission and acquisition of infection.”
But WHO stresses the risk of monkeypox is not limited to people who are sexually active or men who have sex with men.

“Anyone who has close physical contact with someone who is infectious is at risk. Anyone who has symptoms that could be monkeypox should seek advice from a health worker immediately,” it says.

How concerned should we be?

At this point, experts advise that the risk to the general population is low, but awareness is important in managing the outbreak.
Sylvie Briand, WHO director for Global Infectious Hazard Preparedness, said on Tuesday that while the outbreak was “not normal”, it was “containable”.

“Let’s not make a mountain out of a molehill,” she said speaking at the World Health Assembly in Geneva.

In Australia, Dr Moy said there is currently no need for the general public to panic.
“It’s really more a medical issue that we need to be watching out for, and hopefully as we get more information, we’ll have a better idea about what we need to be doing,” he said.
“We’ve all been shell-shocked after COVID-19, but I don’t think we’re going to be talking about anything like that with regards to monkeypox.”
Professor Blakey said people should take simple measures that have already become common practice due to the COVID-19 pandemic, including maintaining physical distance, being cautious with coughing and sneezing, wearing masks in crowded public places and sanitising your hands.

He said people should also be aware that the virus can also spread by handling infected clothes and linen.

What about a vaccine?

According to WHO, vaccines used during the smallpox eradication program also provide protection against monkeypox, while newer vaccines have also been developed and approved for use against the virus.
The WHO is working on new guidance for countries on vaccination strategies and is convening further meetings to support member states with more advice on how to tackle the situation.
Some countries are already taking precautionary measures to vaccinate people who might have been exposed to the virus.
France and Denmark have begun vaccinating close contacts for the virus, while Germany has ordered 40,000 doses to be ready to deploy a similar strategy if an outbreak in the country becomes more severe.
Dr Moy said there is currently no vaccination strategy for monkeypox in Australia, but if there were a need for one in the future, it would focus predominantly on close contacts.
Victorian Chief Health Officer Brett Sutton said on Saturday that conversations were underway with the Commonwealth about the national medical stockpile and the use of smallpox vaccine for those who may have been exposed, along with the potential need for a small portion of frontline healthcare workers to be vaccinated.
He said close contacts of someone with the virus will likely be asked to quarantine. Who is regarded as a close contact and a timeframe for isolation would be determined, he said.
The state’s health department asks anyone who develops symptoms, particularly if they have recently travelled overseas or had contact with a case, to seek medical care.

With Reuters

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