What is Monkeypox and what’s its connection to Smallpox?

What virus family does the monkeypox belong to and what other viruses do we know from this family?

The virus family is Poxvirus. This family is well known in pediatrics because of the ubiquitous virus that causes the all too common, benign viral wart known as molluscum (see article on molluscum or viral warts, here). But the viral family is about the only thing that these two viruses have in common.

Also, the infamous smallpox virus belonged to this family as well before it was eradicated from the globe not too many years ago. The connection between smallpox and monkeypox is important to know, as you will see later in this article, since the vaccine that eradicated smallpox may use to induce immunity in certain circumstances against monkeypox.
Essentially, up until 1970, smallpox and monkeypox could not be accurately differentiated. It was only when smallpox was eradicated while simultaneous cases of monkeypox appeared that we understood that we are dealing with two different pathogens.

Where did monkeypox come from and how is it transmitted?

Monkeypox is a zoonotic virus, meaning it was transferred to people from animals. Nevertheless, the name is quite misleading since it doesn’t only infect monkeys. This virus can be found in many rodents and even in our adorable household pets.
So how does a human get infected from an animal? Well simple, through direct contact with an infected secretion or direct contact with an infected animal.
Moreover, this recent outbreak proves that transmission is possible between people as well. People can catch the virus through direct contact with infected secretions (e.g. contact with the rash or even infected linens and clothes), as well as through respiratory droplets.

What’s the incubation period (the period in which a person is infected until they are symptomatic) for the monkeypox?

Usually between 6-13 days, but the range is officially 5-21 days.

Are children more susceptible to this virus?

The answer to this question is tricky. Research from previous outbreaks show that children contracted this disease more often than adults. However, it is possible that the data is skewed since some of their adult counterparts may have been immune due to the smallpox vaccine that was still routinely administered in their childhood; and as we already stated, this vaccine confers some immunological protection against the monkeypox as well.

What are the symptoms of monkeypox?

Well before the rash appears, temperatures spike along with myalgia (muscle pain), headaches, swollen lymph nodes and general malaise. 1-3 days later the telltale rash appears, beginning in the face, which includes raised papule that later turn into vesicles and large scabs.
The disease lasts for about 2-4 weeks and its usually self-limiting.

What are the complications of this disease?

It’s quite similar to other viral infections. It can cause secondary bacterial infections on the skin (bacteria enters through open wounds), pneumonia, brain inflammation (encephalitis) and corneal infections.

Is monkeypox a dangerous disease?

Note the difference between smallpox, which is a considered to be a serious disease with about a 30% mortality rate, to monkeypox which is a milder disease with much lower rates of morbidity and mortality. Furthermore, most of the data that we have about this disease comes the outbreak over 50 years ago in remote places in the world in people were already more vulnerable who often received limited and outdated treatment.

How can we diagnose monkeypox?

As always, the suspicion comes from the epidemiological connection in combination with the relevant symptomatology.

The definitive microbiological analysis is via a PCR test from fluid-filled vesicles or other bodily fluids in a reference laboratory.

What’s happening in the current monkeypox outbreak?

First of all, it’s important to know that sporadic cases happen all the time, especially in people who travelled to certain endemic countries in Africa. In this current outbreak, which possibly can be traced back to a festival in Spain, tens of cases were identified throughout the world. The number of cases and countries continues to rise, however, relatively not rapidly.

Is there a treatment for the monkeypox?

Aside from supportive treatment (e.g. antipyretics for fever and pain and fluids to prevent dehydration) there is no specific or proven anti-viral treatment to date for the monkeypox.

Is there is a vaccine against the monkeypox?

Well that’s complicated.
There is a vaccine against smallpox that confers immunity against monkeypox.
Remember that many developed countries administered the smallpox well into the 1980’s. Additionally, many countries continued to vaccinate military personnel well into the 1990’s.
The old vaccine was called ACAM2000 and it was a live, attenuated vaccine that contained the virus Vaccinia which was very similar to the smallpox virus (also known as Variola). Transmission of the virus from the vaccine receipt to other people was reported, especially among the immunocompetent or those with atopic dermatitis.

There is a new vaccine, that’s also a live attenuated vaccine, named JANNEOS (also known as Ivamnex or Imvamune). This vaccine is given in two doses, at least 4 weeks apart from each other, to adults over the age of 18 years old to prevent smallpox and monkeypox.
Although this new vaccine is a live attenuated one, it cannot replicative in the human cells and thus, can be given also to immunocompromised people.

Will the vaccine be reinstated because of the recent monkeypox virus?

As of now it seems that we are far from that point. People that are high risk for this disease, such as laboratory personnel or those exposed to monkeypox will be vaccinated.

But, as always, we’ll follow this current outbreak together and update when necessary.
Most importantly, we won’t let anyone unnecessarily concern us!