Monkeypox — a global health issue after COVID-19
By: Sherilyn Wong
Just as we started to see the light at the end of the tunnel that was the COVID-19 pandemic, on July 23, 2022, the World Health Organization declared the growing monkeypox outbreak a global health emergency of international concern. (1) As of 19 September 2022, over 64,000 cases of monkeypox have been reported, with the United States of America having the highest number of cases. (2) Many of these cases were found in men who have sex with other men. (3)
Monkeypox is not a new viral infection. It was first identified in 1970 and previously occurred in Central and West Africa. The monkeypox virus is part of the same family of viruses as smallpox. It is transmitted from animals to humans through direct contact with bodily fluids, while human-to-human transmission can occur via respiratory droplets. Symptoms include a rash, which can initially appear as blisters and may be painful or itchy, and flu-like symptoms (fever, chills, muscle aches, fatigue, headache). (4) These are self-limiting and usually resolve within 2–4 weeks; however, severe cases, such as in immunocompromised people, can lead to complications and hospitalization. Additionally, swelling of the lymph nodes is characteristic of monkeypox compared to similar diseases, such as chickenpox, smallpox, or measles. A person is considered infectious and can spread monkeypox from the time symptoms start until the rash is completely healed, scabs have fallen off, and a new layer of skin has formed.
Previous smallpox vaccination has been demonstrated to be at least 85% effective at reducing the risk of contracting monkeypox. (5) As smallpox vaccination campaigns ceased after the disease was eradicated in 1980, the majority of the younger generation today may not have the same level of protection against monkeypox. (6) The JYNNEOS vaccine, which is a live-modified viral preparation, is recommended for those people at high risk of infection and is administered in two doses spaced 28 days apart. (7) The ACAM2000 vaccine is also available and requires special training for administration. (8)
Reducing the risk of human-to-human transmission is critical in preventing another pandemic. While symptomatic, the individual should remain isolated, wear a mask, and keep all parts of the rash and lesions covered. (9) Close contacts should monitor for symptoms for 21 days after exposure. Pharmacists should be able to recognise the features of monkeypox to distinguish it from COVID-19 or influenza, as the flu-like symptoms may be similar, and advise relevant patients to self-monitor or isolate. As we have become very proficient in doing over the past 3 years, maintaining high standards of cleaning, disinfecting, and wearing personal protective equipment in healthcare settings can help reduce the risk of transmission.
While monkeypox is not yet classified as a pandemic, COVID-19 has taught us to stay vigilant and not become complacent in doing our part to spread awareness and prevent community transmission.
References:
1. World Health Organization. WHO Director-General declares the ongoing monkeypox outbreak a Public Health Emergency of International Concern 2022 [Available from: https://www.who.int/europe/news/item/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern.
2. Centers for Disease Control and Prevention. 2022 Global Map & Case Count 2022 [Available from: https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html.
3. World Health Organization. Monkeypox questions and answers 2022 [Available from: https://www.who.int/news-room/questions-and-answers/item/monkeypox.
4. Centers for Disease Control and Prevention. Monkeypox symptoms 2022 [Available from: https://www.cdc.gov/poxvirus/monkeypox/symptoms/index.html.
5. World Health Organization. Monkeypox 2022 [Available from: https://www.who.int/news-room/fact-sheets/detail/monkeypox.
6. Centers for Disease Control and Prevention. Smallpox 2022 [Available from: https://www.who.int/health-topics/smallpox.
7. Centers for Disease Control and Prevention. JYNNEOS Vaccine 2022 [Available from: https://www.cdc.gov/poxvirus/monkeypox/interim-considerations/jynneos-vaccine.html.
8. U.S. Food & Drug Administration. ACAM2000 (Smallpox Vaccine) Questions and Answers 2022 [Available from: https://www.fda.gov/vaccines-blood-biologics/vaccines/acam2000-smallpox-vaccine-questions-and-answers.
9. Centers for Disease Control and Prevention. Infection Control in Healthcare Settings 2022 [Available from: https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html.
