Smallpox is the only disease we’ve ever managed to fully eradicate in humans; it hasn’t existed anywhere in the world since 1980. But its close relative, monkeypox, is still around. Monkeypox isn’t anywhere near as dangerous as smallpox, but a few recent outbreaks have public health officials worried.
In recent weeks, there have been 23 suspected cases in Spain, all in or near Madrid. There are 15 suspected and five confirmed cases in Portugal, and seven in the U.K. Two cases cropped up today in the United States. The U.S. CDC is concerned.
That’s because monkeypox is usually rare outside of tropical rainforest areas of Africa. But the patterns of recent cases suggest that the virus is more transmissible than in past outbreaks. For example, the U.K. cases include two clusters of people who were not in contact with each other, and only one involves a person who had recently traveled to an area with endemic monkeypox. It’s too early to say whether there’s potential for a pandemic here, but the pattern exhibits some of the red flags that make health officials worry.
How bad is monkeypox?
Monkeypox isn’t as deadly as smallpox, but it’s still dangerous. Fatality rates range from 0% to 11%, according to the World Health Organization. The better the medical care you can access, the better your chances of recovery.
Monkeypox hits children especially hard. People older than 50 or so are less likely to get it, because they were alive during the smallpox eradication campaign. Smallpox vaccination was common decades ago; if you’re young enough that you don’t have a smallpox vaccine scar on your arm, your parent or grandparent probably does.
What are the symptoms of monkeypox?
With an incubation period of 5 to 21 days, you won’t know if you’ve been infected right away. Once symptoms start, there is an “invasion phase,” lasting about the first five days, where you may have fever, muscle aches, fatigue, intense headaches, and swollen lymph nodes. The swollen lymph nodes are one of the big differences between monkeypox and other infections such as chickenpox.
Next comes the rash: You’ll get little lesions that start flat and then become raised, with liquid and then pus inside. These appear most often on the face (in 95% of cases) and the palms of the hands and soles of the feet (in 75% of cases). Other, similar diseases don’t usually have lesions on the palms of the hands; that’s a monkeypox special.
In total, illness lasts two to four weeks, and then you get better.
Is there a treatment or vaccine for monkeypox?
There is no specific treatment or drug for a person who has monkeypox. Treatment is “supportive care” that may include things like keeping skin lesions clean, making sure your airways are clear, and administering medications to handle fever and secondary infections.
Here’s the good news: we do have a vaccine. The smallpox vaccine, which is still available, seems to be effective against monkeypox.
How is monkeypox transmitted?
First, a fun fact: It’s not usually from monkeys. Monkeypox got its name from an outbreak that occurred in monkeys, but scientists aren’t sure which animal or animals most commonly carry the virus. Rodents are probably involved, and primates like monkeys and humans are also susceptible.
The virus is transmitted, according to the WHO, by “contact with lesions, body fluids, respiratory droplets, and contaminated materials such as bedding.” There is some suspicion that one of the clusters of cases in the U.K. may have come from sexual transmission.
Usually the virus doesn’t transmit very well from person-to-person; the WHO reports that the longest identified transmission chain involved six people. But if the latest outbreaks are more transmissible than before, that could change. Masks may help, since respiratory droplets are one of the means of transmission (and unlike COVID, monkeypox is thought to be spread by only large droplets, and not aerosols).
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