Monkeypox Existed Before 2022 Outbreak, But Human-to-Human Transmission Was Uncommon: Expert

The World Health Organization (WHO) has said that the monkeypox virus is now spreading among vulnerable groups, such as pregnant women, immunocompromised people, and children. It describes monkeypox as a zoonotic disease, spreading from animals to humans. Before the 2022 outbreak, monkeypox already existed in West and Central Africa.

More than 3,400 confirmed cases of monkeypox have been reported in 50 countries, according to the WHO. The majority of cases have been reported in Europe (86%), the US (11%), and Africa (2%). At least one death has been reported in Nigeria. The organization said that "it occurs primarily in tropical rainforest areas of central and west Africa and is occasionally exported to other regions."

Sputnik spoke to Dr. Vikram Vora, medical director at International SOS, to understand what the trajectory of the outbreak shows, as well as the behavior of the disease.

Sputnik: There has been an uptick in monkeypox cases in many countries. What factors might have led to this?

Dr. Vora: What we know about monkeypox so far is based on historical data from the 1970-80s. The virus, in the current outbreak, is behaving very differently from the previous outbreaks. The virus [learned to spread] earlier, from animals to humans. But now it is spreading from human to human.

Now, unlike in the 80s, humans are more interconnected and travelling than ever. Geography is not limiting. Now, these are some of the things that are thought to be responsible for this current uptick in cases across countries.

Sputnik: Even the WHO report sheet said that monkeypox could be transmitted by close contact with respiratory secretions, skin lesions of an infected person, and recently contaminated objects. In such a situation, what precautions are suggested?

Dr. Vora: Monkeypox and smallpox are related, they're from the same family of viruses. The monkeypox virus lives in large droplets, when we speak or cough, some droplets are released, and most of the time, they fall to the ground immediately. Hence, they don't travel. When they fall to the ground, the virus gets inactivated.

Also, these droplets can travel when a person has prolong close face-to-face contact with an infected person, which is very unlikely in public places or community scenarios.

It is not as severe as smallpox or COVID. Its symptoms include fever along with rashes and pus-filled pustules. Precautions include social distancing and regular hand washing. Moreover, avoid contact with sick animals.

Sputnik: Are there chances of asymptomatic transmission?

Dr. Vora: Asymptomatic transmission has so far not been recorded. And that's because monkeypox takes about five to 21 days during its incubation period, it is not infective. So it's only after this incubation period when symptoms develop in an individual. That's when a person is capable of transmitting the infection.

Sputnik: There are some concerns that most of the monkeypox cases have been reported among people from sexual minority communities. Can a novel monkeypox outbreak create a pattern like the HIV/AIDS epidemic?

Dr. Vora: The monkeypox outbreak is not the same as the HIV/AIDS epidemic. It is a very mild disease compared to HIV/AIDS and is self-limiting. It gets cured in about two to three weeks. So, disease patterns are very different.

Because of fear and uncertainty, individuals are under the impression that monkeypox can only affect those of a specific sexual orientation. Although, a large number of cases of monkeypox have already been seen in a particular sexual orientation group, monkeypox can affect any sexual orientation. And that's something that we must remember.

Sputnik: After the eradication of smallpox, some reports suggested a previous outbreak of monkeypox, especially in vulnerable countries (in Africa). Were these reports neglected?

Dr. Vora: We must understand where monkeypox is actually endemic and rare. It is seen every year, but this year is different. Normally, monkeypox cases are reported in African countries. These African countries are resource-strapped economies and dependent upon the rest of the world, especially for updated research and support.

In 1980, the WHO declared smallpox as eradicated. Many developed countries who has remaining vaccines, pledged them to the WHO.

However, these were first generation vaccines which had serious side effects (including fatalities). Hence using them for endemic countries was not thought to be suitable.

Once the WHO confirmed smallpox eradication (especially in developed nations), global research was reduced. Even if someone introduced new vaccines, they were either small in number or fewer distributors were available, affecting African nations, as no vaccines or research was available.

That is the thing about research and innovation – there has to be a pressing need that will ensure funding.

Sputnik: How do you foresee the impact of this outbreak?

Dr. Vora: Monkeypox has not yet been declared a global public health emergency of international concern. As of now, we have seen case numbers rise right from the beginning of May. But this rise has been gradual, it's not exponential, like COVID-19 cases.

So far, only one death has been seen.

Countries have already begun preparing either by putting together screening protocols, management strategies, organizations, and individuals, all of which are actively playing some role and they're updated with the latest information, this is helping nations to minimize the impact of this outbreak.

Sputnik: There are many countries, including India, where no cases have been detected.

Dr. Vora: It's not a question of if this disease comes to India, it's when India will see its first case in the future. In the meantime, the government has set strict surveillance for international fliers at airports to detect symptoms.

During the initial stage of COVID, the Indian population was subjected to an overload of misinformation. Now, states like Maharashtra and Karnataka have opened special isolated wards for infectious diseases.

But the most important role has to be played by the individual. We must ensure that when we travel internationally, we stay away from sick animals and maintain social distancing. Don't consume raw meat or meat from hunted animals, don't indulge in unsafe practices (sexual or otherwise). After travels, keep yourself isolated for a few days.

Sputnik: Is there a possible cure available? Can vaccination help to stop the outbreak?

Dr. Vora: Monkeypox, as I said, is a self-limiting disease, it takes about two to three weeks for an infected person to recover fully. And some antiviral medications target smallpox and are expected to work [on] monkeypox.

But what these do is shorten the duration of symptoms. They're not curative.

However, these drugs are not available worldwide. It is because trials of these drugs have not been done worldwide. So, I think they need to undergo wider trials globally before they can be approved for global use.

Smallpox vaccines provide about 85% protection against monkeypox. However, not all individuals have received it before 1980. But if we start vaccinating everybody, [it] would not be a good idea at this time. So, what the most affected countries are doing is that they're relying on a strategy that we call ring vaccination in the medical fraternity.

This ring vaccination means that all those who are in close contact with infected people are isolated and given this vaccine. That helps control the chain of infection and hence reduces the spread. So, vaccination at this stage should be reserved. Also, universal vaccination doesn't seem to be required.

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