Monkeypox | Monkeypox Symptoms, Diagnosis and Treatments


Monkeypox | Monkeypox Sign and Symptoms, Preventions, Diagnosis and Treatments

Monkeypox Introduction

A viral zoonosis is monkeypox (a virus that spreads from animals to people). It displays symptoms that are comparable to those of smallpox but is less severe clinically. Since smallpox was eradicated in 1980 and smallpox immunizations were subsequently discontinued, monkeypox has taken the position of smallpox as the most important orthopoxvirus for public health. Monkeypox has been spreading into cities and is commonly found close to tropical rainforests; it primarily affects central and west Africa. Animals are hosted by a variety of dangerous rodent species and non human primates.

The pathogen

The Orthopoxvirus genus of the Poxviridae family contains the enclosed double-stranded DNA virus known as the monkeypox virus. The central African (Congo Basin) clade and the west African clade are two separate genetic clades of the monkeypox virus. In the past, it was believed that the Congo Basin clade was more contagious and caused more severe sickness. The only nation where both viral clades have been discovered is Cameroon, which serves as the geographic boundary between the two groups.

Natural host of monkeypox virus

The monkeypox virus has been found to be susceptible to several animal species. This comprises non-human primates, dormice, rope and tree squirrels, Gambian pouched rats, and other species. There is still uncertainty about the monkeypox virus's natural history, and further research is required to pinpoint the precise reservoir or reservoirs and understand how the virus circulates in the wild.

Monkeypox Outbreaks

The first case of human monkeypox was discovered in the Democratic Republic of the Congo, where smallpox had been eradicated since 1968, in a 9-month-old boy. Since then, there has been a gradual increase in the number of human cases across central and west Africa, with the bulk of cases occurring in the rural, rain forest regions of the Congo Basin, primarily in the Democratic Republic of the Congo.

The 11 African nations where human cases of monkeypox have been recorded since 1970 include Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Cote d'Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan.Unknown is the true cost of monkeypox. For instance, in the Democratic Republic of the Congo in 1996–1997, an outbreak with a lower case fatality ratio and a greater attack rate than usual was observed. It is possible that the varicella virus, which is not an orthopoxvirus, altered the dynamics of transmission in this case, explaining the simultaneous epidemics of chickenpox and monkeypox. Since 2017, Nigeria has recorded over 500 suspected cases, over 200 confirmed cases, and a case fatality rate of roughly 3%. Even now, cases are still being recorded.

Given that it affects the rest of the world in addition to countries in west and central Africa, monkeypox is a disease of worldwide public health significance. The first monkeypox outbreak outside of Africa occurred in the United States of America in 2003, and contact with pet prairie dogs that had the disease was to blame. These pets had been kept with dormice and pouched rats from Ghana that were imported from the Gambia. In May 2022, instances of monkeypox were discovered in a number of non-endemic countries. Studies are being conducted right now to learn more about the epidemiology, sources of illness, and patterns of transmission.

First case of Monkeypox in india

On July 24, 2022, the day after the World Health Organization proclaimed it a Public Health Emergency of International Concern, Delhi reported its first case of monkeypox.

A 34-year-old male Delhi resident was quarantined at Lok Nayak Hospital due to a probable case of monkeypox, according to the Health Ministry.

"The National Institute of Virology (NIV), Pune, has confirmed the diagnosis. The patient is currently healing at Lok Nayak Hospital's authorised isolation facility, according to the Ministry.

Transmission of Monkeypox

Animal-to-human (zoonotic) transmission can occur by direct contact with the blood, bodily fluids, cutaneous, or mucosal lesions of infected animals. Numerous animals in Africa, including rope squirrels, tree squirrels, Gambian pouched rats, dormice, various species of monkeys, and others, have shown signs of monkeypox virus infection. Although it has not yet been determined, rodents are the most likely candidates for the monkeypox natural reservoir. Consuming raw meat and other infected animal products can increase risk.  People who live in or close to forests may be indirectly or minimally exposed to infected animals.

Human-to-human transmission may be triggered by close contact with respiratory secretions, skin lesions on an infected person, or recently contaminated objects. Health professionals, family members, and other close contacts of current patients are more at risk because droplet respiratory particles typically require extended face-to-face contact. The number of person-to-person infections in a community's longest documented chain of transmission has increased from 6 to 9 in recent years. This might be an indication of a general decline in immunity brought on by the end of smallpox vaccination campaigns. Congenital monkeypox can result through transmission through the placenta, which can also happen during intimate contact during labour and after delivery. Although close physical contact is a known risk factor for transmission, it is not known at this time whether monkeypox can particularly spread through sexual intercourse. Studies are required to comprehend this risk better.

Symptoms and Signs

Monkeypox normally takes 6 to 13 days to incubate, while symptoms can show up anywhere between 5 and 21 days later.

There are two phases to the infection:

the 0–5-day invasion period is marked by fever, severe headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle aches), and severe asthenia (lack of energy). In contrast to other illnesses that may initially look similar (chickenpox, measles, smallpox), monkeypox is distinguished by lymphadenopathy. The skin eruption typically starts 1-3 days after the onset of fever.  Along with the cornea, oral mucous membranes (in 70% of cases), genitalia (30%), conjunctivae (20%), and the genitalia are also impacted. The progression of the rash goes from flat macules to slightly elevated hard papules, vesicles filled with clear fluid, pustules filled with yellowish fluid, and finally crusts that dry up and fall off. Lesions can range from a few to several thousand in number. In severe cases, lesions may combine to the point where substantial amounts of skin slough off.

Monkeypox often has symptoms that last between two and four weeks and is a self-limiting condition. Children are more likely to experience severe cases, which are connected to the level of viral exposure, the patient's condition, and the type of problems. In the event of immunological impairments, the outcomes might be severe. Although smallpox immunisation proved protective in the past, people under the age of 40 to 50 (depending on the country) may now be more susceptible to monkeypox due to the worldwide discontinuation of smallpox vaccine campaigns after the illness was eradicated. Monkeypox complications can include secondary infections, bronchopneumonia, sepsis, encephalitis, and corneal infections with subsequent vision loss. How widespread an asymptomatic infection might be is unknown.

In the general population, the case fatality ratio of monkeypox has traditionally fluctuated from 0 to 11%; it has been higher in young children. Recently, the case mortality rate ranged from 3 to 6 percent.


Other rash disorders, such as chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies, must be taken into account when making a clinical differential diagnosis. As a clinical characteristic, lymphadenopathy during the prodromal stage of the illness can help differentiate monkeypox from chickenpox or smallpox.

Health professionals should get the right sample and arrange for it to be delivered safely to a lab with the right equipment if monkeypox is detected. The kind of laboratory test used and the type and quality of the specimen used determine whether monkeypox is confirmed. As a result, specimens should be shipped and packaged in accordance with local, state, and federal regulations. Given its accuracy and sensitivity, polymerase chain reaction (PCR) is the preferred laboratory test. The best diagnostic samples for monkeypox come from skin lesions, such as dry crusts and the liquid that comes from vesicles and pustules. Biopsy is a possibility when it is possible to do so. Lesion samples must be maintained cool and stored in a dry, sterile tube without viral transport medium. Due to the short period of viremia in relation to the date of specimen collection after symptoms begin, PCR blood tests are typically inconclusive and should not be regularly obtained from patients.

Antigen and antibody detection techniques do not offer proof of monkeypox-specific infection because orthopoxviruses are serologically cross-reactive. Therefore, in cases where resources are scarce, serology and antigen detection procedures are not advised for diagnosis or case inquiry. Furthermore, recent or distant immunisation with a vaccinia-based vaccine (for example, anyone immunised prior to the eradication of smallpox, or more recently due to heightened risk, such as orthopoxvirus laboratory employees) may result in false positive results.

The following patient data must be included with the specimens in order to interpret test results: a) age; b) date of onset of fever; c) date of specimen collection; d) date of current condition of the patient (stage of rash); and e) date of beginning of rash.


In order to treat monkeypox symptoms effectively, handle complications, and avoid long-term effects, clinical care must be properly optimised.  The secondary bacterial infections should be treated as necessary. Based on information from both animal and human research, the European Medicines Agency (EMA) granted tecovirimat, an antiviral drug originally created to treat smallpox, a licence to treat monkeypox in 2022. It is still not readily accessible.

If tecovirimat is used to treat patients, it is ideal to track its effectiveness in a clinical research setting with ongoing data collection.



Several observational studies have shown that smallpox vaccination is roughly 85% effective in preventing monkeypox. A previous smallpox vaccine may result in a milder illness. A scar on the upper arm is typically present as proof of previous smallpox immunisation. The first-generation (original) smallpox vaccines are no longer accessible to the general population. Some laboratory or healthcare employees may have had a more current smallpox vaccination to safeguard them from orthopoxvirus exposure at work. A brand-newer vaccine for the protection of monkeypox was approved in 2019 and is based on the Ankara strain of the modified attenuated vaccinia virus. This two dose vaccine is still only partially available till now. Because the vaccinia virus provides cross-protection for the immune response to orthopoxviruses, formulations of the smallpox and monkeypox vaccines are based on this virus.


The most effective way to prevent monkeypox is to raise public awareness of risk factors and inform people of the activities they may take to reduce viral exposure. A scientific evaluation of the viability and suitability of vaccination for the prevention and control of monkeypox is now being conducted. Some nations have policies in place or are creating them to provide vaccines to people who may be at risk, including laboratory staff, members of quick reaction teams, and healthcare professionals.

Reducing the risk of human-to-human transmission

To contain an outbreak, surveillance and quick case identification are essential. The main risk factor for monkeypox virus infection during human monkeypox epidemics is intimate contact with sick people. The risk of infection is higher for household members and healthcare staff. Health professionals should follow the recommended infection control procedures while caring for patients with a monkeypox virus infection that has been suspected or confirmed or when handling specimens from such patients. Caretakers should ideally be people who have already received a smallpox vaccination.

Samples taken from individuals and animals that may have been exposed to the monkeypox virus should only be handled by trained personnel working in appropriately furnished laboratories. In compliance with WHO recommendations for the transfer of infectious substances, patient specimens must be safely packaged for transportation using triple packaging.

It is unusual to see clusters of monkeypox cases in May 2022 in numerous non-endemic nations with no known travel connections to an endemic region. More research is being done to identify the infection's likely origin and stop its further spread. In order to protect public health, it is crucial to consider all potential channels of transmission as the cause of this outbreak is being looked into.

Reducing the risk of zoonotic transmission

Over time, primary animal-to-human transmission has been the cause of the majority of human infections. It is important to avoid unprotected contact with wild animals, especially those that are sick or dead, as well as their flesh, blood, and other byproducts. All items containing animal meat or parts must also be fully cooked before consumption.

Preventing monkeypox through restrictions on animal trade

Some nations have laws in place that limit the importing of non-human primates and rodents. Animals kept in captivity who might have monkeypox should be quarantined right away and kept separate from other animals. Animals that may have come into contact with an infected animal must be confined, handled with standard safety precautions, and kept under observation for 30 days for indications of monkeypox.

How monkeypox relates to smallpox

A closely related but now extinct orthopoxvirus disease, smallpox, and monkeypox share a number of clinical traits. Smallpox was more easily spread and more frequently lethal because roughly 30% of patients died from it. The final naturally occurring incidence of smallpox occurred in 1977, and smallpox was declared eradicated globally in 1980 following a global vaccination and containment programme. Since all nations stopped administering vaccinia-based vaccines for routine smallpox vaccination, it has been at least 40 years. Unvaccinated populations are now more vulnerable to infection with the monkeypox virus because vaccination also provided protection against monkeypox in west and central Africa.

The global health community is on high alert in case smallpox might reappear owing to natural processes, laboratory errors, or purposeful release even though it is no longer a naturally occurring illness. Newer vaccines, diagnostics, and antiviral medicines are being developed to ensure worldwide preparation in the event of the return of smallpox. These may now be useful in the treatment and prevention of monkeypox.

Monkeypox Key facts

  • The monkeypox vaccines employed in the smallpox eradication operation also offered protection from that disease. One of the more recent vaccinations that has been created is licenced to prevent monkeypox.

  • The monkeypox virus, a species of the Orthopoxvirus genus in the family Poxviridae, is the culprit behind monkeypox.
  • Monkeypox often has symptoms that last between two and four weeks and is a self-limiting condition. Severe cases could exist. Recently, the case mortality rate ranged from 3 to 6 percent.
  • Monkeypox can be spread to humans by close contact with infected animals or people, as well as through coming into contact with contaminated materials.

  • The monkeypox virus can be transferred from one person to another by coming into close contact with lesions, body fluids, respiratory droplets, and infected items like bedding.

  • A viral zoonotic illness called monkeypox is most common in tropical rainforest regions of central and west Africa, with sporadic exportations to other places.

  • Monkeypox has been officially treated with an antiviral drug that was originally created to treat smallpox.

  • Monkeypox has a clinical appearance similar to smallpox, an orthopaxvirus infection that was eradicated globally in 1980.

  • Compared to smallpox, monkeypox is less contagious and has milder symptoms.

  • Fever, rash, and swollen lymph nodes are some of the clinical signs of monkeypox, which can also cause other health problems.

WHO response

In afflicted nations, WHO assists Member States with surveillance, outbreak response, and preparation efforts for monkeypox.

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