Infection control
Monkeypox symptoms manifest as pimply rashes on the body.
across the planet. But that hardly means these are questions not worth posing. In the way medical professionals and community activists can use education to fight the disease, or in the way governments have to ramp up vaccine production if they hope to successfully beat the virus, many of the challenges we faced during Covid have returned with monkeypox, and look set to stay relevant long into the future too. Even if monkeypox proves not to be as deadly or as enduring as Covid, it still has to be addressed with a public health strategy.
“It is important to keep in mind that anyone with close contact to someone with monkeypox lesions may become infected.” Professor Wafaa El-Sadr
Monkey business 77% The jump in
infections in the first week of July, without more than 6,000 known to have caught the disease.
WHO 36
Read some of the more breathless reports and you might be tempted to imagine that monkeypox is totally new. In fact, the disease, a virus that originally spread from animals to humans, has been around for years. As long ago as 1958, to give just one example, Danish scientists identified it as a distinctive disease – or perhaps that should be diseases. After all, there are in fact two strains of monkeypox, one more dangerous type originating in the jungles of the Congo basin, and a milder version further west. More to the point, both ‘clades’ of monkeypox, as they’re known officially, have long been endemic across nearly a dozen African countries. The Republic of the Congo has, for instance, recorded more than 1,000 cases in 2022 alone. Of course, the difference now, explains Wafaa
El-Sadr, is that monkeypox in more recent times has left the DRC and is infecting people in New York
and London. But how did this happen? El-Sadr, a professor at Columbia University and founder of the International Centre for AIDS Care and Treatment Programs, takes up the story. “It is thought that a person who was incubating the monkeypox infection travelled from one of the endemic countries, developed the disease, and then transmitted it to others through close contact, resulting in the current outbreak in non-endemic countries.” That certainly chimes with what we know: unlike Covid, monkeypox is not airborne, instead requiring physical touch, or else contact with infected clothes or bed sheets. Nor is that the only way that monkeypox differs from Covid. While the latter’s symptoms manifest internally – shortness of breath and flu-like symptoms – the most striking indication of monkeypox is pimply rashes on the body itself. Some of the more invisible symptoms include a fever, exhaustion and headaches. If all that sounds rather grim, the physical characteristics of monkeypox can at least be a useful way of figuring out if someone is infected. “Whether it’s monkeypox in the genital area, or monkeypox on another part of the body, just being suspicious of anyone with open sores, making sure that you don’t come in physical contact with them, is good advice for everyone,” stresses David Heymann, a distinguished epidemiologist and former chairman of Public Health England, who is now a professor at London School of Hygiene and Tropical Medicine.
Community transmission This last point is important – not least given the demographics that have borne the brunt of monkeypox across Europe and North America. According to a recent paper by the New England Journal of Medicine, around 95% of reviewed cases were transmitted by men during sex with other men. Yet Heymann speculates the gay community’s long and unhappy relationship with STDs is arguably at play here. Though monkeypox isn’t an actual STD, after all, Heymann hints that long traditions of self- diagnosis and check-ups mean the disease is being “amplified” by the gay community. This education- heavy approach is shadowed by actual rules. In England, to give one example, doctors are required to inform their local council or Health Protection Team if they suspect a patient has monkeypox. Not that monkeypox – like HIV before it – is a disease only the gay community can catch. For if self-reporting is helping turn that particular group into the virus’s reluctant standard bearers, all that’s needed to be infected is close contact with infected material, or non-sexual touch with a sick individual. As El-Sadr puts it: “It is important to keep in mind that anyone with close contact to someone with monkeypox lesions may become infected.” This
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