Infection control
is gradually being borne out in the statistics. At the time of writing, the Centre for Disease Control and Prevention (CDC) reports two cases of monkeypox in children, while a Texan woman recently tested positive. That’s echoed by rising case numbers more broadly. Naturally, total cases are still dwarfed by Covid, but the first week of July nonetheless saw a 77% jump in infected individuals, with more than 6,000 people now known to have caught the disease. And that’s before you consider the many unrecorded cases that are likely to be circulating too.
Behind these alarming headlines, though, what’s the actual threat of monkeypox to the average person? Here, fortunately, there’s a spot of good news. “Based on prior information,” explains El-Sadr, “most cases tend to be mild or self-limited.” That’s amply reflected in the figures. No one in the Western world yet is known to have died from monkeypox, testament to the relative gentleness of the West African clade, the one that made the jump from Liberia, Sierra Leone and other endemic countries. In practice, most people can expect their case of monkeypox to remind them of childhood chickenpox, with those tell-tale spots completely disappearing within about a month.
Our passport out of here? Not that we should lower our guard just yet. For as El-Sadr emphasises, monkeypox can still be dangerous for a minority. For one thing, she explains how lesions in the urethra or anus can cause severe pain, especially when urinating or defecating. Lesions in the eye can cause even nastier problems, especially for immunosuppressed individuals. That’s shadowed by broader concerns. We might have been lucky by importing the West African clade – but if the Congolese ever arrives, we risk more serious trouble. Nearly 60 people are estimated to have been killed by Congolese strain so far this year, with some researchers arguing that hundreds of deaths are going unrecorded in isolated jungle settlements. To put it another way, what’s arguably needed in the fight against monkeypox is a response as robust and speedy as the one we eventually saw with Covid, if only to prevent a more serious outbreak in future. As a disease that spreads through close contact, in fact, that response surely begins with keeping infected individuals away from the rest of society. It also means providing people who exhibit severe disease with the treatment they need. One option is antiviral drugs, which El-Sadr stresses are effective, and which have successfully been used to attack the side effects of AIDS. Then there’s the question of vaccines. Like with Covid, they promise to stop monkeypox in their tracks, especially since doctors already have doses
Practical Patient Care /
www.practical-patient-care.com
at their disposal. “There is a vaccine,” says Heymann. “In fact, it’s been licensed to prevent monkeypox.” Similar to the traditional smallpox vaccine, Heymann adds this new vaccine, known as Jynneos, doesn’t replicate in the human body, making it safer for HIV-positive people who are at risk of more serious disease generally. Given that available summary surveillance data from the European Union, as well as separate reports from Portugal, Spain and England suggests that 30% to 51% of patients with monkeypox also have HIV – that’s undoubtedly good news.
‘Clades’ of monkeypox have long been endemic across nearly a dozen African countries.
“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.” Professor David Heymann
Of course – as the past few years once again make clear – getting a vaccine approved is only half the battle. The fight against monkeypox might only truly be won if doctors succeed in getting jabs into arms. In part, that’s a question of capacity. Like with Covid, governments are rushing to get doses through factory gates, with the FDA hoping to have 800,000 Jynneos shots available soon. Not that they’ll necessarily all have to be used: between careful quarantining and continuing active education of vulnerable groups, the second global health emergency of recent years could yet be stopped in its tracks, unless the Congolese clade spreads anyway.
1,000
The number of monkeypox cases in the Republic of the Congo.
WHO 37
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