Monkeypox is a viral zoonotic disease seen in Central and West Africa . It resembles smallpox in appearance . Outbreaks are recently reported from North America and Europe.
Monkeypox is caused by monkeypox virus,
a member of the Orthopoxvirus genus in
the family Poxviridae.
Monkeypox typically presents clinically
with fever, rash and swollen lymph nodes and may lead to a range of medical complications.
Monkeypox is usually a self limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases can occur.
In recent times the case fatality ratio has been around 3-6%.
Monkeypox is transmitted to humans through close contact with an infected
person or animal or with material contaminated with the virus .
Monkeypox virus is transmitted from one person to another by close contact with lesions ,body fluids, respiratory droplets
and contaminated materials such as clothes.
The incubation period of monkeypox is
usually from 6 to 13 days but can range from
5 to 21 days .
The infection can be divided into two periods:
The invasion period (lasts between O-5
days) : characterized by fever, intense
headache lymphadenopathy , back pain, myalgia
and intense asthenia .
Lymphadenopathy is a distinctive feature of monkeypox compared
to other diseases that may initially appear
similar to it like (chickenpox, measles, smallpox).
The skin eruption usually begins within 1- 3 days of appearance of fever. The rash tends to be more concentrated on the face and extremities rather than on the trunk .It
affects the face and palms of the hands and soles of the feet . Also
infected are oral
mucous membranes ,
genitalia , conjunctivae, as
well as the cornea.
The clinical differential diagnosis includes other rash illnesses, such
as chickenpox , measles ,bacterial skin infections, scabies ,syphilis, and medication
the prodromal stage of illness can be a clinica
feature to distinguish monkeypox from
chickenpox or smallpox.
If monkeypox is suspected , health workers should collect an appropriate sample and have it transported safely to a laboratory with
appropriate testing facilities.
reaction (PCR) is the preferred laboratory test
given its accuracy and sensitivity.
The clinical presentation of monkeypox
resembles that of smallpox, a related
orthopoxvirus infection which has been
Smallpox was more easily
transmitted and more often fatal as about 30% of patients died . The last case of
naturally acquired smallpox occurred in 1977
and in 1980.
Smallpox was declared to have
been eradicated worldwide after a global
campaign of vaccination and containment. It
has been 40 or more years since all countries,
ceased routine smallpox vaccination with
vaccinia based vaccines .
Whereas smallpox no longer occurs naturally,
the global health sector remains vigilant in the
event it could reappear through natural
mechanisms like laboratory accident or deliberate
To ensure global preparedness in the event of reemergence of smallpox, , newer
vaccines diagnostics and antiviral agents are
being developed . These may also now prove
useful for prevention and control of monkeypox.
Clinical care for monkeypox should be fully
optimized to alleviate symptoms ,manage complications and prevent long-term
An antiviral agent
known as ” tecovirimat ” that was developed for
smallpox was licensed by the European
Medical Association (EMA) for monkeypox in
It is not yet widely available for patient care.
deally be monitored in a clinical research
Vaccination against smallpox was demonstrated through several observational
studies to be about 85% effective in
preventing monkeypox .
Thus, prior smallpox
vaccination may result in milder illness .
Evidence of prior vaccination against smallpox
can usually be found as a scar on the upper
At the present time the original (first-
generation) smallpox vaccines are no longer
available to the general public .
laboratory personnel or health workers may
have received a more recent smallpox vaccine
to protect them in the event of exposure to
orthopoxviruses in the workplace .
A still newer vaccine based on a modified
attenuated vaccinia virus (Ankara strain) was
approved for the prevention of monkeypox in 2019 . This is a two-dose vaccine for which availability remains limited .
monkeypox vaccines are developed in
formulations based on the vaccinia virus due
to cross-protection afforded for the immune
response to orthopoxviruses .
Raising awareness of risk factors and
educating people about the measures they
can take to reduce exposure to the virus is the main prevention strategy for monkeypox.
Scientific studies are now underway to assess
the feasibility and appropriateness of
vaccination for the prevention and control of
Some countries have, or are
developing, policies to offer vaccine to
persons who may be at risk such as laboratory
personnel, rapid response teams and health
Reducing the risk of human to human transmission,
surveillance and rapid identification of new cases is critical for outbreak containment.
During human monkeypox outbreaks, close
contact with infected persons is the most
significant risk factor for monkeypox virus
Health workers and household
members are at a greater risk of infection.
Health workers caring for patients with suspected or confirmed monkeypox virus
infection, or handling specimens from them,
should implement standard infection control
selected to care for the patient.