Does monkeypox have the potential to become the next pandemic?

Dr. Jeff Hersh

Q: Is monkeypox the next pandemic?

A: The mechanism of transmission of this disease (see below) is a big reason I am hopeful this will not be the case.

Monkeypox is an orthopoxvirus, in the same family as smallpox, cowpox and vaccinia (the virus used to create the smallpox vaccine as it is similar enough to give immunity to smallpox but does not cause the disease), but does not have any relation to chickenpox. It is called monkeypox because the first documented cases of it in 1958 were in monkeys being kept for polio research in Denmark (it did not jump from these monkeys to humans at that time). It is actually thought that rodents/small mammals in Africa (and maybe other places) such as certain squirrels, rats, dormice and maybe others, are the reservoir where this virus resides (often without any symptoms), then possibly passing to other animals/species to cause an outbreak.

In fact, the first cases in the U.S. were in 2003 when some prairie dogs became carriers when they shared bedding and/or caging with other mammals that had been brought from Africa as exotic pets, and these prairie dogs spread the disease to people. So monkeypox is a very misleading name.

Monkeypox can spread from certain animals to humans, and also human-to-human in the following ways:

  • Direct contact with the virus from liquid oozing from the rash’s lesions (this is thought to be the most common method if spread) and/or certain body secretions. This can be through direct contact with the infected person’s/animal’s fluids or from contact with a fomite (an object or material that has been contaminated with the virus; the Centers for Disease Control says monkeypox may be able to survive on surfaces for up to 15 days).

  • Prolonged very close face-to-face and/or intimate contact with someone who is infected (it is thought it may be possible for it to spread if someone inhales respiratory particles directly from an infected person), but at this time it is not thought to be spread via the airborne route (it does not seem to be carried on small respiratory and/or dust particles that can carry it further and allow it to stay in the air for prolonged periods of time).

  • A pregnant woman may transmit it to her fetus.

  • Although it is thought that some people who become infected with monkeypox may not develop symptoms, it is not clear whether these patients can spread the virus. Although this is being studied, and may be possible, at this time it does not seem like spread of the virus from asymptomatic people is a main way it is spreading.

From this, we can see why it seems less likely that monkeypox will cause a widespread pandemic.

In patients who do develop symptoms, they typically begin 3 to 21 days after becoming infected (this is the incubation period of the virus in the host) and will often begin with a "flu-like" illness (not every patient gets this, some just get the rash), including fever, headache, swollen glands, muscles aches, fatigue and/or other non-specific symptoms. The rash of monkeypox (blister/pimple-like pustules that often develop a central depression) may begin 1 to 10 days after these other symptoms, potentially anywhere on the body.

Although there are no specific treatments for monkeypox (other than supportive care for the symptoms), several anti-viral medications are being studied to see if they are safe and effective. For most patients, the symptoms of monkeypox seem to resolve on their own over two to four weeks. For the present "strain" of monkeypox virus in the U.S., the fatality rate has been less than 1% (although some strains of monkeypox in Africa have had fatality rates as high as 10%).

There is an FDA-approved vaccine to prevent monkeypox. Efforts are underway to produce more of it so it will be available to more people. Right now it is being used for higher risk people, specifically those who may have come into contact with someone who has the disease. An infected patient is thought to be potentially contagious until all their lesions have crusted over, the scabs have fallen off and the ‘normal skin’ has grown back (re-epithelization has occurred).

As of the time of my writing this column, there are already about 20,000 cases in the U.S., with at least one case in every state. Testing to confirm the diagnosis of monkeypox may include a PCR test of fluids swabbed from at least two lesions, which typically takes a couple of days to have yield results. Other testing approaches are being researched and developed.

This article originally appeared on MetroWest Daily News: Dr. Jeff Hersh address monkepox and its potential to be next pandemic