Monkeypox is a zoonotic virus similar to smallpox that is endemic to parts of Africa. It can be transmitted from animals to humans via contact with bodily fluids or consumption of undercooked meat. Human to human transmission is also possible. Symptoms include fever, headache, rash and lesions. There have been increasing outbreaks linked to international travel and exotic pet trade. While there is no proven treatment, isolation and vaccination can help control outbreaks. Prevention requires education on risks, offering PPE, and restricting animal importation.

1. MONKEY POX
VIRUS
By Sonia Kaur

2. Introduction
• Monkey pox is a zoonotic orthopoxvirus causing disease in humans, simillar
smallpox.
• Clinically relevant virus due to being an endemic to western and central Africa, close
to tropical rain forests. There has been increase in outbreaks in urban areas.
• Outbreaks are due to exotic pet trade, raw meat consumption and international
travel, increasing its potential to become a global pandemic.
• Animal hosts include a range of rodents and non-human primates.

3. Background Information :
• Monkeypox is from the family: Poxviridae, subfamily: chordopoxvirinae, genus:
orthopoxvirus, and species: Monkeypox virus.
• Monkeypox virus was first isolated and identified in 1958 when monkeys shipped from
Singapore to a Denmark.
• First confirmed human case was in 1970 isolated from a child in the Democratic
Republic of Congo suspected to have smallpox.
• The natural reservoir of monkeypox has not yet been identified, rodents are the most
likely the cause.
• Immunity was previously achieved with vaccinia vaccination, eradicating smallpox.

4. Outbreak History:
There have been more outbreaks in Central Africa via human-human transmission,
compared to West Africa.
• 2003, Gambian giant rats imported from Ghana infected prairie dogs sold as house
pets United States, leading to 70 human cases.
• 2018- 2021, monkeypox was reported in travelers from Nigeria travelling to different
countries like Israel, UK, Singapore and USA.
• May 2022, multiple cases confirmed in non-endemic countries like the UK.

5. Monkey Pox Virus Under The Microscope
• Monkeypox virus is
large (200-250
nanometers under
electron microscope).
• Brick-shaped and
surrounded by a
lipoprotein envelope
with a linear double-
stranded DNA
genome.
• Rely on host cell
ribosomes for mRNA
translation.
• Poxviruses include all
necessary replication,
transcription, assembly,
and egress proteins in
their genome.

6. Transmission
Zoonotic transmission (animal to human) by direct contact with
animal :
• Blood
• Bodily fluids
• Cutaneous (skin related) or mucosal lesions of infected animals
The viral infection has found in animals like squirrels, rats, dormice
and different species of monkeys. Eating undercooked meat of
infected animals is a risk factor of infection.
Human to human transmission can occur by contact with respiratory
secretions from face-to-face contact , skin lesions of an infected
and contaminated objects. Transmission can also occur through
the placenta from mother to foetus ( congenital monkey pox) or
proximity after birth with an infected person.

7. Signs and Symptoms
• Incubation period 6 to 13 days or range from 5 to 21 days.
Two periods:
1. Invasion period (0-5 days) involving fever, intense headache, back pai, myalgia, lymphadenopathy (swelling of the
lymph nodes and intense asthenia (lack of energy). Lymphadenopathy is a distinctive characteristic of monkeypox
compared to other diseases that may initially appear like chickenpox and smallpox.
2. Skin eruption (1–3 days of appearance of fever), in the form of a rash mainly on the face affecting 95% of cases,
however it is not limited to the face and can affect other body parts. The rash can also affect the palms of the hands
and soles of the feet (in 5% of cases). The rash evolves sequentially from to papules (raised lesions), vesicles ( filled
with clear fluid), pustules (lesions f with yellowish fluid), and crusts which dry up and fall off.
Symptoms can last from 2 to 4 weeks. Sever cases are more common in children rather than adults and are due to viral
exposure and health status, such as underlying immune deficiencies which increase the chance of the infection to worsen.
Case fatality ratio has ranged from 0 to 11% in general population and higher in younger children (3 to 6%).

8. Diagnosis
• Monkey pox can be identified by blood test or via microscope using sample swab
from the rash, to help indicate the presence of orthopoxviral.
• Infection confirmation from patients DNA via isolation in viral culture or PCR
• ELISA tests can help detect IgM (indicating recent exposure) and IgG (indicating
prior exposure or vaccination).

9. Treatment and Prevention
No clinically proven treatment, however there are treatment strategies to manage
symptoms caused by the virus.
Management strategies:
• Isolation of infected patient
• Correct PEE such as masks and gloves for patient, health care professionals and
relatives.
• Bandages to cover lesions on infected patients
Post exposure vaccine such as Ankara could be considered. This is a live not replicating
vaccine and is given in 2 shots, 4 weeks apart. Unlike Vaccina vaccination this vaccine
does not cause skin lesion or risk of spread. It helps stimulate antibody production.

10. Social and Economical problems
Social:
• Men are at a greater risk of infection due working and hunting because of cultural norms.
• Increase infection rate due to discontinuation of smallpox vaccination and other antivax
campaigns, results in people refusing vaccination. This prevents herd immunity and
increases risk of spread between humans.
Economical:
• Poor medical care and infrastructure affects the ability to make discissions on the virus
leading to neglect of prevention strategies, such as vaccinations.

11. Prevention:
• Raise awareness of risk factors accosted with touching and eating infected animal
meat.
• Educate people on the benefits of vaccination against viruses.
• Offer correct PPE to everyone to help control the spread of monkeypox.
• Rapid surveillance to help identify cases and trace the source, to prevent further
outbreaks.
• Restrict importation of animals and have immediate quarantine plans in place to
prevent the risk of spread of infection, leading to a global pandemic.