MONKEYPOX is a zoonotic disease with a presentation similar to smallpox. Clinical differentiation of the disease from smallpox and varicella is difficult. Laboratory diagnostics are the principal components of the identification and surveillance of the disease, and new tests are needed for a more precise and rapid diagnosis. Monkeypox earned its name in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. However, the main disease carrier of monkeypox is still unknown.

The monkeypox virus is a member of the orthopoxviras genus in the family Poxviridae. It is a mild infection with symptoms including fever, headaches, and skin rashes. Children are typically more prone to severe symptoms. The virus can also be passed to a newborn through birth or early physical contact. Early genomic sequencing of a handful of the cases in Europe has suggested a similarity with the strain that spread in a limited fashion in Britain, Israel, and Singapore in 2018.

Experts say that close contact with an infected individual is required to spread the monkeypox virus. Infection can develop after exposure to broken skin, mucous membranes, respiratory droplets, infected body fluids, or even contact with contaminated linen. The painful, raised poxes are pearly and fluid-filled, often surrounded by red circles. The lesions finally scab over and resolve in two to three weeks.

The World Health Organisation has declared monkeypox a ‘Public Health Emergency of International Concern’. The health experts focused on generating public awareness about the monkeypox virus. They also advised going to the hospital if any symptoms were present. Hospitals should be prepared to collect patient samples and send them to the IEDCR. People coming to Bangladesh from endangered areas should have health check-ups at the airport.

Droplet respiratory particle transmission often requires prolonged face-to-face contact, putting health professionals, family members, and other close contacts of active patients at increased risk. In contrast, close physical contact is a well-known risk factor for transmission. Transmission through sexual activity was suspected in 95 per cent of the cases.

It may be dangerous, with a case fatality rate of roughly 3–6 per cent, although most individuals heal at home without the need for hospitalisation or medicine. Monkeypox is often a self-limiting illness with symptoms lasting 2–4 weeks. It includes fever, severe headache, lymphadenopathy, back pain, muscle pains, and a severe lack of energy.

The following are a few of the recommendations issued by the WHO to activate or establish health and multi-sectoral coordination mechanisms to strengthen monkeypox preparedness and stop human-to-human transmission. As part of existing national surveillance systems, establish and intensify monkeypox-compatible disease surveillance, including access to reliable, affordable, and accurate diagnostic tests. Raise awareness about monkeypox virus transmission, prevention and protective measures, and symptoms and signs among communities affected elsewhere in this multi-country outbreak. Raise awareness and train health workers in primary care, genitourinary and sexual health clinics, emergency departments, dental practices, dermatology, paediatrics, HIV services, infectious diseases, maternity services, obstetrics and gynaecology, and other acute care facilities. Implementing a coordinated response to stop human-to-human transmission of the monkeypox virus and protect vulnerable groups like immunosuppressed individuals, children, and pregnant women at risk of severe monkeypox disease. Intensify surveillance for illnesses compatible with monkeypox and strengthen laboratory and genomic sequencing capacity.

Restrictions on international travel for those showing warning signs of monkeypox. It is possible to mitigate the transmission of this contagious monkeypox if the public could abide by the rules set by the health authorities and the health organisations. Severe complications and sequelae were found to be more common among unvaccinated patients than vaccinated patients. Patients have been observed with pulmonary distress or bronchopneumonia, often late in the course of illness, suggesting a secondary infection of the lungs. Vomiting or diarrhoea can occur by the second week of illness and can contribute to severe dehydration. Encephalitis was observed in one patient and septicaemia in another patient. Ocular infections can occur and may result in corneal scarring and permanent vision loss. The average case fatality rate of unvaccinated patients has been recorded as high as 11 per cent.

The incubation period of monkeypox is usually 6–13 days but can range from 5–21 days. Monkeypox is usually self-limiting but may be severe in some individuals, such as children, pregnant women, or persons with immune suppression. The treatment is generally supportive, as there are no specific drugs available. Eating inadequately cooked meat and other animal products from infected animals is a possible risk factor. People with mpox are considered infectious until all their lesions have crusted over, the scabs have fallen off, and a new layer of skin has formed underneath. All the lesions on the eyes and in the body — the mouth, throat, eyes, vagina, and anus — have healed too, which usually takes 2-4 weeks.

Diagnostic assays are important components of the identification of infection. Tests are most powerful when they are combined with clinical and epidemiological information, including a patient’s vaccination history. Given the limited cold chain and diminished resources for sample collection and storage, lesion exudate on swabs or crust specimens remains one of the best and least invasive acute patient specimens. Viral DNA present in lesion material is stable for a long period if kept in a relatively dark, cool environment, an important factor to consider when a cold chain is not readily available.

Health experts focused on creating public awareness of the monkeypox virus. They also advised going to the hospital if any symptoms were present. Monkeypox enters the body through the nose. Wearing masks and washing hands frequently could be a good deterrent. The same rules apply to both the Covid and monkeypox viruses. At airports, anyone showing signs of monkeypox should be quarantined for at least 14 days.

The monkeypox outbreak, if it happens, probably will not resemble the early days of the Covid pandemic because it does not transmit as easily. Those who suspect they may have been exposed or who show symptoms should avoid close contact with others.

New therapeutics and vaccines offer hope for the treatment and prevention of monkeypox. Data from one study has recently been released, but more information is needed to determine tecovirimat’s effectiveness in treating mpox infection in people. Based on the animal efficacy data that showed survival benefit over placebo in lethal animal models, it may be reasonable to anticipate that tecovirimat may provide benefit in treating some people with diseases caused by orthopoxviruses, including the virus that causes mpox. If you think you might have mpox, you can act to protect others by seeking medical advice and isolating yourself from others until you have been evaluated and tested. Isolate yourself from others until all your lesions have crusted over, the scabs have fallen off, and a new layer of skin has formed underneath. Follow your local health authority’s instructions on isolation at home or in a health facility.

Dr Zubair Khaled Huq is a family medicine, gerontology and public health specialist.