By Kevin McCurry, MD
Chief Medical Officer
So, what is monkeypox? Year 1958 brought the discovery in monkeys of a relative to the deadly Smallpox virus. It was named…the Monkeypox virus. Fortunately, Smallpox was eradicated in 1980, and the last case was noted in 1977. There is rare animal to human transmission with Monkeypox and the first case occurred in 1970. It is primarily in Central and West Africa. There are two varieties, the Congo basin variety, which seems to be more deadly, and the less lethal West African variety. Most cases in humans come from contact with mammals and their body fluids. Cases are rare outside of Africa. Human to human transmission is also very unusual, and when it occurs, it is through large respiratory droplets, so close prolonged contact is necessary. Since 1958 we have gone from discovery to having a monkeypox treatment via vaccine.
Monkeypox In Humans
As of August 2, 2022, there are 5,811 cases in the United States. In 2021, there was one case in Texas and one in Maryland, both related to travel to Africa. Forty-seven cases occurred in six US states in 2003, all traced back to pet prairie dogs in contact with infected imported mammals from Ghana. There were no deaths in that outbreak.
Is Monkeypox Dangerous?
The current case in Massachusetts seems to be related to the less dangerous West African variety. Case death rate in that variety is 1 in 100. In the Congo basin variety, the death rate is more like one in 10. For comparison, smallpox was three in 10 or 30%. COVID, on the other hand, has a lethality rate of just over 1% per 100 cases, of course, higher lower based on your age and overall health status. The typical influenza death rate is less than one in 100 cases.
Symptoms of monkeypox
Monkeypox symptoms are flulike with headaches, fevers, chills, body aches, and swollen lymph nodes. There is a rash that looks like a chickenpox rash. It starts as a flat red spot, becomes raised, and turns into a blister or vesicle, then it dries and crusts over, which is similar to the chickenpox rash sequence. The illness lasts 2 to 4 weeks and typically has a benign course. Monkeypox is not currently considered to be an STD/STI. The current cases seem to be occurring in people engaging in gay or bisexual sex. This is likely related to body fluid exposure.
Monkeypox treatment comes via vaccines and antivirals that seem to be effective against it, but none of these have been proven to be highly effective. The US has a stockpile of 100 million older generation smallpox vaccines and much less of the newer generation type, but manufacturing is ramping up. In short, this is not something to worry about in your everyday lives unless you have high-risk behavior associated with high-risk monkeypox exposures, you hunt in West Africa, or you have high-risk travel. Compared to COVID, the transmission rate is very low, and we know this because we’ve been aware of this virus for over 60 years. This is not like COVID, which sprang onto the world completely new and novel with no previous history.
Kevin McCurry, MD, is Arbor Health's chief medical officer. He also authors a website where he discusses current medical issues and answers patients' medical questions. You can find it as StraightTalkMedicine.com.