Is Monkeypox the new COVID?!

(SPOILER ALERT: No.)

Monkeypox, a smallpox-like virus that originated in Central and West Africa, has popped up in >200 cases in Europe and North America this Spring 2022. On the heels of 3+ years of COVID turning our lives upside down and costing over 1 million US lives, this headline understandably has us all on edge. 

Here are some fast facts about monkeypox that I think will both reassure and inform:

Hallmark symptoms: fever, headache, muscle aches, rash, swollen lymph nodes

How does it spread: contact with bodily fluids, including respiratory droplets (it is not very contagious – infected persons can infect ~1-2 other people and individuals are not contagious until symptomatic)

According to an infectious disease specialist/poxvirus expert at the CDC (Agam Rao) “the risk is still very rare…and the strain of monkeypox currently being detected is relatively mild”. 

Unlike COVID-19 which is a novel coronavirus, monkeypox is *NOT* a new virus (it was identified in the 1970s). There was an outbreak in midwestern US in 2003 due to contact with infected prairie dogs (who contracted it from rodents imported from Ghana). Nobody died. 

Monkeypox does not commonly lead to deaths in high-resource countries. In rural Africa, where access to hospital/supportive care is lower, mortality rates can approach ~4%.

Because of the similarities between Monkeypox and Smallpox – many of the drugs and the vaccine approved for smallpox could potentially be used to protect against and treat Monkeypox. 

There is a lack of good data on the impact of Monkeypox on pregnancy. A small case report from 2017 (Mbala et al.) reported on 4 of ~200 cases that involved pregnant women – there was a stillbirth (of an apparently infected fetus), a healthy live birth, and 2 first trimester miscarriages. There is a known increased morbidity/mortality in pregnancy with smallpox infection. Antivirals and immunoglobins against smallpox can be used to treat pregnant people with Monkeypox but it is only recommended in cases of sevre infection. 

After the 2003 outbreak, the CDC recommended that persons with close contacts to a case of Monkeypox could be vaccinated with the smallpox vaccine, regardless of their pregnancy status. Usually, the smallpox vaccine is not used in pregnancy because it is a live virus vaccine – however, the risk of contracting the illness is thought to outweight the risk of using a live virus vaccine (Jamieson et al. ACOG 2004; 103(4): 754-6). 

The good news is, currently the risk posed to public health appears low and if cases do increase in prevalence, we likely now have the infrastructure, know-how, and funding from COVID that go towards a large-scale response, if need be. For now, the combination of low infectivity and effective prevention and treatment strategies are reassuring and can provide us with the hope that this can be easily contained and snuffed out in a short period of time. However, it is always prudent to remain aware and vigilant,. 

What questions do you have? Comment below!