Monkeypox – a sign of things to come?

The monkeypox virus is part of a larger poxvirus family which includes the smallpox virus, variola, and the vaccine virus used for its eradication. Endemic in Central- and West Africa monkeypox is primarily carried by rodents which can, in rare instances, pass the infection to humans. In Africa, infection is associated with 1%-10% mortality - depending on the virus clade - with immunocompromised, pregnant and/or young individuals being most at risk. The current outbreak of monkeypox, first detected in the UK, has climbed to over 1,300 confirmed cases in 28 countries around the world. 

Being in the midst of an ongoing pandemic, our response to COVID has taught us that knowing is half the battle. Providing rapid and accurate information to the public regarding how to identify a monkeypox infection, what to do if you are infected, and the level of risk this poses to the population serves to stem the spread of infection and misinformation. Taking another lesson from the global response to COVID, within weeks of the first confirmed case, draft genome sequences of the monkeypox virus associated with this outbreak became available. This information is critical to staying ahead of the virus and determining if and how the virus adapts as it moves within the population.

Is this current outbreak a foreshadowing for the emergence of other poxvirus risks? In short, not likely. Despite the termination of routine smallpox vaccination 40 years ago, there are only two human-specific poxviruses smallpox, which is eradicated, and molluscum contagiosum, a usually benign self-limiting virus that infects children. While there are other zoonotic poxviruses such as camelpox and cowpox, these infections require direct contact with infected animals. Documented human infections are mild, self-limiting and have never been reported to spread from person to person. That said, due to the cessation of smallpox vaccination, cases of monkeypox in endemic and non-endemic countries have been increasing in frequency over the last few decades. I think the current outbreak should serve as an eyeopener that we need more research on monkeypox its epidemiology, potential animal reservoirs, transmission and clinical outcomes.

Fortunately, unlike Covid, poxviruses including monkeypox are a well-known entity. Taking lessons from the 20-year global smallpox eradication campaign we know how to stop the spread of monkeypox. We have safe and effective vaccines and if needed antiviral agents in our monkeypox arsenal. To our advantage, monkeypox spreads poorly between people, requiring prolonged contact or proximity, and it culminates in a distinct pustular rash, which makes tracking and tracing of infected individuals more clear cut. Finally, as monkeypox mutates less frequently than SARS-CoV-2, genome sequencing efforts combined with the current isolation and ring-vaccination strategies being employed are likely to prove very effective methods for stemming the spread of monkeypox and keeping us one step ahead of this outbreak.