Monkeypox

Monkeypox virus that usually occurs in the jungle regions of Central and West Africa. All cases identified outside these areas until May 2022 were imported or linked to animals. The main form of transmission is through direct or indirect contact with live or dead rodents or primates. Secondary transmission between humans is limited.

On 17 May 2022 an alert was received regarding the recent occurrence of several cases of Monkeypox with no history of recent travel to endemic areas or contact with other known cases. This is the first time that transmission chains have been reported in Europe with no known epidemiological links to West or Central Africa.

The symptoms and the clinic

The initial symptomatology usually includes a period with fever, headache, myalgia, weakness and lymphadenopathy. A skin rash may appear between 1 and 5 days after the first symptoms, usually starting on the face and spreading to the rest of the body, including the palms of the hands and soles of the feet. The number of lesions can vary from a few to multiple disseminated lesions. In the current outbreak and given the transmission pattern, lesions are frequently located in the genital, perianal and perioral area, with an area of hyperpigmentation around the lesions. Characteristically, the lesions evolve in a uniform and sequential manner until they become crusts that dry up and fall off.

It usually evolves as a mild illness lasting 2 to 4 weeks, but complications such as pneumonia, pharyngeal lesions that compromise the airway, sepsis, encephalitis and corneal ulcers can appear, resulting in loss of vision.

Who is affected by the condition?

Cases have been identified mainly in the population of men who have sex with other men, and in most cases the transmission mechanism identified is very close physical contact, mainly during sexual intercourse. However, the infection can affect anyone who comes into contact with an infected person.

How is it transmitted?

The main transmission mechanism is currently through close and direct physical contact with lesions on the skin or body fluids of an infected person, during sexual intercourse or other continuous and prolonged contact over time.

It can also occur through other less important mechanisms such as face-to-face contact, respiratory secretions, or indirectly by coming into contact with objects used by an infected case. Furthermore, transmission can occur from pregnant women through the placenta to the foetus, as well as through contact with infected animals.

Incubation period

The incubation period is 6 to 16 days, but can range from 5 to 21 days.

Diagnosis

The diagnosis is carried out by means of a specific test to detect the virus, with a PCR test.

El tractament habitual

The treatment is mostly symptomatic. Good hygiene must be maintained in the affected areas, which must be cleaned frequently or even with topical antiseptics. In lesions with superinfection, the application of topical or systemic antibiotics can be considered, following current guidelines. In the event of severe inflammation, the administration of corticosteroids may also be considered.

Specific antiviral treatments are reserved for severe complications and must be administered under hospitalisation. The only antiviral currently authorised for treatment is Tecovirimat.

The Monkeypox vaccine

The vaccine available against monkeypox is marketed under the name Jynneos and contains a virus that has been modified so that it cannot grow in humans, produce the disease or spread. As with other vaccines, when it is administered the immune system produces antibodies, which help to protect against the monkeypox virus. 

Who is the vaccine recommended for?

Currently, the Spanish Government recommends the administration to people who:

• Engage in sexual practices; mainly, but not exclusively, homosexuals, bisexuals and men who have sex with men (GBHSH).
• Are contacts of people with confirmed cases of the disease and at high risk of complications, such as children under 18 years of age, pregnant women and immunocompromised people.

Does the vaccine work?  

The vaccination schedule consists of two doses of vaccine separated by a minimum of 28 days and most people develop antibodies. For this reason, it is expected to provide a good level of protection against monkeypox 

At the moment the availability of doses is severely limited, so that only one dose of the vaccine is offered to the maximum number of people. This can help to modify or reduce monkeypox symptoms. The response with a single dose of the vaccine is lower than with two doses and is not immediate: becoming effective approximately 4 weeks after receiving the vaccine.

Vaccine side effects:

Like all medication, this vaccine can cause side effects, although not everyone suffers from them. The most common include pain and itching at the injection site and headache, muscle pain, malaise and fatigue. Approximately 1 in 10 people will have chills and a fever, but they should not last more than a few days. If you experience any of the side effects mentioned above, you should rest and take the appropriate dose of paracetamol to help alleviate the symptoms.