Rare monkeypox outbreak in U.K., Europe and U.S.: What is it and should we worry?

By Edward Era Barbacena

An international monkeypox outbreak has puzzled experts.

So far, health agencies around the world have counted at least 69 cases of suspected monkeypox — including one “possible” case in New York City, as well as at least one other case in the US and potentially more throughout North America and Europe.

The New York City Department of Health and Mental Hygiene announced an investigation into the NYC case on Thursday afternoon, and it reportedly involves patient being cared for at NYC Health + Hospitals/Bellevue.

Exactly how and why the illness — which is typically passed from an infected animal to a human host — has cropped up, and spread across continents, remains a mystery.

Historically, most cases have come out of West and Central Africa, following contact with an infected animal — mostly rodents, scientists believe, but also occasionally non-human primates.

“This [outbreak] is rare and unusual,” epidemiologist Susan Hopkins, chief medical adviser of the UK Health Security Agency, said in a statement on Monday, announcing eight cases of the illness in England alone. “Exactly where and how they [the people] acquired their infections remains under urgent investigation,” the agency added.

Experts worry that the virus may be spreading rapidly, just below doctors’ radars, by unconventional means — sex — as several of the current cases appear to have had nothing to do with animals or travel to Africa, according to UKHSA.

“What is even more bizarre is finding cases that appear to have acquired the infection via sexual contact,” said UKHSA epidemiologist Mateo Prochazka in a tweet on Tuesday. “This is a novel route of transmission that will have implications for outbreak response and control.”

Here’s what we do know about monkeypox, how to spot it and how to protect yourself from infection.

What is monkeypox?

Monkeypox is a viral disease first discovered in 1958, originating in colonies of monkeys (hence the name), according to the US Centers for Disease Control and Prevention. The first human to be diagnosed was in 1970, in the Democratic Republic of Congo — during a time when public health efforts in the region were focused on eliminating smallpox, which presents similarly with fever, aches and pox lesions across the body. Until now, most cases of monkeypox in animals or humans have come out of central and western African countries.

What are the symptoms of monkeypox?

Those infected with monkeypox will initially come down with a fever, headache, body aches, swollen lymph nodes and exhaustion. Within one to three days after the virus takes hold, patients will develop a rash — pox — often starting with the face before spreading throughout the body. Pox lesions go through a gruesome process, beginning as flat sores that later become raised and filled with infected pus, then turn into scabs that eventually flake off — the whole cycle of which can take up to four weeks to complete.

How contagious is it?

Monkeypox transmission usually occurs through a relatively close exchange of bodily fluids, such as saliva traveling via cough, or from contact with the pus-filled lesions of a monkeypox patient. That’s why cases are so rarely seen outside of Africa and, when they are, usually involve someone who recently traveled to the continent — as with one current patient who recently visited Nigeria. However, many of the cases now ongoing appear to be unconnected in that regard.

Though sexual intercourse is being investigated as a potential vehicle for the current outbreak, it could just as well be attributed to “close contact associated with sexual intercourse,” such as kissing, infectious diseases expert Keith Neal, from the University of Nottingham, UK, told the Associated Press on Wednesday.

What do we know about this 2022 outbreak?

So far, reports have amounted to 68 confirmed or suspected cases around the world: one in Massachusetts, one in Sweden, nine in the UK, 13 in Canada and potentially more than 20 each in Portugal and Spain. Just one of those individuals is known to have traveled to Africa recently.

So far, no one has died from the illness, while some patients have already made a full recovery.

The alarm for monkeypox last sounded in summer 2021 across the US and UK, after visitors to Nigeria, including one Texas man, carried their infections back home.

How is it treated? Is there a vaccine?

As there is no cure for monkeypox, treatment is focused on symptom mitigation. While many cases of monkeypox will resolve on their own, at least one strain of the virus is known to be deadly and kills up to 10% of the people it infects, according to the World Health Organization. Fortunately, the currently circulating virus carries a fatality rate of less than 1% and clears up in two to four weeks.

Though monkeypox is considered milder than its viral cousin, the smallpox vaccine is known to provide some protection against both infections. Thus, children who are inoculated against smallpox at a young age are less likely to develop a serious case of monkeypox later in life.

However, smallpox vaccines — first developed in 1800, leading to the worldwide eradication of smallpox in 1980 — are no longer administered to the general public, WHO warns. A new vaccine for both viruses was approved in 2019 but is also not yet widely available.