Monkeypox in Pakistan: Here is what you should know

Pakistan has detected its first two cases of Monkeypox or Mpox among people who came from abroad this week. Here is what you should know about the feared disease.

Monkeypox is an illness caused by the monkeypox virus. It is a viral zoonotic infection, meaning that it can spread from animals to humans. It can also spread from humans to other humans and from the environment to humans.

The monkeypox virus was discovered in Denmark (1958) in monkeys kept for research and the first reported human case of mpox was a nine-month-old boy in the Democratic Republic of the Congo (DRC, 1970). Mpox can spread from person to person or occasionally from animals to people. Following eradication of smallpox in 1980 and the end of smallpox vaccination worldwide, mpox steadily emerged in central, east and west Africa. A global outbreak occurred in 2022–2023. The natural reservoir of the virus is unknown – various small mammals such as squirrels and monkeys are susceptible.

Symptoms

Monkeypox can cause a range of signs and symptoms. While some people have less severe symptoms, others may develop more serious illness and need care in a health facility. Those typically at higher risk include people who are pregnant, children and persons that are immunocompromised.

The most common symptoms of monkeypox identified during the 2022 outbreak include fever, headache, muscle aches, back pain, low energy and swollen lymph nodes, followed or accompanied by the development of a rash which may last for two to three weeks. The rash can affect the face, palms of the hands, soles of the feet, groin, genital and/or anal regions. It may also be found in the mouth, throat, anus or vagina, or on the eyes. The number of sores can range from one to several thousand. Sores on the skin begin flat, then fill with liquid before they crust over, dry up and fall off, with a fresh layer of skin forming underneath.

There are ongoing studies to keep track of and better understand symptoms during this new outbreak, including what parts of the body can be affected and how long symptoms may last.

Anyone who has symptoms that could be monkeypox or who has been in contact with someone who has monkeypox should call or visit a health care provider and seek their advice.

Symptoms usually go away on their own or with supportive care, such as medication for pain or fever. People remain infectious until all of the sores have crusted over, the scabs have fallen off and a new layer of skin has formed underneath.

Can someone die from Monkeypox?

Complications from monkeypox include secondary skin infections, pneumonia, confusion, and eye problems. More recent complications include proctitis (sores and swelling inside the rectum that cause pain) and pain or difficulty when urinating. In the past, between 1% to 10% of people with monkeypox have died. It is important to note that death rates in different settings may differ due to a number of factors, such as access to health care. These figures may be an overestimate because surveillance for monkeypox has generally been limited in the past.

In the newly affected countries where the current outbreak is taking place, some deaths have been reported. This underscores the fact that monkeypox is a serious disease and that people should continue to do everything they can to protect themselves and others.

Who is at risk of catching monkeypox?

People who live with or have close contact (including sexual contact) with someone who has monkeypox are most at risk. Anyone living with someone who has monkeypox should take steps to reduce the risk of becoming infected. A person who has a monkeypox infection should be assessed by a health care provider to determine if they are well enough to be cared for at home and if isolation can be safely managed at home. Health workers should follow infection prevention and control measures to protect themselves while caring for patients with monkeypox. Newborn infants, young children and people with underlying immune deficiencies may be at higher risk of more serious symptoms, and in rare cases, death from monkeypox. Pregnancy can also increase one’s risk of adverse events such as miscarriage or stillbirth.

People who were vaccinated against smallpox may have some protection against monkeypox. However, younger people are unlikely to have been vaccinated against smallpox because smallpox vaccination stopped in most settings worldwide after the disease was eradicated in 1980. People who have been vaccinated against smallpox should continue to take precautions to protect themselves and others.

How does Monkeypox spread?

Monkeypox can spread to people when they come into physical contact with an infected animal such as a non-human primate, terrestrial rodent, antelope, gazelle, or tree squirrel – for example through bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses. The virus can also be caught through eating infected animals if they are not cooked thoroughly. The risk of catching monkeypox from animals can be reduced by avoiding unprotected contact with wild animals, especially those that are sick or dead (including their meat and blood). In countries where animals carry monkeypox, any foods containing animal parts or meat should be cooked thoroughly before eating.

What to do when you have Monkeypox?

People with monkeypox should avoid scratching their skin and take care of their rash by cleaning their hands before and after touching sores and keeping skin dry and uncovered (unless they are unavoidably in a room with someone else, in which case they should cover it with clothing or a bandage until they are able to isolate again). The rash can be kept clean with sterilised water or antiseptic. Saltwater rinses can be used for sores in the mouth, and warm baths with baking soda and Epsom salts can help with sores on the body. Paracetamol can be used to help manage the pain caused by sores, if needed. If stronger pain medicine is needed, advice should be sought from a health professional.

Many years of research on therapeutics for smallpox have led to development of products that may also be useful for treating monkeypox. An antiviral that was developed to treat smallpox (tecovirimat) was approved in January 2022 by the European Medicines Agency for the treatment of monkeypox under exceptional circumstances. Experience with these therapeutics in the context of an outbreak of monkeypox is limited. For this reason, their use is usually accompanied by enrolment in a clinical trial or expanded access protocol accompanied by collection of information that will improve knowledge on how best to use them in future.

Source: WHO