Debunking the Pandemic Potential of Monkeypox Virus: A Brief Overview of the Current Surge in Monkeypox Virus Infection

1. BACKGROUND

Monkeypox, caused by the monkeypox virus, is a viral zoonosis as the disease transmits from an infected animal to humans. Its clinical symptoms are very similar to that of smallpox, despite the fact that it is less severe than smallpox. The monkeypox virus belongs to the orthopoxvirus genus of the poxviridae family. It has two different genetic clades: one is the west African clade, and the other is the Congo basin clade. As this virus was discovered for the first time in monkeys in 1958, it is named the monkeypox virus. The first case of human monkeypox was reported in 1970 in the Democratic Republic of Congo [1, 2]. Since then, the majority of cases have been reported in African countries until 2003, when the first case outside of Africa was reported in the United States, which occurred due to contact with infected pet dogs. In this outbreak, more than 70 cases of human monkeypox were reported [3]. There are numerous other incidences reported on multiple continents, which were either associated with international travel to monkeypox-endemic countries or imported animals [4]. Although there is uncertainty about the natural reservoir of the monkeypox virus, its host range encompasses a majority of mammal species [5]. Monkeys and African rodents are known for harboring the virus and infecting humans [4]. The transmission of the monkeypox virus between humans can occur through respiratory droplets, saliva, contaminated fomites and mainly by physical contact with skin lesions. Viral shedding in feces has also been recorded [6-8]. Despite the resemblance to smallpox, monkeypox has a major difference in its clinical features, such as swollen lymph nodes that are typically observed after the onset of fever during the infection. The incubation period normally ranges from 7-14 days. Fever, chills, swollen lymph nodes and characteristic rash on the skin are the common symptoms of monkeypox. The recently reported cases are mostly linked to sexual contact, as the virus has been reported from MSM (Men having sex with Men) [9-13].

As of June 22, numerous reports have emerged regarding the multiple cases of monkeypox from 50 different countries, including those previously not known as endemic for this viral zoonosis. The majority of laboratory-confirmed cases of monkeypox have been recorded in the European region (86%), followed by the US (11%) and African (2%) regions [14]. Among those locations where not a single monkeypox case was reported in history, a high number of laboratory-confirmed cases has been documented in the US, Spain, Brazil, France, Germany, UK, Canada, Peru, Netherlands, Portugal, Italy, and Belgium. A total of 13 deaths have been confirmed so far: 7 in previously endemic countries and 6 in non-endemic countries [15]. According to the World Health Organization reports, the number of cases is increasing in different parts of the world. Since the world’s health systems are already under the burden of a pandemic caused by SARS-CoV-2, a rapid surge in the new viral outbreak has resulted in panic across the globe. However, there are some key differences between monkeypox and COVID-19, which rules out the possibility of it being a new epidemic or pandemic. For instance, the recent cases of monkeypox have no evidence of being travel linked; however, in the case of COVID-19, international travel played a vital role in its transmission. Moreover, the newly emerged cases of monkeypox are mostly diagnosed in men having sex with men (MSM). As of 21^st May, 2022, 92 confirmed cases of monkeypox had been documented, while at the same time, COVID-19 was transmitted a hundred times more than monkeypox. An interesting fact regarding the recent monkeypox outbreaks is that the majority of cases were reported in the US, UK, and other European countries, which were not previously endemic for this viral disease. Despite it, only a few deaths have been reported so far. On the other hand, there were a number of deaths at the same time due to COVID-19. Moreover, there is no particular need for a new vaccine intervention for the prevention of monkeypox, and the vaccines previously used for smallpox eradication can readily protect against monkeypox virus infection. However, vaccine development was important for the prevention and treatment of infection caused by SARS-CoV-2. In addition, monkeypox virus infection is self-limiting in most cases, which means that it can be cured by itself without any therapeutic intervention. Its symptoms can last for 2 to 4 weeks. As the virus is found in skin lesions, skin-to-skin contact, including sexual contact, can serve as a major source of transmission. While in the case of COVID-19, respiratory droplets serve as the major transmission source. In the recent monkeypox cases, as well as previously recorded cases in endemic areas (tropical regions and central West Africa), the clinical symptoms of infection are mainly rash and lesions on the skin with backache and swollen lymph nodes. Whereas a variety of clinical signs and symptoms are observed in COVID-19, including fever, headache, sore throat, dry cough, and in some cases, severe complications, such as ARDS (Acute Respiratory Distress Syndrome) can also occur [1, 14, 16, 17].

CONCLUSION

A recent surge of monkeypox virus infections in non-endemic countries has caused panic among the masses and health authorities worldwide. While comparing the monkeypox virus to COVID-19, some key differences can be observed in the nature of both viruses. The pandemic potential of SARS-CoV-2 is due to its more virulent nature, the severity of infection, and rapid transmission using different ways compared to the monkeypox virus, which rules out the possibility of a monkeypox epidemic or pandemic. However, monkeypox virus infection is also not easy to handle, and extreme care should be taken to avoid physical contact with a suspected infected individual. Furthermore, most of the population is already protected against monkeypox, as vaccines used against smallpox can readily protect against the monkeypox virus. If necessary, smallpox vaccines may be administered in high-risk areas. Therefore, it eliminates the requirement for the development of a new vaccine against the monkeypox virus.

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