At least eight countries in the WHO European Region — the United Kingdom, Belgium, France, Germany, Italy, Portugal, Spain and Sweden — have reported cases of monkeypox in recent days. Outside of countries where monkeypox is known to be endemic, recent similar cases have also been reported in Australia, Canada and the United States.

These recent cases are atypical for several reasons. Firstly, because in this instance all but one of the recent cases have no relevant travel history to areas where monkeypox is endemic, in West Africa or Central Africa. Many cases were detected through sexual health services and are among men who have sex with men. Also, the geographically dispersed nature of the cases across Europe and beyond, suggests that transmission may have been ongoing for some time.

WHO is working closely with the countries concerned to investigate these cases further, determine the likely source of infection, how the virus is spreading, and how to limit further transmission. 

In India, Union Health Minister Mansukh Mandaviya has directed the National Centre for Disease Control (NCDC) and the Indian Council of Medical Research (ICMR) to keep a close watch on the situation.

What is monkeypox?

• Monkeypox is a rare disease that is caused by infection with monkeypox virus. 
Monkeypox virus belongs to the Orthopoxvirus genus in the family Poxviridae. The Orthopoxvirus genus also includes variola virus (which causes smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus.

• Monkeypox has symptoms similar, but less severe, to smallpox. While smallpox was eradicated in 1980, monkeypox continues to occur in countries of central and west Africa.

• Monkeypox is zoonosis: a disease that is transmitted from animals to humans.

• Monkeypox was first discovered in 1958 when outbreaks of a pox-like disease occurred in monkeys kept for research, hence the name ‘monkeypox’.

• The first human case was recorded in 1970 in the Democratic Republic of the Congo (then known as Zaire), and since then the infection has been reported in a number of central and western African countries. Most cases are reported from Congo and Nigeria. 

• In 2003, monkeypox was recorded in the United States when an outbreak occurred following importation of rodents from Africa. Cases were reported in both humans and pet prairie dogs. All the human infections followed contact with an infected pet and all patients recovered. 

Transmission

• Monkeypox does not spread easily between people.

• Spread of monkeypox may occur when a person comes into close contact with an animal (rodents are believed to be the primary animal reservoir for transmission to humans), human, or materials contaminated with the virus. 

• The virus enters the body through broken skin (even if not visible), the respiratory tract, or the mucous membranes (eyes, nose, or mouth).

Person-to-person spread is very uncommon, but may occur through:

• Contact with clothing or linens (such as bedding or towels) used by an infected person.

• Direct contact with monkeypox skin lesions or scabs.

• Coughing or sneezing of an individual with a monkeypox rash.

Symptoms

Initial symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body. The rash changes and goes through different stages before finally forming a scab, which later falls off.

Treatment

• Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for monkeypox. 

• Monkeypox, in most cases, is a mild condition which will resolve on its own and have no long-term effects on a person’s health. Most people recover within a few weeks. However, severe illness can occur in some individuals.

• Treatment of monkeypox patients is supportive dependent on the symptoms. Various compounds that may be effective against monkeypox virus infection are being developed and tested.  

• Prevention and control of human monkeypox rely on raising awareness in communities and educating health workers to prevent infection and stop transmission.

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