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Will Monkeypox become the next global pandemic?

Listen to a podcast from the talk radio show, The Laura Coates Show, on SiriusXM's Urban View. Laura Cotes speaks with Dr. Soumi Eachempati about Monkeypox on 5/23/2022.

In the past two weeks, there have been at least 92 new cases of monkeypox in western Europe and the United States. Almost all the cases have been associated with travel to Africa or contact with someone who has traveled there. In the Democratic Republic of Congo, there have been 1284 cases and 58 deaths since the beginning of 2022. Recently, a new case was just detected in California. With the case numbers rising and the United States now on alert, it is important to see what factors will lead to a repeat of the COVID-19 pandemic.

COVID-19 became such a large and lasting pandemic since the virus was contagious, amenable to aerosolized spread, mutable, and prevalent in asymptomatic carriers. Initially, the disease had a high mortality rate, especially among those with comorbidities. Even though the mortality of COVID-19 has become low, it is still a major concern as the volume of cases still exceeds over 100,000/day in the United States.

Monkeypox has been studied for over 50 years, and so much is known about its disease characteristics. This virus is a poxvirus, a family of viruses that also includes smallpox, cowpox, and vaccinia. The disease was first described in monkeys in 1958 but the current spread is mainly through rodents. A major outbreak of monkeypox occurred in 2003 in the United States where 47 people became infected from the importation of small mammals from Africa that spread to domestic prairie rats.

Indeed, most of the disease spreads via close contact via close breathing, skin contact, and mucous membranes. Shared clothing or bedding may also spread the disease. In the US in 2003, it was observed that the spread was worsened by petting prairie dogs and being scratched or bitten by them. Transient contact or passing aerosolized exposure does not appear to spread the disease.

Symptoms of monkeypox are like smallpox but only milder. There may be a fever, rash, swollen lymph nodes, and the development of characteristic pustules over part of the body. Smallpox had a 30% case fatality rate whereas monkeypox is from 1-10%. There appears to be a mild and severe presentation. In the DRC, the disease has a higher rate of mortality, and children seem to be the most serious victims. None of the 92 initially described cases have died.

The treatment is mainly supportive and involves quarantining with contact tracing. Immunoglobulin, also known as antibodies, could be given for severe cases. Giving a vaccine after up to 4 days after exposure is recommended if available as it may limit or prevent the disease. Preemptively, the smallpox vaccine may prevent about 85% of cases of monkeypox.

Currently, individuals at risk for monkeypox include those who have traveled to Africa or been in close contact with someone who traveled there. If someone suspects they may have monkeypox, they should isolate themselves and their recent contacts, and call local health officials. Although the pictures of the disease are frightening, the likelihood of monkeypox becoming an uncontrollable pandemic is virtually zero. The close contact required for the spread is not conducive to massive spread and the travel history required poses another obstacle. Unlike the COVID-19 virus, the monkeypox virus has not historically mutated much and its reproductive spread is usually less than zero.

Monkeypox is now in the United States. Disease awareness and caution should prevent it from becoming the health care disaster that COVID-19 has become. Time will tell if the virus mutates and creates more favorable characteristics for spread. Stay tuned!

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