I keep getting asked the same question again and again; is this outbreak of monkey pox a real threat, or is this another case of overstated and weaponized public health messaging? I am going to save my answer to this question for the end of this article and instead focus on what monkey pox is, the nature and characteristics of the associated disease, what we know and don’t know.
The monkeypox virus, which originates in various regions of Africa, is related to SmallPox (Variola), which are both members of the genus Orthopoxvirus. However, it is important to understand that Variola (major or minor) is the species of virus which is responsible for the worst human disease caused by the Orthopox viruses. For example, Cowpox, Horsepox, and Camelpox are also members of this genus, none of which are a major health threat to humans, and one of which (Cowpox) has even been (historically) used as a Smallpox vaccine. My point is that just because Monkeypox is related to Smallpox, this does not in any way mean that it represents a similar public health threat. Anyone who implies otherwise is basically engaged in or otherwise supporting weaponized public health-related propaganda. In other words, spreading public health fearporn.
Monkeypox was first identified in 1958 in colonies of monkeys, and the first human case of the virus was identified in 1970 in the Democratic Republic of the Congo. Most likely this was just the first case identified, as people living in Africa have been in contact with monkeys and the other Monkeypox animal hosts for millennia. The “West African” monkeypox clade (clade = variant) circulating outside of Africa at this time causes a milder disease compared to the closely related virus found found in other regions of Africa (Congo clade).
The symptoms of monkeypox are somewhat similar to, but much milder than smallpox disease. The general clinical presentation of the disease caused by the West African monkey pox clade virus involves Influenza-like symptoms — fever, body aches, chills — together with swollen lymph nodes. A rash on the palm of the hand is often observed. In the latter stage of the disease, which may last for up to a month or more in some cases, may involve small lesions which develop a crust, and which can result in a small depigmented scar. There is no evidence of asymptomatic transmission. In other words, current medical knowledge indicates that it is only spread by person to person contact between an uninfected individual and someone who already has symptoms of the disease. Therefore, disease spread can be readily controlled by classical public health interventions such as contact tracing, temporary quarantine of those who have had physical contact with someone who is infected, and longer term quarantine of those who develop symptoms. Essentially all of the current cases in the west which we are seeing in the news are among men who have sex with men, and appear to be due to close physical contact. Monkeypox is endemic in many parts of Africa, and is a “zoonotic” virus, meaning it can be transmitted from a variety of animals (not just monkeys) to humans. Initial animal to human transmission followed by limited human to human transmission is probably the cause of the sporadic cases typically observed in Africa. Chicken pox, which is highly transmissible, is not part of the genus Orthopoxvirus, despite that name “pox.” Once again for emphasis, Cowpox and Camelpox are also in the genus Orthopoxvirus, and they are not particularly pathogenic when contracted by humans; just because Monkeypox is a “pox” virus in the genus Orthopoxvirus, does not mean it is particularly deadly.