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Monkeypox Outbreak Sweeps Across Europe, But Should SA Be Worried?

Monkeypox Outbreak Sweeps Across Europe, But Should SA Be Worried?..  A handful of cases of monkeypox have now been reported in Europe or are suspected, BUT should South Africa be worried?

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Monkeypox Outbreak Sweeps Across Europe, But Should SA Be Worried?

With a handful of cases of monkeypox now being reported or are suspected in Britain, Portugal, Spain, and the United States, we take a look to see if South Africa should be worried? 

WHAT IS MONKEYPOX? 

According to the World Health Organisation (WHO) Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) with symptoms similar to those seen in the past in smallpox patients. 

However, it is clinically less severe. 

With the eradication of smallpox in 1980 and subsequent cessation of smallpox vaccination, it has emerged as the most important orthopoxvirus. Monkeypox occurs in Central and West Africa, often in proximity to tropical rainforests.

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WHAT ARE THE SYMPTOMS OF MONKEYPOX? 

The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days.

The WHO said the infection can be divided into two periods:

  • The invasion period (which lasts between 0-5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle aches), and an intense asthenia (lack of energy). Lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may initially appear similar (chickenpox, measles, smallpox).
  • The skin eruption usually begins within 1-3 days of the appearance of fever. The rash tends to be more concentrated on the face and extremities rather than on the trunk. It affects the face (in 95% of cases), palms of the hands, and soles of the feet (in 75% of cases). Also affected are oral mucous membranes (in 70% of cases), genitalia (30%), conjunctivae (20%), as well as the cornea. 
  • The rash evolves sequentially from macules (lesions with a flat base) to papules (slightly raised firm lesions), vesicles (lesions filled with clear fluid), pustules (lesions filled with yellowish fluid), and crusts that dry up and fall off. The number of lesions varies from a few to several thousand. In severe cases, lesions can coalesce until large sections of skin slough off.
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Monkeypox is usually a self-limited disease with symptoms lasting from 2 to 4 weeks. 

Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and nature of complications. 

Complications of monkeypox can include secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision.

People living in or near forested areas may have indirect or low-level exposure to infected animals, possibly leading to subclinical (asymptomatic) infection.

The case fatality ratio of monkeypox has varied between 0 and 11 % in the general population and has been higher among young children. In addition, persons younger than 40 or 50 years of age (depending on the country) may be more susceptible to monkeypox as a result of the termination of routine smallpox vaccination worldwide after the eradication of smallpox.

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HOW MANY CASES HAVE BEEN REPORTED OR ARE SUSPECTED? 

According to a report by Reuters, Portugal has logged five confirmed cases, and Spain is testing 23 potential cases. Neither country has reported cases before.

The United States has also reported one case.

SHOULD SA BE WORRIED? 

The outbreaks are raising alarm because the viral disease, which spreads through close contact and was first found in monkeys, mostly occurs in west and central Africa, and only very occasionally spreads elsewhere.

“Historically, there have been very few cases exported. It has only happened eight times in the past before this year,” said Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine, who said it was “highly unusual”.

Transmission this time is puzzling experts, because a number of the cases in the United Kingdom – nine as of May 18 – have no known connection with each other. Only the first case reported on May 6 had recently traveled to Nigeria.

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As such, experts have warned of wider transmission if cases have gone unreported.

The UK Health Security Agency’s alert also highlighted that the recent cases were predominantly among men who self-identified as gay, bisexual or men who have sex with men, and advised those groups to be aware.

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Scientists are now carrying out genomic sequencing to see if the viruses are linked, the World Health Organization (WHO) said this week.

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