Monkeypox sign of disease ‘new normal’?

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Monkeypox cases are being reported from around the world.

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The first case in Europe in early May was in the UK — someone who had visited Nigeria — and after that, Reuters said WednesdayPortugal reported 14 cases and Spain has at least 20.

There are cases in Canada (17 in Montreal), the US, Italy, France and Sweden.

Monkeypox is a virus, first identified in people in 1970 in the Democratic Republic of the Congo. It’s spread has been mostly limited to other central and western African nations — until now.

It’s almost never reported outside Africa, so this sudden jump in cases all over the world is worrying.

You can expect to hear of more cases in more places now, because health-care workers will be looking more closely.

Do these numbers indicate a more easily transmissible form of monkeypox?

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Not necessarily.

Reuters reports there are two main strains of monkeypox: the Congo strain, which is severe – up to 10% mortality – and the West African strain, which kills about 1%.

There were close to 50 cases of monkeypox in the United States by 2003, the very first cases confirmed outside Africa; the CDC reported they came from infected prairie dogs kept as pets that were infected via small mammals imported from Ghana.

Despite the name, the zoonotic monkeypox is spread by rats, squirrels and small mammals. It was named after it turned up in lab monkeys in the 1950s.

Transmission is possible via large droplets, bodily fluids and close contact, and infected persons are advised to keep their laundry and bedding to themselves.

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The usual symptoms are flu-like, with fever, headache, fatigue and muscle ache being most common.

Then the skin rashes or pustules appear, with the distinctive oozing center.

There were two cases of monkeypox in the US last year, both in people who had traveled to Nigeria. The uptick in cases recently, and globally, “is noteworthy, but it’s important to keep it in context,” said Dr. Kamran Khan, an infectious disease expert at St. Michael’s Hospital.

Khan is also the founder and CEO of Blue Dot, a globally respected company that uses human and artificial intelligence to track infectious diseases around the world, project their trajectory and warn those who will be affected; Blue Dot became invaluable to clients such as the government of Canada during COVID.

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“We’re seeing cases of monkeypox in people who haven’t traveled and have no clear connection to those infected during travel, so that is also noteworthy.”

Transmission thus far, he explained, is in social networks, and most often among men who have sex with men, close physical contact being the way monkeypox is spread.

Community transmission suggests the general population is at risk, and that does not appear to be the current situation, “nor is it consistent with the epidemiology,” said Khan.

“Some respiratory transmission is thought possible, which is part of close and prolonged contact,” he said, but it’s not as easily transmitted as measles, say, or COVID.

Cases now number in the 10s; Khan said he would be surprised if they go much past the hundreds. And he thinks it will all wrap up within a few months.

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That said, adds Khan, “The risks from emerging diseases are increasing and we are going to continue to face more of these threats going forward. We’re now seeing an infectious disease event roughly every two years. This is the new normal, a new era of epidemics that we are going to have to manage.”

The smallpox vaccine protects against monkeypox, but nobody has been vaccinated against smallpox since 1980 and immunity in older people is waning now.

That may help account for the current outbreak.

So does the proximity of humans to wild animals, “and the way we interact with the world around us,” said Khan.

Travel, population growth and climate change are also involved.

“And so is the fact that there’s more and more inequality in the world, more of the world is fragile and our fates are intertwined. We’re not fully safe until everyone is protected.”

One concern related to monkeypox is the general exhaustion in the medical community after two years of COVID.

Ace one physician tweeted this week:

“If monkeypox spreads, I think I’m leaving medicine. I’m not exposing myself to a disease with 10% mortality because this country of selfish f—s refuses to mask or get vaccines when they’re available.”

“Make whatever health choices you want. My choice will be to leave.”

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