Monkeypox: What we know

monkeypox, smallpox, virus,

Monkeypox is a disease caused by an Orthopoxvirus. It originates from countries in Central and West Africa (Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan). It occurs in populations that handle and consume bushmeat. There are two distinct clades (organisms of common ancestry), the West Africa clade and the Congo Basin clade (also called the Central African clade). 

As of 1st of June 2022, the following countries have reported cases of Monkeypox: Afghanistan, Argentina, Australia, Austria, Belgium, Bolivia, Brazil, Canada, Costa Rica, Czech Republic, Denmark, Finland, France, Germany, Gilbraltar, Hungary, Italy, Israel, Iran, Ireland, Malta, Mexico, Netherlands, Norway, Paraguay, Portugal, Slovenia, Spain, Sweden, Switzerland, the United Arab Emirates, the United Kingdom, the United States of America. All cases have been of the West Africa clade. 

How is Monkeypox transmitted?

Transmission can happen when a person is in close contact with an infected animal or person. Human to human transmission occurs via respiratory droplets or contact with body fluids or lesion / contaminated material. 

Early symptoms include fever, headache, myalgia (muscle aches), backache, swollen lymph nodes, chills, fatigue and malaise. Later, a raised rash appears on the face, spreading to other body parts, including the palms and soles. 

The incubation is 5 to 21 days. Spread to others can occur from when the fever starts until the lesions have scabbed over like chickenpox. For most patients, this is a self-limiting disease lasting 2-3 weeks. However, a small number can develop a more severe illness.

Complications of Monkeypox can include:

  • Secondary infections
  • Bronchopneumonia
  • Sepsis
  • Encephalitis
  • Infection of the cornea causing loss of vision

Is there a vaccination for Monkeypox?

Smallpox vaccination does confer 85% protection against this illness. Still, most people below 40-50 years old would not have had this due to the vaccine campaigns beings stopped in the 1970s when smallpox was eradicated. This vaccine is not available privately. 

At the time of writing this, there has been one confirmed case of a traveller who transited through Changi Airport travelling to Sydney on the 2nd of June. As the traveller did not enter Singapore or interact with persons in the community, there is no significant risk of community transmission.

The only recorded case of Monkeypox in Singapore was in 2019, when a traveller from Nigeria was diagnosed with Monkeypox. He was treated at the NCID. Exposed individuals were quarantined and offered vaccination.  

The Ministry of Health (MOH) says, travellers are strongly advised to maintain vigilance and take the following precautions:

  • Maintain a high standard of personal hygiene, including frequent hand washing after going to the toilet or when hands are soiled.
  • Avoid direct contact with skin lesions of infected living or dead persons or animals and objects that may have become contaminated with infectious fluids, such as soiled clothing or linens (e.g. bedding or towels) used by an infected person.
  • Avoid contact with wild animals that could harbour the virus and consumption of bushmeat.
  • Returning travellers, especially from areas affected by monkeypox1, should seek immediate medical attention if they develop any disease symptoms (e.g. sudden onset of high fever, swollen lymph nodes and rash) within three weeks of their return. They should inform their doctor of their recent travel history.
  • Given the evolving global situation, keep updated with health issues that impact travellers’ health, including disease outbreaks and travel risks at travel destinations.

As this is a rapidly evolving situation, please check the MOH and World Health Organisation (WHO) websites for updates using the links below.

MOH Monkeypox updates

WHO Monkeypox explained

Dr Ho Tzin Yih is a graduate of the Royal College of Surgeons, Dublin in 1994, he also has a Bachelor of Science degree from Baylor University in Waco, Texas. He is registered with UKOOA and trained in Occupational Medicine and a Designated Workplace Doctor. Dr Ho has been with IMC for over 10 years and is the Deputy Medical Director based in our Camden Clinic.

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