 Over the past few weeks, multiple reports have emerged of monkeypox. In its latest report, the World Health Organization has said that there have been about 550 cases of monkeypox reported in countries outside of Africa where the disease is usually seen. The virus was first discovered affecting humans in 1917, the continent. There is still a great deal of uncertainty over how the disease is spreading. Amid the heightened coverage of health issues in the aftermath of COVID-19, there has been a lot of interest in monkeypox as well. What causes monkeypox? What are the symptoms and modes of transmission? How dangerous is it? What lessons can we learn from the global spread of monkeypox? Immunologist Dr. Satya Jitrat has the answers. So this week we are talking about a new viral disease that has been in the news for quite some time now, quite a few weeks now. And that is monkeypox. First of all, even though it's called monkeypox, it's actually found in a very broad and diverse range of animal species. It's found in rodents and mice, rats, some monkeys, many non-monkey species, and occasionally, especially from the forest animal communities from which it transfers into human communities. It is seen in humans. So what is monkeypox? So we are all familiar, or at least we've all heard of viral diseases that cause rash, blisters, and blisters that heal into scabs and then the scabs fall off. The most dramatic, the most lethal, the most spectacular example in human history is, of course, being smallpox. But there are a number of other poxviruses. Some of them are more closely related to each other. Some of them are more distantly related to each other. The monkeypox virus belongs to the poxvirus family. It's related to the smallpox virus. Smallpox, of course, has been eradicated as a disease. And exactly like any other viral infection of skin and of throat-nose linings, the way that monkeypox is transmitted from one person to another is by large droplets because there are blisters in the mouth and so on and so or by the fluid from the blisters or by the scabs. And all of this, as far as we can tell, needs fairly close contact. And the fairly close contact is perhaps why it has been known to be transmitted during sexual intercourse and relationships. As a result of this, it is not a very efficiently transmitting virus as compared, for example, to our current situation with SARS-CoV-2, the COVID-19 virus and its most recent Omicron, BA4, BA5, BA221 lineages, which spread extremely rapidly. In comparison with that, monkeypox spread is generally thought to be much slower and there is no evidence suggesting that it's spreading any faster. What does the virus infection cause? As I said, it causes blisters, a rash that converts into blisters, blisters ooze. Sometimes they can get secondarily infected with bacteria but by and large they ooze, they dry, the scabs fall off and people recover. And in that sense, it seems to be by and large and illness without major long-term severe consequences. Immunocompromised people, as with any other infection, including COVID-19, immunocompromised people can be overwhelmingly infected and can die. In fact, I think there has been perhaps one report in the last month or so of an immunocompromised individual dying of monkeypox. In association with the rash and the blisters, it also of course starts with fever, body ache, fatigue, all the usual symptoms of almost any infection in the body. Everybody wants to know if this is a new virus. No, it's not a new virus. So monkeypox we have known about for many decades. It sporadically comes with animal to human transmission from forest communities. There seem to be two major lineages of the virus. One lineage is Central African, the other lineage is West African. The current outbreak that has been seen as cases outside Africa, the couple of hundred cases that have been reported, all appear to belong to the West African strain rather than the Central African lineage. By and large, as I said, this is a relatively mild illness, although there is always some risk of severe illness. Severe illness in addition to immunocompromised people has been known on occasion to be seen in children, which is quite different from COVID-19. This is a DNA virus as different from the COVID-19 virus SARS-CoV-2, which is an RNA virus. The chances of errors in copying, in making progeny in expanding populations is much greater in RNA viruses than in DNA viruses. So RNA viruses tend to change and give rise to potential variants somewhat more rapidly than DNA viruses do. And there is no reason so far to think that there is any new variant of monkeypox circulating. These sorts of outbreaks, both within West Africa or Central African communities, and on occasion, by some contact traveling outside Africa into small outbreaks in other places, have been known in earlier decades. And what seems to be happening so far, isn't any different from that. So the question is, what are the precautions then that we should be taking? And I would argue that both in terms of precautions, in terms of treatment and in terms of prevention, there is a personal component and a community public health component. At the personal level, if you are infected, you should be quarantined for the couple of weeks that it's going to take for you to be completely recovered. Diagnosis like COVID-19 is with PCR testing exactly like COVID-19. There are antiviral drugs, but they provide modest improvements and they're not widely available. And by and large, they don't seem to be needed since by and large, it's a relatively mild illness. The vaccine is the interesting thing. The smallpox vaccine, which most people across the world of my generation have had, appears to provide studies have shown that monkeypox can be protected against by the smallpox vaccine to a very substantial extent. The numbers of estimates are 80 plus percent protection. However, since globally we eradicated smallpox in the late 70s by 1980, we no longer have the cowpox vaccine supplies that has been used until 1980 as a smallpox vaccine. And therefore, if we were to gear up to vaccinate for monkeypox, we would have to expand the old cowpox vaccine stocks, which brings me to the final point, which is what we really need to ask is not so much a direct concern about this virus, but the lessons drawn from COVID-19, monkeypox, influenza and related viruses, which is do we globally have public health systems funded by communities and states rather than by profit-making companies, which reach remote communities, which reliably monitor with good technological backup for a variety of viral diseases, does information get collated, analyzed and put into public health policies by developing vaccines, by developing networks and by enhancing our public health care capacities for delivery to the poorest, most disempowered of communities. That still remains the monkeypox question.