Monkeypox is a rare but potentially dangerous viral disease closely allied to Smallpox, although much less severe. Two major strains have been identified – one in West Africa and one in Central Africa, principally in the Congo. Most cases have been reported as occurring in rural rainforest areas where the disease has most probably been entrenched for centuries nurtured in wild animals. The virus is spread by contact with an infected animal or person and in Africa, around 10 per cent die from the infection. The virus can also spread by inhalation of respiratory droplets from infected persons or by contact with their lesions or body fluids.
It would also appear that some recent cases have occurred among men who have had sex with other men. Incubation once infected can take between 6 and 14 days. In humans, the disease produces a headache and muscular aches as well as a swelling of lymph glands. A rash, particularly on the face, often follows and then spreads to other parts of the body. The illness typically lasts for around 2-4 weeks.
There is no specific treatment for Monkeypox.
African countries have suffered sporadic outbreaks over the last few decades. In 2017, Nigeria experienced an important outbreak with more than 170 cases mostly young men. Monkeypox has also been exported from Africa on a number of occasions over the last 20 or so years including to America in 2003 as well as more recently to Israel and the UK in 2018, and Singapore in 2109. In all cases, the disease was spread by people travelling from Nigeria or in the case of America in 2003, by imported wildlife.
Over the last two years, Monkeypox has spread to Europe as well as the UK and Australia, in all cases carried by people from Nigeria or Central Africa.
The outbreak of Monkeypox that took place in the mid-Western states of America in mid-2003 revealed just how critical human behaviour and globalisation are in the emergence and spread of infectious disease.
The 2003 outbreak, the first time Monkeypox had occurred outside of Africa, reflected the huge surge in the international trade of animals for pets or exotic cuisine. At the time, America allowed a wide range of exotic animals to be imported without restriction including lions, tigers, bears, and monkeys.
In 2002, for example, more than 216 million fish, 49 million amphibians, 2 million reptiles, 365,000 birds, and 38,000 mammals were imported. During 2003, several pet shops imported a species of Gambian giant pouched rats for sale as pets. Little attention was shown to the fact that such a rat was one of the natural hosts of Monkeypox. Once they arrived the rats were kept in close proximity to prairie dogs, and Monkeypox seems to have jumped from rats to infect prairie dogs (which were popular as pets).
Handling animals that carried the Monkeypox virus saw the infections spread to humans. In total, 80 Americans caught Monkeypox in 2003. Although no one died the outbreak caused considerable fear and panic. In particular, it was feared that the virus might invade the countryside and become permanently entrenched amongst native wildlife establishing a permanent reservoir just as the Bubonic plague had done a century earlier. Currently, animal species have been shown to be susceptible to Monkeypox including Gambian pouched rats, dormice, tree squirrels as well as a number of other species.
The eradication of Smallpox was perhaps the greatest victory we have had over infectious disease, but Monkeypox suggests that we are paying the price for this success. Global smallpox vaccination ceased in the late 1970s and then Monkeypox emerged as more of a threat. Prior to this, the Smallpox vaccine provided protection against Monkeypox.
Evidence now seems to show that Monkeypox is more widespread in the Congo and parts of West Africa than ever before. Human mobility and intrusion on natural reservoirs of the disease play an important part in the spread of the infection.
In parts of Africa, contact with infected animals during forest clearing, agricultural development and civil unrest have greatly increased the likelihood of exposure to the disease. In the Congo, Monkeypox has been entrenched for many years more. Africans are intruding on previously isolated and remote rural areas in search of food, a place to live, or escaping from civil unrest, all increasing the likelihood of exposure to animals infected with the disease. In addition, more and more tourists as seeking to visit isolated areas in remote parts of Africa. Add this to increased mobility around the world, it is small wonder that infectious disease spreads so easily.
We live in a globalised, interconnected world filled with microbial threats that arise in one place are often amplified by human behaviour and activities, and move around our world in days, sometimes hours.
Human mobility has transformed our world and the number of international travellers crossing international borders by air is now well over one billion per year with most journeys taking far less than the normal incubation time of most infectious diseases. National borders have lost their significance and no longer offer protection against the invasion of infectious disease.
We continue to underestimate the significance of the natural biological environment and believe that we are the dominant species in the world. As Influenza, Covid, and Monkeypox demonstrate, nothing could be further from the truth.
Monkeypox reveals the fragility of our relationship with the natural world and demonstrates how globalisation and population movement makes us more vulnerable to infectious disease. In addition, we still tend to believe that we have won the battle against infectious diseases.
Nothing could be further from the truth.
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