Monkeypox is an infectious disease caused by the monkeypox virus, of the orthopoxvirus. It was first discovered in 1958 among groups of monkeys used for research and then it was just seen as a pox-like disease.


There are two significant types of the monkeypox virus: West Africa and Central Africa types. Monkeypox is not a common infection but the number of cases is higher in Africa than in other parts of the world.


It is important to note that the current world outbreak is the milder form of the West Africa type (7). Monkeypox was first seen in children in 1970 in six children who were never vaccinated during the fight to eradicate smallpox. The youngest of them was nine months old from the Republic of Congo while the remaining five were from Sierra Leone and Liberia (6).


Who can be infected with Monkeypox?

Anyone can get infected by the monkeypox virus. The majority of the cases within Africa affect mostly children less than fifteen years of age and outside Africa, it affects mostly Men, but it is interesting to note that there are lots of cases that don’t fit into the category stated above but are nevertheless infected (7).


How does one get infected with the Monkeypox virus?

Monkeypox is spread via contact with an already human being or animal. Animal to-human spread occurs through contact of the animal with the broken skin of the individual or scratches and bites (6). 


Human-to-human transmission of monkeypox is not common and it has been documented that the last person to be infected by a human is six generational links away from this current outbreak. Human to-human transmission can occur via body fluid like saliva from kissing, skin contact, or air droplet (8).


The 2003 Monkeypox Outbreak in the United States

Monkeypox initially was limited to just Central and West Africa (5). The first outbreak in the US was in 2003. A three-year-old Schyan Kautzer was the first person to be infected. She got the infection from one of her two prairie pet dogs after she was bitten by it. 


Her mother told the Washington Post that the bite on the finger kept getting bigger and she could only cry and sleep. She also had swellings on her neck that was very obvious to see. Only one of the dogs could recover from the illness, the second one died and they name the survivor dog Chuckles (3).


Consequently, her parents were also infected. Her mother presented to Marshfield Clinic on the 27th of May, 2003 with vesicles on her hand, excessive sweating, and throat pain, and after 24 hours, the vesicles had spread around her body and the sweat became drenching. 


A biopsy was conducted on her skin lesions after which the child was discharged home. 31st of the same month her father presented with excessive sweating, skin vesicles, and weakness. The result of the investigations came out and all pointed to a pox virus infection (4).


Investigations recorded that the Monkeypox in the US in 2003 was from animals shipped in from Ghana that were imported to Texas in the April of the same year. The animals were six different types of rodents and we're going to about 800 mammals. The rodents were named to be tree squirrels, striped mice, dormice, rope squirrels, African giant pouched rats, and brush-tailed porcupines.


After importing the animals into the US, most of the animals were kept near the prairie dogs by an animal vendor. The prairie dogs showed no signs of infections before they were sold out as pets. 


The 2003 outbreak in the US made it the first monkeypox infection outside Africa (2). There was no death record and the infection was only animal to human transmission. Laboratories used polymerase chain reaction and electron microscopy to confirm it was monkeypox (9). By the end of July 2022, there were 72 confirmed and suspected cases of monkeypox reported in Illinois, Wisconsin, and Indiana in the large outbreak (9).


How was the 2003 Outbreak Subdued?

A multi-agency and multi-disciplinary approach was embarked on to fight and contain the 2003 outbreak. The Centre for Disease Control worked together with the Food and Drug Administration of the United state alongside the Department of Agriculture to make sure the spread of monkeypox was further prevented. 


Vaccines were introduced to curb the viral infection, aggressive laboratory work and testing were done and treatment of the index cases. Potential human contacts were traced and possibly infected animals were isolated and treated as well. 


An embargo was placed on the importation of animals especially certain specie of rodents and the prairie dogs. Interstate transportation of rodents and pets was also suspended but after a while, the embargo on interstate transportation, sale, and importation of prairie dogs was removed while rodents remain highly prohibited (2). 


The 2021 Outbreak

On the 14th of July 2021, another case of monkeypox was recorded in the United State from an American returning to the state from Nigeria. The case patient who is a man was reported to have traveled from Texas, the USA to Lagos state in Nigeria in June 2021, he also visited Ibadan, a city in Oyo State in Nigeria. He was said to have had cough, vomiting, fever, and rashes in his genial region while in Nigeria, and on the 8th of July 2021, he returned to Dallas, Texas, United State.


On the 13th of July, he presented to a local hospital where he was admitted and was under isolation before the case was confirmed to be monkeypox on the 14th of July (1).


The strain of Monkeypox is the West African type. The man was admitted to the hospital and he spent 32 days on admission undergoing treatment with tecovirimat he was discharged after testing negative for the monkeypox virus (6).


The Centre for Disease Control (CDC) was able to identify over 200 people who initially came in contact with the patient from the two commercial flights he boarded to the United States from Nigeria. After 21 days of monitoring and strict surveillance, there was no additional case recorded from the contacts. CDC worked together with both local and state health departments as well as the airport and airlines to ensure that no additional case was recorded (2).


Maryland health department alongside the CDC confirmed another case of Monkeypox on the 16th of November, 2021. The patient was a resident of the US who had just returned from Nigeria at the time.


CDC supported the local and state health departments and the airline to locate other people on the flight who were in contact with the patient. The contacts were asked to monitor their health for 21 days and this is because it takes up to 21 days before the manifestation of the symptoms after the infection. 


CDC is committed to partnering with other health departments and airlines to ensure that there will be no additional cases of monkeypox to be recorded in the United States (2).


The 2022 Outbreak

The 2022 outbreak is also currently ongoing and CDC is working on tracking this outbreak that has successfully spread to countries not known to normally record cases of monkeypox and unfortunately, this includes the United States.


The current monkeypox outbreak is spreading via human-to-human contact mostly among those who already contracted the disease, also there has been noticed spread through sexual intercourse. CDC encourages everyone to get vaccinated especially those at high risk of contracting the viral infection and those who have been exposed.


The local and state health department are currently on alert for any patient presenting with rashes keeping with monkeypox rash (10).


Vaccination against Monkeypox virus in the United State

Monkeypox is very similar to the smallpox virus and because of this, a similar vaccine can be used for both to prevent monkeypox infection. The United States government has made available variants of the vaccine: ACAM2000 and the JYNNEOS type have been produced to help protect the people.


CDC recommends the vaccines for individuals who are at high risk of contracting monkeypox and also those who have been exposed in one way or the other. This includes contacts with people who have been diagnosed with monkeypox, individuals who had sex with a contact or with multiple sexual partners in a place known to have index cases of monkeypox, and also those whose jobs expose them to the virus such as laboratory workers and health workers (11).


The most preferred vaccine is JYNNEOS against the infection and it is taken as one dose each on two different occasions. The effect of immunity reaches the maximum potential after two weeks. ACAM2OO is an alternative to JYNNEOS on the contrary, it is a single dose but the side effect is more and it is not the best for individuals with immunosuppression or chronic diseases.


Even after vaccination, precautions should be adhered to protect against monkeypox infection until the vaccine has reached its maximum potential (11).


Treatments available for Monkeypox infection

The World Health Organization (WHO) and the Centre for Disease (CDC) are yet to confirm a definitive treatment for monkeypox but due to its similarity with smallpox, the antivirals used in the management of smallpox are also used to treat monkeypox infection (10). This is applicable in the United States and other places across the globe.