Monkeypox: 3 unknowns that worry about this growing disease

A recent outbreak of a rare infectious disease alarmed the world: Monkeypox. Since the beginning of 2022, over 1200 cases were confirmed in countries where the disease has not previously been reported. Before the current eruption, Monkeypox was a rare disease, endemic in few Sub-Saharian countries including Congo, Cameroon and Nigeria. Also, very few sporadic cases were reported in other countries, notably the US and the UK. Although the virus was discovered in Denmark over 60 years ago, it remained relatively unknown until the recent spread of Monkeypox which raised awareness and wakened interest in the virus and the disease across the globe. However, key unknowns concerning emerging rare diseases like Monkeypox are and remain a challenge in healthcare. Discover in this article 3 key unknowns around the spread of Monkeypox that represent major challenges for public health and the healthcare industry.

Spotting major wrong beliefs around the spread of Monkeypox

The origins of Monkeypox

Monkeypox belongs to the Orthopoxvirus genus that also includes viruses causing smallpox and cowpox. The famous chickenpox is however not included is this family. Indeed, not only the names but also the symptoms are often misleading.

Monkeypox owes its name to the first documented cases of outbreaks in non-human primates in an animal facility. This does however not mean that the disease originates and spreads in monkeys only. Squirrels, rats or mice have notably been identified as viral hosts and might therefore represent an important reservoir and source of infection, in addition to human-to-human transmission. As the population lives much closer to rodents compared than monkeys in urban or other areas, a rodent reservoir could therefore lead to an accelerated spread of Monkeypox.

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Symptoms of Monkeypox

The symptoms resemble the well-known chickenpox. However, it is much more dangerous and can lead up to 11% of deaths among infected patients.

Besides the characteristic rash appearing on most body parts, fever, swollen lymph nodes and muscle aches are also signs of Monkeypox. The symptoms resemble to the well-known chickenpox. However, it is much more dangerous and can lead up to 11% of deaths among infected patients. Hence, misinterpretation of the symptoms can be a serious burden.

Such mistaken understanding of the disease is indeed a serious threat as it contributes to the spread of Monkeypox. With the recent outbreak, research received a new momentum to better understand the virus and the disease.

Indeed, to prevent an outbreak, efforts are needed in three key areas: virology, epidemiology and therapies.

Monkeypox and its virologic unknowns

Understanding the biology of a virus is key to preventing infections and spread. It notably allows taking adapted sanitary measures and is also necessary to develop drugs.

For Monkeypox, zoologic reservoirs, type of transmission, or metagenomics are three research questions that remained poorly explored for a long time and still need to be further understood today. In endemic countries, the need to know more about these topics was clear. Experts on the topic were working on the spread of Monkeypox, however, they faced financial and technological barriers as resources were not locally available.

As the virus has expanded to new countries, research has been activated in several institutions.

Monkeypox and its epidemiologic unknowns

After national outbreaks in past years, Congo, Nigeria and other sub-Saharan countries have developed reporting systems specifically designed for Monkeypox. However, the disease was overall unknown by the population, representing barriers to the reporting of cases of infection.

For example, lack of training of medical staff contributes cases are not being diagnosed. Also, people staying home to avoid hospitalisation and treatment costs are missed by these reporting systems.

Indeed, cases are probably under reported for all infectious diseases, including HIV, malaria or COVID 19. But this is even more problematic for a rare disease as the virus might seem to be totally absent.

Therapeutic unknowns

As the cases were very low, very few resources were previously allocated to develop monkeypox-specific therapies. Fortunately, given its resemblance to the smallpox virus, the previously available vaccines are effective against monkeypox too.

Compared to other pandemics such as COVID 19, the health system is better prepared to the spread of monkeypox. While there still are unmet medical needs, outbreak of other rare disease could be much more threatening.

Rare or emerging infectious diseases represent a serious threat given their unknown in various unknonws. The main difference between Monkeypox and COVID 19 is the history and previous existence of a solution for any pox virus. One of the key learnings is therefore that rare diseases deserve special attention not only from public health, but also from the healthcare industry. While emergence of a new disease is hard to anticipate, Monkeypox has shown that rare infectious disease can and will happen.

About the authors, 

Christina, Consultant and Quentin, Project Manager in Alcimed’s Life Sciences team in Switzerland