How prepared are we for Monkepox?

How prepared Are we For a Monkeypox outbreak?

There are currently over 30,000 cases of Monkeypox reported from across the world.

Anyone can get Monkeypox. However, there are several reasons why “everyone” is unlikely to get impacted by Monkeypox in the same way as COVID-19.

1. Monkeypox virus is not a novel Pathogen of Humans

Unlike SARS-CoV-2 which emerged as a human pathogen in 2019, outbreaks of Monkeypox have been noted for decades. Cases have been reported from over 11 countries in Africa since the 1970s (1).

The first case of Monkeypox in India was reported in July 2022 and 9 cases have been reported so far.

We therefore have experience with detecting and treating the disease and prior knowledge about how this virus spreads.

2. We already have several vaccines that Can be used to prevent Monkeypox

In the USA, two vaccines, an updated smallpox virus vaccine (ACAM2000) and a Monkeypox vaccine JYNNEOS have been approved for use against Monkeypox (2,3).

India currently does not manufacture or hold stocks of a smallpox vaccine.

There are two related issues here that I will take up later- Do we have enough vaccines and who should get vaccinated?

3. Treatment Strategies – Antivirals in advanced stages of Trials

Atleast two antivirals that have FDA approval for treatment of Smallpox are being considered for treatment of Monkeypox. Tecovirimat is being considered in the Expanded Access Investigational New Drug Protocol for Monkeypox by the CDC, USA. It has previously been used to treat a single patient in the UK. A study of three patients treated with Tecovirimat in USA has recently been published. The other antiviral Brincidofovir is also being considered and has been used in previous outbreaks of Monkeypox.

There is an urgent need to have larger studies that can demonstrate efficacy and for consideration of availability and equity in access.

4. Previous Immunization with with smallpox vaccines may be protective against Monkeypox

The smallpox vaccine which was used for eradication smallpox (caused by the Variola Virus) also protects from monkeypox and cowpox (6).

These vaccines were last used over 40 years ago for routine immunizations as part of the smallpox eradication efforts. If you were born before this time, a scar in the upper arm is an indication that you were vaccinated.

We do not know if this previous dose of vaccine confers life-long immunity. In fact studies from past outbreaks suggest that this cross-protection can wane or be incomplete (7,8,9). We also don’t know if the cross-protection will continue against currently circulating Monkeypox virus.

For now, we believe that previous smallpox vaccination would confer some level of protection or result in reduced severity of illness (1).

These are some of the reasons I believe we will be able to limit the impact of the current Monkeypox outbreak in people and animals.

There are a few other important factors – how the virus changes and how well it spreads. I’ll address these in future posts.

Next – How do you know you’ve got Monkeypox?

References and Further Reading:

1. WHO Monkeypox FactSheet (accessed Aug 9, 2022).

2. Petersen BW, Harms TJ, Reynolds MG, Harrison LH. Use of Vaccinia Virus Smallpox Vaccine in Laboratory and Health Care Personnel at Risk for Occupational Exposure to Orthopoxviruses — Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2015. MMWR Morb

Mortal Wkly Rep 2016;65:257–262.

3. Rao AK, Petersen BW, Whitehill F, et al. Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:734–742.

4. Wilfredo R Matias, Jacob M Koshy, Ellen H Nagami, Victor Kovac, Letumile R Moeng, Erica S Shenoy, David C Hooper, Lawrence C Madoff, Miriam B Barshak, Jennifer A Johnson, Christopher F Rowley, Boris Julg, Elizabeth L Hohmann, Jacob E Lazarus, Tecovirimat for the treatment of human monkeypox: an initial series from Massachusetts, United States, Open Forum Infectious Diseases, 2022;, ofac377

5. Adler, Hugh et al. “Clinical features and management of human monkeypox: a retrospective observational study in the UK.” The Lancet. Infectious diseases vol. 22,8 (2022): 1153-1162. doi:10.1016/S1473-3099(22)00228-6

6. Fenner, Frank, Henderson, Donald A, Arita, Isao, Jezek, Zdenek, Ladnyi, Ivan Danilovich. et al. (‎1988)‎. Smallpox and its eradication / F. Fenner … [‎et al.]‎. World Health Organization.

7. Jezek, Z et al. “Human monkeypox: a study of 2,510 contacts of 214 patients.” The Journal of infectious diseases vol. 154,4 (1986): 551-5. doi:10.1093/infdis/154.4.551

8. Jezek, Z et al. “Human monkeypox: disease pattern, incidence and attack rates in a rural area of northern Zaire.” Tropical and geographical medicine vol. 40,2 (1988): 73-83

9. EID Reynolds MG, Davidson WB, Curns AT, Conover CS, Huhn G, Davis JP, et al. Spectrum of Infection and Risk Factors for Human Monkeypox, United States, 2003. Emerg Infect Dis. 2007;13(9):1332.