SINGAPORE — Cases of monkeypox have been on the rise across the world, with a handful appearing in the United Kingdom over the last month, and new cases being reported in Australia, France, Italy and Sweden.
The United States also confirmed its first case on Wednesday (May 18) and there are 13 suspected cases in Canada.
This has caused alarm worldwide because the disease, which causes a distinctive bumpy rash among other symptoms, mainly occurs in west and central Africa and does not usually spread elsewhere in the world.
However, infectious disease experts in Singapore told TODAY that the virus causing monkeypox is not a cause of concern here for now, and that the chances of widespread transmission is far lower than that of the Sars-CoV-2 coronavirus behind Covid-19.
News agency BBC reported that since the first case of monkeypox was detected in the UK on May 7 from a patient who had travelled to Nigeria, there have been a total of 20 confirmed cases in the UK this month.
There was one confirmed case in Sweden and one in Italy on Thursday, and on Friday, Australia reported its first case from a patient who had returned from Europe.
Just what is this illness, why is it spreading farther now, and with the resumption of international travel during the Covid-19 pandemic, what should Singapore do to prevent an outbreak? TODAY speaks to several experts to find out more.
WHAT IS MONKEYPOX?
The World Health Organization (WHO) said that the monkeypox virus is typically transmitted from animals to humans, from animal hosts such as rodents and monkeys.
It was first identified in the late 1950s in monkeys, then found in humans in the 1970s in the Democratic Republic of Congo, WHO’s website stated.
An infected person may have symptoms that include fever, headaches, swellings, back pain, aching muscles and a general fatigue.
Once the fever stops, a bumpy rash may develop, often beginning on the face, then spreading to other parts of the body, most commonly the palms of the hands and soles of the feet.
The rash can be extremely itchy and it goes through different stages before finally forming a scab, which later falls off, but can cause scarring.
The infection usually clears up on its own with symptoms lasting between two and four weeks.
Animal-to-human transmission of the virus can occur from direct contact such as through blood, bodily fluids or lesions of infected animals.
Human-to-human transmission can happen from close contact with respiratory secretions such as mucus, skin lesions of an infected person or recently contaminated objects, WHO said.
For transmissions via droplets from respiratory particles, there usually has to be prolonged face-to-face contact, and this puts health workers, household members and other close contacts of active cases at greater risk.
Outbreaks of human cases of monkeypox have been reported in 11 African countries since 1970. However, outbreaks have also occurred in various other countries, be they among animals or humans.
In 2003, there was a monkeypox outbreak in the US involving infected pet dogs.
In the late 2010s, the virus has also been detected in travellers who went from Nigeria to other countries — including Singapore in May 2019.
The death rate for infected persons used to be 0 to 11 per cent, but in recent times, it has been around 3 to 6 per cent.
Associate Professor Alex Cook said that this is higher than the death rate of Covid-19, but more developed countries such as Singapore should not be too concerned.
The vice-dean of research at Saw Swee Hock School of Public Health added: "We would hope it should be lower in high-income countries with more healthcare resources."
WHY IS MONKEYPOX SPREADING TO MORE PLACES NOW?
Experts told TODAY that the spread of the virus has caught the world by surprise because it is not commonly spread among people.
However, new evidence does suggest that the virus is transmitted sexually between men who have consensual sex and this may explain why cases are spreading.
Professor Dale Fisher, senior consultant at National University Hospital's division of infectious diseases, said that transmission of the virus is traditionally through animal-to-human contact, and that "human-to-human transmission is known to occur but is not common".
However, Dr Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said there is evidence that the disease is "no longer confined to animal-to-human transmission or to travellers", although the sample size has been small in these studies.
Based on the evidence so far, "there is a significant amount of human-to-human transmission in Europe also apparently among men who have sex with men", Dr Tambyah added.
This is the first time that the monkeypox virus has been associated with possible sexual transmission.
Prof Fisher said that even though several monkeypox cases are being identified in this "male demographic", there could be a bias since sexual health clinics may be on higher alert than other settings based on the initial real-life counts.
"You are more likely to get diagnosed because doctors are really on the lookout for it," he said. "It’s a bias to consider when analysing figures."
WHO stated on its website that close physical contact is a well-known risk factor for disease spread, but it is unclear at this time if the monkeypox virus can be passed specifically through sexual contact and that more studies are needed to better understand this risk.
Prof Fisher pointed out that there is also another aspect of the disease spread that is not understood yet: Infected persons who may not have severe symptoms and are still able to go about their lives, interacting with others and potentially spreading the virus further.
Assoc Prof Cook said that measures to prevent disease spread will hinge closely on what is understood about how the virus is transmitted.
"It is as yet unclear what the implications of that will be for infection control, though as more information is gathered, we get a better idea of what measures to take to prevent spread," he added.
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2022-05-20 15:44:00Z
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