As of September 21, the current monkeypox outbreak has infected 62,532 people in 105 countries. However, the World Health Organization (WHO) has not yet classified the current burden as a pandemic.
But can that change? Considering its distribution, it could monkey pox become a pandemic?
The answer to this question depends on the definition of “pandemic”. A pandemic is a “global epidemic” with large numbers of cases or outbreaks in many countries, Rachel Roper, a professor of microbiology and immunology at East Carolina University in Greenville, North Carolina, told Live Science in an email.
“I think it’s a matter of judgment as to how many cases you should have in how many countries,” Roper said. The Centers for Disease Control and Prevention (opens in a new tab) (CDC) defines a pandemic as “a disease event in which there are more cases of disease than expected and spreads to several countries or continents, usually with person-to-person transmission and affecting large numbers of people.”
There is always the possibility that something, such as the genetic code of the virus, could change, but some factors make it less likely that monkeypox will become a pandemic. Experts told Live Science that even if it did, monkeypox would not come close to the effect of the COVID-19 pandemic.
Historically, monkeypox was not highly contagious and outbreaks were small
Monkeypox (sometimes abbreviated MPXV or MPX) is “much less contagious than COVID,” Roper said. Typically, the chain of monkeypox transmission was short — a single case of MPXV was transmitted to a maximum of seven people before dying out — so outbreaks in the past have been short-lived, Roper said. Monkeypox was first documented to infect humans in 1970, and outbreaks since then, except for the current pandemic, have been “small,” she said. In countries where it is endemic, monkeypox is always present in animal hosts and usually spreads between humans only when they pick it up from animals and start passing it on to humans.
But an analysis of the genomes of monkeypox from the current epidemic, published June 24 in the journal Natural medicine (opens in a new tab)suggests that the version of the virus currently circulating has been transmitted from person to person in an unbroken chain of transmission since 2017. This suggests that the average supply chain is growing, Roper said.
However, for monkeypox, the reproduction number (R0), or the number of people directly infected with the disease per person, has historically been less than 1, meaning that any epidemic would eventually die out even without active disease control measures (in in contrast, the R0 for currently circulating micron variants of SARS-CoV-2, the virus that causes COVID-19, is estimated to be between six and 10 Conversation (opens in a new tab).) But researchers don’t know the R0 for the version of monkeypox currently circulating, according to Document for June 2022 (opens in a new tab) in The Lancet Infectious Diseases.
It’s hard to say why monkeypox is now infecting so many people, she added. That could be because mutations have made it more transmissible, or it could be because it has entered new populations that generally have different behaviors or risk factors that increase transmission rates, Roper said.
For example, in African countries where monkeypox is endemic, the virus was not previously known to spread through men who have sex with men, Roper said. But the current outbreak primarily affects men who have sex with men and spreads through sexual and other close physical contact, according to World Health Organization (opens in a new tab) (WORLD HEALTH ORGANIZATION).
Monkey pox mutates quite slowly
Monkey pox is a virus that consists of DNA, as opposed to being composed of single-stranded ribonucleic acid (RNA). This is important because there are fewer errors in DNA replication than in RNA copying, so monkeypox mutates more slowly than counterparts such as SARS-CoV-2 or HIV. According to American Society for Microbiology (opens in a new tab).
However, the monkeypox poxvirus mutates rapidly, according to a June analysis of the genome in Nature Medicine. Compared to the strains circulating in 2018 and 2019, the currently circulating virus has 50 mutations that were most likely acquired while circulating in humans, the paper said. This is 6 to 12 times the number of mutations expected based on the typical mutation rate for poxviruses, the authors of the article note.
Not a lung virus
The virus that causes COVID-19 is “mostly respiratory,” Roper said. “Its main target organ is the lungs.” SARS-CoV-2 is spread when an infected person sneezes, coughs or even just breathes, Roper said. In contrast, monkeypox is spread primarily by “direct contact with the monkeypox rash, scabs, or bodily fluids of a person with monkeypox,” according to the Centers for Disease Control and Prevention (CDC). The virus can also be spread when a person touches objects and surfaces that have been used by a person infected with monkeypox.
“Monkey pox is so inefficient in the way it spreads,” Rodney Rhode, professor and head of the Texas State University Clinical Laboratory, told Live Science. “You have to be very close, skin to skin, or maybe with fomites like bedding or clothing. And it actually takes a long time, so a few hours of contact for that to happen, whereas [for] an aerosolized virus, it can be instantaneous – someone sneezes or coughs in a room and you breathe it in and maybe 8, 10, 12 people get infected.”
We already have vaccines and treatments for monkeypox
Two vaccines, JYNNEOS and ACAM2000, are approved for use against monkeypox in the US as This was previously reported by Live Science.
Although there is no specific treatment for monkeypox, according to the Center for Disease Control (opens in a new tab)antiviral drugs that have been developed to fight natural smallpoxsuch as tecoxiramit (TPOXX) may be recommended for people with weakened immune systems immune system.
Given the availability of vaccines and treatments, combined with other factors, such as the low death rate of the monkeypox strain currently circulating, it should be possible to slow the rate of infection and limit deaths, Rhode said. According to data Center for Disease Control (opens in a new tab). But the current outbreak may be far less deadly; according to WHO at the end of September, the mortality rate is 0.04%. While these numbers are still a rough estimate, they suggest that the number of monkeys from monkeypox is likely to be much, much lower than that from COVID-19, even if monkeypox will truly become a pandemic. “It could be declared a pandemic at some point because of the number of countries that have cases and the kind of linear increase in cases that we’re seeing,” Rhode said. “But I don’t believe it’s going to be the type of global mortality crisis we’ve seen with COVID.”
Originally published on Live Science.
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