On September 14, the National Disease Control and Prevention Administration (NDCP) shared the latest edition of “Monkeypox Prevention and Control Knowledge” through its official WeChat account. We explored some of the key insights about this viral infection.
**What is Monkeypox?**
Monkeypox is a zoonotic viral infection caused by the monkeypox virus, which has two distinct branches: Type I and Type II. Infection sources include monkeypox patients and infected rodents, monkeys, and apes. While monkeypox outbreaks were historically limited to Africa, since 2022, the virus has spread to numerous countries globally. Common clinical symptoms include fever, rash, and swollen lymph nodes.
**What symptoms do monkeypox patients exhibit?**
The most notable symptom of monkeypox is a rash. Before the rash appears, patients often experience fever, headaches, fatigue, and swollen lymph nodes. Rashes typically develop on the face and limbs, but they can also manifest in the mouth, anus, and genital areas. A rash around the anus may lead to bacterial infections, leading to abscesses and ulcers that affect bowel movements.
**Who is at risk for monkeypox?**
The general population is susceptible to monkeypox, although prior vaccination against smallpox can offer some cross-protection against the virus.
**What is the incubation period for monkeypox?**
The incubation period for monkeypox generally ranges from 5 to 21 days, with most individuals showing symptoms within 6 to 13 days.
**What is the prognosis for monkeypox?**
Monkeypox is typically a self-limiting disease, and most cases are mild. With supportive treatment, the majority of patients can expect their symptoms to resolve within a few weeks. However, young children, pregnant women, and immunocompromised individuals, such as those with low CD4 counts or blood malignancies, may experience severe illness or even death if treatment is delayed.
**Why did the World Health Organization (WHO) once again declare monkeypox a “Public Health Emergency of International Concern”?**
The WHO initially classified the monkeypox outbreak as a “Public Health Emergency of International Concern” in July 2022, largely due to the monkeypox Type II virus. Prompt global actions led to effective control of the outbreak, and the emergency status was lifted in May 2023. However, in September 2023, a variant of the monkeypox Type Ib virus was identified in the Democratic Republic of the Congo, leading to ongoing community transmission in nearby countries and an increased risk of further spread. Current data indicates that symptoms from the Type Ib variant could be more severe than those from the Type II variant, with heightened risks of serious illness and mortality. Consequently, on August 14, 2024, the WHO renewed its declaration concerning the monkeypox outbreak.
**What are the similarities and differences between monkeypox Type I and Type II viruses?**
Both Type I and Type II viruses share transmission methods, primarily through direct contact with the lesions or bodily fluids of infected individuals. Common symptoms include rashes, fever, and swollen lymph nodes. However, they differ in geographic distribution; both virus types circulate in Africa, while Type II is more prevalent outside the continent. Regarding demographics, cases in Africa show no significant gender differences, with a higher proportion among those aged 15 and younger, while cases outside Africa mainly involve young adult men who have sex with men. Additionally, Type I infections typically present with larger and more numerous rashes, potentially leading to a greater risk of severe disease and mortality.
**What is China’s response strategy toward monkeypox outbreaks?**
In response to the first reported domestic case of monkeypox in June 2023, China classified monkeypox as a Class B infectious disease and initiated appropriate management measures. The strategy emphasizes prevention, control, and rapid response, focusing on early detection, reporting, isolation, and treatment. A multi-channel monitoring system has been established, targeting medical institutions, high-risk populations, inbound travelers, and specific venues, supplemented by strengthened risk assessments and health education for at-risk groups.
**What is the current status of monkeypox in China?**
Currently, monkeypox remains at a low endemic level across China, with cases reported in most provinces. Over 90% of cases are among males, with primary transmission occurring through close contact during male-to-male sexual activity. More than 40% of patients are known HIV-positive individuals. So far, all confirmed cases have been tied to the Type II virus, with no reported instances of Type I. Continuous monitoring of the international situation and the risk of Type I virus introduction is essential.
**What measures has China taken to further prevent monkeypox?**
China is leveraging lessons from COVID-19 and the management of monkeypox as a Class B infectious disease to enhance cooperative prevention and control measures. This includes improved health quarantine for inbound travelers from high-risk areas, health education, and personal protective practices. The country is also ramping up its monitoring efforts in anticipation of any potential outbreaks and ensuring readiness to manage cases effectively.
**How does monkeypox spread?**
Both Type I and Type II monkeypox viruses primarily spread through direct contact with the lesions or bodily fluids of infected individuals. Common transmission modes include sexual activity, close household contact, and medical caregiving. Environmental contamination can also lead to infection, but it is less contagious than direct contact. The WHO acknowledges that prolonged inhalation of respiratory droplets may transmit the virus, but this method is relatively rare. Data from epidemiological surveys in China indicate no documented cases of respiratory transmission among contacts of monkeypox patients.
**How are transmission methods for monkeypox and HIV different?**
While both monkeypox and HIV can be transmitted through sexual activities, the routes vary. Monkeypox primarily spreads through direct contact with lesions during sex, whereas HIV is mainly transmitted through bodily fluid exchanges. Casual interactions, such as shaking hands or hugging, do not pose a risk for HIV infection. Thus, while using condoms effectively reduces the risk of HIV transmission, they do not completely prevent monkeypox spread. Individuals with compromised immune systems who are HIV-positive may experience more severe symptoms upon contracting monkeypox.
**Are there any vaccines available to prevent monkeypox?**
Currently, four vaccines have been approved internationally for monkeypox prevention, originally developed for smallpox. However, China has yet to approve any monkeypox vaccines, though efforts are underway to expedite research and regulatory approval for a domestic version.
**Why does the smallpox vaccine provide some protection against monkeypox?**
The monkeypox and smallpox viruses belong to the same family and share certain antigens. Consequently, prior smallpox vaccinations can provide some level of protection against monkeypox. However, it is important to understand that monkeypox and smallpox are distinct diseases; smallpox has been eradicated, while monkeypox remains a newly emerging infection with a significantly lower mortality rate.
**Can a person reinfect after recovering from monkeypox?**
Individuals who recover from monkeypox develop protective antibodies that can prevent reinfection for some time. However, these antibodies may diminish, leading to the potential for reinfection, as reported in some cases abroad.
**What should pregnant women do if they contract monkeypox?**
Pregnant women who contract monkeypox are at a heightened risk of severe illness, and the virus may be transmitted to the fetus through the placenta, potentially resulting in miscarriage, stillbirth, or premature birth. The virus can also be transmitted during delivery or shortly after through close contact. Pregnant women who have been exposed to monkeypox or demonstrate symptoms like fever, rash, or swollen lymph nodes should seek medical attention promptly.
**How do monkeypox and chickenpox symptoms differ?**
Monkeypox and chickenpox are caused by different viruses. Chickenpox is caused by the varicella-zoster virus. While both conditions exhibit rash symptoms, monkeypox typically results in larger, firmer lesions that form scabs in 2-4 weeks, potentially leaving scars. Conversely, chickenpox lesions are generally fluid-filled blisters that rupture and crust over within 1-2 weeks, not leaving scars.
**How can individuals under home treatment for monkeypox avoid transmitting the virus to family members?**
Patients with mild cases of monkeypox who can isolate at home should follow specific precautions after evaluation by medical and disease control authorities. This includes staying alone in a single room, avoiding direct skin or mucous membrane contact with others, using separate utensils and linens, and ensuring regular cleaning and disinfecting of personal items and living spaces.
**What should home-treated monkeypox patients consider?**
During home treatment, patients should prioritize nutrition and hydration, maintain cleanliness of their skin and mucous membranes, and avoid scratching rashes to prevent infections. Those experiencing high fevers may employ methods to reduce fever, and pain medication can be utilized as needed. Following medical advice for treating skin infections and related complications is crucial.
**What personal protective measures should caretakers follow when assisting home-treated monkeypox patients?**
Caretakers should wear surgical masks and disposable latex gloves when providing care, wash their hands immediately after contact, and ensure regular ventilation and cleaning of the patient’s living space. Monitoring their health for any changes is also essential.
**How can contaminated items, spaces, and environments potentially affected by monkeypox be disinfected?**
The monkeypox virus can survive for months on surfaces such as scabs, soil, and fabrics. It is sensitive to heat; heating to 56°C for 30 minutes or 60°C for 10 minutes can deactivate it. Common disinfectants and UV light are also effective. For hand hygiene, hand sanitizers should be used. For environmental disinfection, chlorine-based disinfectants, chlorine dioxide, or hydrogen peroxide can be utilized. Fabrics should be disinfected using heat treatment or soaking in appropriate disinfectants.
**How should close contacts of monkeypox patients conduct self-monitoring?**
Individuals recognized as close contacts should self-monitor their health for 21 days under the guidance of disease control professionals. During this period, they should avoid sexual activities or close contact and refrain from donating blood. Daily temperature checks and symptom monitoring are necessary; if symptoms appear, they should seek medical care and inform healthcare professionals about their exposure history.
**How can people prevent monkeypox in everyday life?**
It is crucial for individuals to take responsibility for their health. Familiarizing themselves with monkeypox prevention knowledge, increasing self-protection awareness, and minimizing high-risk behaviors are essential. As a precaution, contact with wild or unknown rodents, monkeys, and other primates should be avoided.
**What precautions should travelers returning from monkeypox-affected areas take?**
Individuals returning from countries with monkeypox outbreaks should declare any contact with infected individuals or symptoms upon entering the country and cooperate with customs officials for health assessments. Those without symptoms should engage in self-monitoring and seek medical attention if they develop symptoms, advising healthcare providers of their recent travel to monkeypox-affected regions.
**Where can authoritative information about monkeypox be found?**
For trustworthy information on monkeypox prevention and control, individuals can consult the websites and social media accounts of the Chinese Centers for Disease Control and Prevention and local health authorities. This ensures that they stay informed and maintain a scientific understanding of the disease while avoiding unnecessary panic.
