MONKEYPOX

Oh no! Is another pandemic coming? Will there be deaths and lockdowns again? Is there a cure? Should we get vaccinated?

First, lean back and take a deep breath calmly... Because we know that stress and fear harm our bodies and, more importantly, our immune system. We also know that there is a glorious generation born before 1980 who were vaccinated… Additionally, with early clinical diagnosis and vaccination, an 85% recovery rate is possible... The risk of transmission appears to be much lower compared to COVID-19 unless there is direct contact with lesions or very close contact.

If you're feeling a little more at ease, let's dive into the details. Let’s start with the name. Although it is most commonly seen in pouch rats and African squirrels, it was named after monkeys because it was first isolated from a monkey in 1958. Monkeys and humans are accidental hosts, and although its natural reservoir is not entirely clear, it is most likely rodents. It is a member of the Poxviridae family, which includes the smallpox virus. They probably added "pox" to the name because they cause widespread rashes all over the body.

I would like to make an important reminder here. Smallpox was the first disease to be completely eradicated from the world thanks to vaccines.

Let’s return to Monkeypox. Recently, its name was changed to Mpox. It is a DNA virus, which means it is more stable and evolves slowly. There are two main types (Type 1 and Type 2), with Type 2 being milder. As you may remember, the monkeypox cases in 2022 were of this type. Unfortunately, the WHO has issued an emergency call in 2024, anticipating the spread of Type 1, which has more severe clinical symptoms and spreads faster. It has been reported that over 100,000 people were infected, and 200 people died.

After reading this, let's not panic. First and foremost, let's not believe everything we hear. Social media is filled with information pollution and conspiracy theories. We should learn information from scientific sources and use it with wisdom.

The goal is to create awareness and take precautions. What can we do? First, let's get to know the disease. The most common symptoms of the disease include fever, fatigue, and swollen lymph nodes. Swelling of the lymph nodes, in particular, is the most distinguishing feature, setting it apart from chickenpox (varicella) and smallpox (variola-smallpox). The incubation period is between 6 to 13 days (sometimes 5 to 21 days). The actual symptoms (skin lesions) can take 1-2 weeks to appear, which is a subtle period. However, there are some advantages to this. (Like Yin and Yang) The infectivity is very low until the symptoms appear. Another very important and good piece of news is that if vaccination is administered during the first ten days, before the rashes appear, the risk of the disease is reduced. It's similar to rabies vaccination... Post-exposure vaccination is one of the few ways to protect against this virus.

About three days after the fever begins, the risk of transmission starts with the appearance of rashes. Transmission occurs mainly through direct contact with lesions, contaminated clothing, or surfaces touched by an infected person.

Let's summarize and wrap up:

During the first 5 days after the incubation period, fever, severe headaches, back pain, and extreme weakness are observed. Since these symptoms can also be seen in other diseases, the swelling of the lymph nodes is a distinguishing feature.
As the fever increases, the rashes begin, usually on the face (most commonly). They can appear anywhere on the body, including inside the mouth, on the soles of the feet, and in the genital area. The rash progresses in the following order: macules (flat redness), papules (raised from the skin), vesicles (filled with clear fluid), pustules (turning yellowish), and finally crusting over.
This is the critical and contagious period. Even the scabs from the rashes are contagious. Avoid direct contact with bare hands. The risk of transmission increases if the healthy person's skin has cuts, scrapes, or wounds.
This process usually lasts 2-4 weeks and heals spontaneously. "The death rate is higher among children and young adults, and the disease is more severe in individuals with weakened immune systems." (1) Secondary infections may include bronchopneumonia, encephalitis, sepsis, and blindness from direct eye contact.
Respiratory transmission: The risk of transmission through respiratory droplets (for example, through coughing or sneezing) occurs during prolonged face-to-face contact. However, this route typically requires closer and longer contact. (2)
Transmission can also occur from an infected mother to her baby, sexually, from contaminated surfaces, or through animal bites.
Individuals showing symptoms should be asked if they have traveled to risk areas in the last month or had close contact with someone showing similar symptoms.
In our country, smallpox vaccination was administered until 1980 when smallpox was eradicated, so those born before this period have been vaccinated and are somewhat protected.
In case of home isolation: The person should isolate themselves in a room, preferably separating the bathroom and toilet. Items, furniture, and personal belongings used in the room should not be taken outside, and skin contact should be avoided. Maintain at least a 1-meter distance.
As we learned from COVID, personal protective equipment (masks, gloves, face shields), along with washing hands with soap, is important. Hand hygiene and surface areas should be cleaned with solutions containing at least 60% alcohol or bleach (1%).

The virus can survive at 4°C for extended periods. However, it is not heat-resistant; it is inactivated after 30 minutes at 56°C. The virus is also easily neutralized by organic solvents such as formaldehyde, methanol, sodium dodecyl sulfate (SDS), phenol, and chloroform. (1) Treatment is mostly symptomatic. Antiviral drugs and smallpox immunoglobulin were used in 2022.

In the United States, a vaccine for Mpox disease was approved by the FDA in 2019. This vaccine is effective against both smallpox and Mpox, and it contains a modified Vaccinia Virus Ankara strain. Yes, the Ankara vaccine, which was developed at the Refik Saydam Hıfzıssıhha Institute’s Vaccine Laboratories and later made safer by researchers at the University of Munich.
This vaccine has been shown to provide approximately 85% protection against Mpox, as well as the Ortopoxviruses, which include smallpox. Moreover, these vaccines can be used for pre- and post-exposure prophylaxis in high-risk groups or when needed. (4)

After reading all this, you may wonder how we can stay calm now… What have we gone through together so far? Who knows what more we will experience? What doesn’t kill us truly makes us stronger… Haven’t we learned so much from the pandemic? Hygiene, the importance of strengthening our immunity, feeding our body and soul, and the importance of vaccines...

I always keep the Hittite prayer in mind: "God, grant me the strength to change what I can, the courage to accept what I cannot, and the wisdom to distinguish between the two..."

Stay healthy.

Yasemin KAYA

Sources:

1) İnsan Sembolizmi Carl C. Jung

2) Büyük Sır Üstadı cilt 2 H. M. Abajoli

3) İnsanın Amlam Arayışı/ Dr. Viktor E. Frank