Five questions about monkeypox Answered by professor Chantal Bleeker-Rovers (update)

In the past weeks there has been a striking number of infections with so-called monkeypox in several Western countries. The first contamination has been spotted in the Netherlands today. What kind of disease is it and should we be worried about a major outbreak? professor Chantal Bleeker-Rovers explains.

What is going on?

'There is currently an outbreak of monkeypox. The first cases of the current outbreak have been described in England. This disease is caused by the monkeypox virus. This occurs in Africa and occasionally outside Africa as an import infection. In this outbreak it is not one case with spread to a few close contacts, but several cases at once in different countries. That's remarkable, because that's not what we normally see with this virus.'
As far as we know now, there has now been one case found in the Netherlands, and we are taking into account that this could change quickly.'

How does the disease monkeypox progress?

'After people become infected it takes 5 to 21 days before clinical symptoms develop. They often start with fever, headache, general malaise, muscle pain and enlarged lymph nodes, i.e. general symptoms. A few days later, skin abnormalities appear. These often start in the face and spread to the rest of the body, including the hands and feet. They may be spots, which turn into lumps, then into vesicles, then into pus and finally into crusts. Usually, these skin abnormalities disappear after two to five weeks. Most people just recover from that. But some get complications, such as pneumonia or encephalitis, and can die as a result. In the outbreak now, it is striking that the rash is more locally present.'

'There are two types of the virus, the West African monkeypox virus and the Central African variant. In England, the West African variant has been found. The death rate from that is 1%. For the variant from Central Africa, it is 10%.'

How does the spread of the virus occur?

'This virus spreads through direct contact with a person who is infected, especially if there is contact with the skin blisters and broken skin. But also through droplets, which we know from corona. In this outbreak, sexual contact also seems to play a role in some of the infections. That is close contact and therefore falls under the direct contact with which you can transmit the virus.

Does monkeypox have a link to regular smallpox?

'The virus is similar to the common smallpox virus and fortunately the old-fashioned smallpox vaccine also protects to a very large extent against infection with the monkeypox virus. But it's not the same virus, they just belong to the same group. The smallpox virus has basically been completely eradicated and is only kept in the laboratory in a few places around the world. Since the 1970s, we don't vaccinate against smallpox anymore because it hasn't been around since then. Therefore, a lot of people are no longer protected against this virus.'

Should we be worried about a large spread of the virus?

'People need to know that this outbreak is going on now and what those blisters look like, so you can recognize them quickly. Then you can take appropriate isolation measures. We don't think this will cause a major outbreak like with corona or influenza, but we do see that it is spreading quite rapidly. Transmission to healthcare workers is often described, so that's why we need to recognize the symptoms as soon as possible. Then we can take the right measures in time. That means strict isolation, as is the case for MRSA, with an FFP2 mask and a faceshield. That way we can protect ourselves and make sure the patient receives the right treatment.'

For more information go to the RIVM website (English).

Photo: Centres for Disease Control and Prevention

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