I took a business trip to Europe in 2022, right in time for a second outbreak to hit the continent. It sent me into a brief- and unsuccessful- scramble to find a vaccine. The outbreak mostly died down, but not without nearly 100,000 cases, 169 confirmed global fatalities as of January 2024, and a heaping dose of panic.
Today’s Moment of Science… A monkeypox on our house.
As news outlets have assured me, monkeypox is a virus related to smallpox. Initially identified in 1958, infections in humans were observed for the first time in 1970. Visually it’s similar to smallpox, but it rarely leaves scarring resembling its crankier cousin. The symptoms are similar, but much milder. Thing is, “milder” is all relative with orthopoxviruses. Along with the fluid-filled lesions that first appear on the face, hands and forearms, it’s a miserable 2-4 weeks of fever, headaches, body aches, swollen glands, and wondering why in Edward Jenner’s name you weren’t goddamn vaccinated.
Endemic to West Africa, it’s typically spread by eating infected bushmeat or other contact with infected animals that live in the region. Though it can spread from person to person via infected bodily fluids, this is not the typical route of transmission. With most cases originating outside of West Africa via community transmission, this outbreak presented epidemiologists with some anomalies.
There are two strains, the Congo Basin clade with a fatality rate at about 10%, and the West African clade which is typically fatal about 1% of the time. All cases in this outbreak have been confirmed to be the West African clade. Which is clearly the less jesus-titty-fucking-christy option, but it’s not exactly comforting to know another disease that’s “only” as deadly as COVID is floating about.
There’s good news and bad news. The good news is we have effective vaccines to prevent it. The bad news is that the vast majority of us below the age of forty never got it. If you’re over forty? It wore off long ago, you need a booster, and your doctor’s office almost certainly didn’t have it kicking around at the beginning of the outbreak.
The smallpox vaccine also prevents monkeypox. A decade after we gained an awareness that monkeypox could infect humans, smallpox was eradicated. We then promptly stopped doling out smallpox vaccines. Continuing the program may have seemed like a misplaced resource when measles and malaria were still infecting and killing people in the region. But to be fair, monkeypox isn’t a fucking picnic either, and maybe the full suite of vaccines should be properly funded for vulnerable regions and population.
So, the fuckery.
There was a rumor that monkeypox has become sexually transmitted. That’s, at best, a stretch and at worst, a bit of homophobic nonsense. The UK Health Security Agency reported that cases so far have predominantly been diagnosed in gay or bisexual men. Which might make people assume it’s being spread via sex itself, but it isn’t clear if it spread via seminal fluids or via all the other delightful ways that we exchange fluids.
The disease can spread via respiratory droplets, and if you remember your virology lessons from the last pandemic, those are the bigger particles that can only travel a few feet. This allows it to spread via prolonged, close contact with another person. Sharing a meal indoors, some Netflix and chill, or just, uh, some Netflix? All close contact.
It seems unlikely that the disease became more transmissible suddenly, but perhaps people were mingling a bit too close for this particular microbe. Monkeypox is also known to spread between members of a household, likely a main contributor to this chain of transmission.
The first case in this outbreak was diagnosed on May 7th, 2022 in the UK. The day I wrote about this nearly two years ago, it went from being confirmed in five countries to eleven. While it’s down to a dull roar for now, viruses are sneaky fuckers and there wasn’t exactly a coordinated vaccination campaign to end this thing. So as always, choose your sources of information carefully, and don’t panic If monkeypox circulates in your area in your area. There are both treatments and vaccines. Check with your local municipality for vaccine availability if/when this takes another wander through your area.
And finally, someone will pop into the comments to tell me “But Mrs. Auntie SciBabe, you just said it’s only spread via close prolonged exposure, why do you hate freedom?” I made this mistake with that other pandemic, and I won’t make this mistake again.
So I’m only saying this once
Wear your fucking masks.
This has been your Moment of Science, looking forward to, one day, taking a trip that requires some new vaccinations.
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Wait, I’m an old guy from the generation who had a smallpox inoculation as a child, the kind that leaves the little round scar on the upper arm.
Am I protected against monkeypox?
It wears off in a decade, so.
That we shelved the vaccinia based vaccine makes sense, it was literally our most dangerous vaccine, complete with a measurable morbidity and mortality rate. But, it was against a disease with a 35% mortality rate, so it made sense – right until smallpox became extinct in the wild.
“In the 1960s, serious adverse events associated with smallpox vaccination in the United States included death (1/million vaccinations), progressive vaccinia (1.5/million vaccinations), eczema vaccinatum (39/million vaccinations), postvaccinial encephalitis (12/million vaccinations), and generalized vaccinia (241/million vaccinations).”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069029/
The smallpox vaccine being cross-reactive against all orthopoxvirus infections. Work continues on a similarly wide vaccine against the entire family of virus and does look promising.
I was vaccinated pre-deployment, which likely has waned since I’ve retired. Not exceptionally concerned, as the US infection rate is extremely low and the probabilities of my becoming exposed is quite vanishingly low.
And after contracting COVID-19, despite vaccination, yeah, I take precautions, as while the infection was extremely mild in symptoms, it did damage my mitral valve.
So, mask up and wash your lunch hooks often, people!