Last week Wednesday (22 June 2022), the National Institute for Communicable Diseases confirmed that the first case of monkeypox in South Africa had been identified in a 30-year-old Gauteng resident who reported no recent travel history and said that contact tracing had begun to identify any additional linked cases of monkeypox in the country. Professor Veronica Ueckermann, from the Department of Internal Medicine at the University of Pretoria (UP), answers questions you might have about monkeypox:

What is monkeypox and how do you get it?

Monkeypox is a viral infection belonging to the group orthopoxvirus, which presents with a rash very similar to smallpox.  Importantly, monkeypox is less serious and less infectious than smallpox.  Monkeypox spreads through close contact with persons or contaminated objects.  Direct contact with the monkeypox rash and sores or scabs can lead to infection.  Contact with fabrics such as bedding or towels used by someone with the infection, or surfaces with which an infected person was in contact, can also lead to infection.  Unlike the SARS CoV-2 virus, which had airborne spread, the monkeypox virus spreads through respiratory droplets (such as saliva or mucous) and requires prolonged person-to-person contact to spread in this way. 

Why the disease is called ‘monkeypox’?

Monkeypox was first isolated in the late 1950s from a colony of laboratory monkeys in Denmark, hence the name.  The first human case of monkeypox was identified in the 1970s in the Democratic Republic of Congo. Previously, human monkeypox was mainly reported in West and Central Africa among individuals who were exposed to forest animals.  Of late, we have seen cases in non-endemic areas and human-to-human spread in the current outbreak (first reported in Europe in May 2022).

Is monkeypox highly contagious?

Monkeypox is not highly contagious.  Prior to the current outbreak, human-to-human spread was rare.  Close contact is required for the spread of the virus.

Is monkeypox a sexually transmitted infection?

It is not classified as a sexually transmitted infection; however, the virus does spread through close contact and monkeypox DNA has been detected in semen of infected individuals.

Where is monkeypox typically found?

Monkeypox is endemic to Central Africa and West Africa traditionally.  However, since May this year we have seen cases in many non-endemic countries in Europe, the United States, Australia, the United Kingdom and of course now South Africa.

What are the symptoms of monkeypox?

The symptoms of monkeypox are flu-like, including fever, headache, muscle aches, swollen lymph nodes (glands), chills and exhaustion.  The typical rash begins within one to four days of the appearance of these symptoms, but cases have been reported where the rash appears before other symptoms.  The rash tends to concentrate on the face, palms of the hands, soles of the feet and genital areas.  The rash typically progresses to form vesicles (blisters) that eventually crust over and fall off.

Can people die from monkeypox?

For most people, monkeypox is a self-limiting disease that lasts for two to four weeks.  Complications can occur, such as secondary infections.  Underlying immune deficiencies may lead to worse outcomes.  There have been deaths reported from monkeypox in Central Africa.  To date, no deaths have been reported during the outbreak that was first reported in May 2022.

How does monkeypox spread from animals to humans?

It is possible for people to contract monkeypox from animals, either by being scratched or bitten by the animal, or by preparing and consuming products from infected animals.  The spill-over from infected animals to humans is rare and currently there is no risk of monkeypox infection from animals in South Africa.

How does monkeypox spread from person to person?

Close contact with infected body fluids, surfaces contaminated by infected people, or linen used by infected people.

Who is at risk of catching monkeypox?

Anyone can develop monkeypox if they come into close contact with a person who has the infection.  The disease is contagious from the onset of symptoms to complete resolution of the rash.  Many of the cases reported were associated with sexual contact, but this is not the only close contact that can lead to infection.

How can I protect myself and others against monkeypox?

The best way to protect yourself is to avoid contact with infected individuals.  Isolation of individuals with the disease until they are no longer infectious is advised to avoid further spread.  If you suspect you have monkeypox you should report to a healthcare facility as soon as possible.  Good hand hygiene is an important measure to protect yourself.  Those caring for infected patients should use personal protective equipment.

Can children get monkeypox?

Children can contract monkeypox.

What should I do if I think I may have monkeypox?

You should stay calm and seek medical attention immediately.  The urgency relates to curbing your infectivity to others, rather than the severity of the disease (as most people will have mild, self-limiting illness).

Is there a vaccine against monkeypox, or a treatment for the disease? 

There is no vaccine or treatment for monkeypox, and as most infections are mild, treatment is usually aimed at alleviating symptoms.  As smallpox and monkeypox are genetically related, antiviral drugs and vaccines that were developed to manage smallpox may be effective for monkeypox.  At present, antivirals may be used for people who are at risk of severe illness due to weakened immune systems.  

Where in the world is there currently a risk of monkeypox?

There have been outbreaks in many non-endemic areas all over the world and South Africa has now also reported a case.  Therefore, you should consider yourself at risk anywhere in the world.

Is there a risk of this becoming a larger outbreak? 

The concern with the monkeypox outbreak relates to case reports in 29 countries which are not considered endemic for the disease.  The World Health Organization has stated that the monkeypox outbreak does not currently constitute a global public health concern, however, it cautioned that "intense response efforts” are required to curb spread.  The outbreak could become larger if we do not diligently apply ourselves in a public-health effort of case-finding, isolation and containment.