Monkeypox: UAE-based professor explains why disease is spreading in non-endemic countries

The current outbreak of monkeypox is not the first instance of the rare zoonotic disease being reported in non-endemic countries, a UAE-based professor has said.

In an exclusive interview, Professor Abiola Catherine Senok from the Mohammed Bin Rashid University Of Medicine and Health Sciences (MBRU) told Khaleej Times that the main occurrence of the disease remains localised in Central and West African countries.

“Previous human occurrences outside of Africa were linked to international travel or imported animals. Before the current outbreak, there were reported cases in the United States, Israel, Singapore, and the United Kingdom,” she said.

As on June 6, over 900 confirmed or suspected cases of the virus have been reported in 30 countries where monkeypox is not endemic. The UAE has seen a total of 13 infections so far.

Is smallpox vaccine effective?

The smallpox vaccine is known to be protective against monkeypox, the professor said.

“People who have been vaccinated against smallpox in the past may still have some protection against monkeypox.”

Smallpox immunisation was suspended decades ago after the virus was eradicated.

“People below the age of 40-50 years are unlikely to have been vaccinated. Whether this may somehow be contributing to this transmission pattern we are seeing now remains an unanswered question,” said Professor Abiola.

When was monkeypox first detected?

Professor Abiola, who is Chair of Basic Sciences and Professor of Microbiology & Infectious Diseases, College of Medicine at the MBRU, explained that the rare virus was first discovered in 1958 during an outbreak of pox-like disease in monkeys.

“The first human case was in 1970 in the Democratic Republic of Congo,” she said.

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Why is the disease spreading now?

When asked why the disease is spreading despite the virus being around for decades, she referred to the statement of Director-General of World Health Organisation Dr Tedros Adhanom Ghebreyesus: “The sudden appearance of monkeypox in many countries at the same time suggests there may have been undetected transmission for some time.”

She explained that for the current outbreak, epidemiological investigations are ongoing to establish the pattern of transmission.

“However, majority of reported cases thus far have no established travel links to endemic areas … The virus is transmitted through close physical contact, hence those who are most at risk are those who have had close physical contact with symptomatic infected individuals,” Professor Abiola said.

Suspected, probable and confirmed cases: How they are defined

According to the professor, a suspected case is a person having an acute illness with fever higher than 38.3⁰C and/or an unexplained rash and two more symptoms that include intense headache, lymphadenopathy, back pain, myalgia and intense asthenia.

A probable case meets the case definition for a suspected one, and has one or more of the following:

- Epidemiological link to a confirmed or probable case of monkeypox in the 21 days before symptom onset;

- Has travelled to monkeypox endemic countries in the 21 days before symptom onset;

- Has had direct physical contact with skin or skin lesions, including sexual contact;

- Has had contact with contaminated materials such as clothing, bedding or utensils to a probable or confirmed case of monkeypox in the 21 days before symptom onset.

A case is classified as confirmed after laboratory confirmation for monkeypox virus.

How is monkeypox confirmed?

According to Professor Abiola, the disease is confirmed in this manner:

- Swab samples should be taken from one or more vesicles/open sore/ulcer or from the surface of a vesicle or crusted vesicle. Swabs from skin lesions are best for lab diagnosis. Additional samples from other body sites that can be obtained include blood, urine and throat swab. Strict protocols for sample collection, handling and transportation must be followed.

- Laboratory diagnosis: Nucleic acid testing (viral PCR) is the primary diagnostic tool.

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