Monkeypox and "monkey brain"

Will we have quarantines again? Will we have to be vaccinated against smallpox once more, given that the West's latest generations have grown susceptible to orthopoxviruses? What kind of measures should be used to curb the spread of monkeypox outbreaks among the MSM community and what can we do to ensure that the media refrain from dubbing monkeypox another "gay plague”?

A new shit-storm is sweeping through the Internet, all because those raising the latest alarms about virus-related topics lack any expertises. The comments on monkeypox are being made by people who have no idea which pox they have been vaccinated against, not even understanding that chickenpox is as related to smallpox as a living room chair is to an electric chair. Those who claim to be experts on viruses, tanks, howitzers, even the intricacies of air traffic ground control, claim that the current news about monkeypox is nothing more than the latest attempt to scare people with the threat of another plandemic, calling it "another freak of nature", some even claiming that "this [monkeypox] applies only to members of the gay community who indeed deserve it!". All this means that once again, just as with the coronavirus pandemic, ignorance, misinformation and panic are rampant.

So here is what we should know. Unlike chickenpox, but just like smallpox, monkeypox is caused by a virus from the orthopoxvirus genus. These are viruses with genetic material in the form of DNA, of large size, with approximately 250 genes each (and not just a dozen, as is the case for coronavirus). That monkeypox belongs to the same group as smallpox is good news because the classic smallpox vaccine, created at the end of the 18th century by Edward Jenner on the basis of cowpox virus, that was widely used until the 1980s, is 85 per cent effective against monkeypox.
Skin lesions caused by monkeypox on a child's arm and leg in Bondua, Liberia, 1971. This infectious disease also causes fever, muscle aches and chills. Photo: CDC / Getty Images
Therefore, one can safely say that, unlike Covid-19, monkeypox is not a new disease. The virus was initially identified in monkeys imported from Africa by Danish laboratories in 1959. However, the name given to it is misleading since its main carriers are in fact rodents. The first human cases of the disease were recorded in the Democratic Republic of the Congo in 1970. The disease is endemic in both Central Africa, where it is more lethal, as well as West Africa, where a milder variant of the virus is present. Each year in these two regions, some 2,000 highly symptomatic cases of the disease are recorded, with a mortality rate of between 1 and 10 per cent, depending on the variant of the virus, compared to a 30-to-85 per cent lethal rate in case of smallpox. It should be noted that these rates apply to African population groups that can be malnourished and suffering from other diseases, including AIDS.

The first non-African monkeypox epidemic took place around 20 years ago in the US Midwest, where 47 cases were recorded. Those infected had come into very close contact with people who had the misfortune of buying seemingly innocuous rodents that turned out to be virus-infected -- rats believed to have originated from Gabon. Nobody died in the epidemic that was caused by the West African variant of the virus.

Because of this first monkeypox epidemic, since 2019 we have had a vaccine against it, registered in the US, the European Union and in Canada. It prevents the disease even when administered up to four days after a person has been exposed to the virus. It can also provide protection for contacts of suspected or confirmed cases. This is especially useful given the increasing number of wealthy Poles now spending their holidays in exotic locations where tropical diseases (such as monkeypox) can be caught. In this context, it is worth noting that medicines against monkeypox such as tecovirimat and brincidofovir also exist. However, they are not widely available.

Sexually transmitted

Up to now monkeypox has been a classic viral zoonosis, meaning it can "jump” from animals to humans, whereas transmission among humans has been less likely to occur. However, the current epidemic indicates that it is spreading exceptionally fast between people, something that never occured before, even in Africa. Surprisingly, in just a few weeks, the total number of cases is higher than all the non-African cases combined since 1970. And even though we know the so-called index case, i.e. we know exactly who was first diagnosed with the disease (a British male who returned from Nigeria on May 4 and fell sick two days later, diagnosed as a postive case of monkeypox), in no way can we be 100 per cent certain that the entire epidemic, or simply the British wave, started because of him. This is bad news but it shouldn't cause panic.

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Since the asymptomatic incubation period of this disease can be quite long (five-21 days after infection), while in the United Kingdom we have many cases that cannot be traced to contact with the first registered case, epidemiologists remain quite puzzled. Accordingly, it is possible that there were earlier unrecorded cases of the disease in the UK, especially in the Greater London area. And if this is true, the same is possible in other countries where the virus has just been recorded ...

On May 27, there were 200 confirmed cases of monkeypox globally, with more cases under diagnosis. Monkeypox diagnostics can be both traditional [1] as well as molecular, involving rt-PCR [2]. Sequencing its entire viral genome is a complex and demanding task and cannot be done speedily anywhere. Cases of monkeypox outside the UK (where to date there are 70) have been also found in Spain (84), Portugal (58), Canada (25), the USA (11) and from one to several in Italy, the Netherlands, Germany, France, Belgium, Denmark, Finland, Sweden, the Czech Republic, Austria, Slovenia, Australia, Argentina, Israel and the United Arab Emirates.

As reported in editorials published in such scientific journals as "Science" or "Nature", the sudden appearance of a disproportionately large number of cases of monkeypox (in 13 countries on four continents) drew the attention of experts monitoring public health and infectious diseases in various international health institutions (WHO, the US Center for Disease Control and its European equivalent).

Scientists are especially worried about the fact that the disease is spreading among men who have sex with men (MSM). Right now, for example, in Spain, such cases constitute a disproportionately large number. Usually, the virus is supposed to spread through close contact and via droplets (saliva), but it seems that the current epidemic may be also transmitted sexually. That the infection could be transmitted through semen had been suggested just once before -- in Africa -- but it had never been proved before.

Monkeypox is so rare that doctors in the West have seldom encountered it. It is extremely difficult to diagnose by a simple physical examination of a patient while molecular diagnostics are not widely available. The disease starts out like a flu, with the lymph nodes enlarged and skin lesions initially resembling those of chicken pox or syphilis. In most cases in Europe, where living conditions and medical standards are high, the illness does not require any special treatment and "passes by itself" within two or three weeks after the onset of symptoms. However, in Africa some cases are more complicated and the disease can leave scars or even cause blindness, not to mention that in some cases it can be lethal.
According to the World Health Organization (WHO), the latest monkeypox epidemic is largely sexually transmitted, although the virus is not classified as a sexually transmitted disease. It penetrates the body through damaged skin, respiratory tract, eyes, nose and mouth. Photo Illustration: Pavlo Gonchar/SOPA Images/LightRocket via Getty Images
The current outbreak is a disturbing return of the orthopoxvirus genus to the global spotlight at a time when we had all but forgotten about this threat. The WHO announced that smallpox was globally eradicated in 1980. Will the situation change now? Will quarantines be imposed again on wide circles of those deemed at risk of contact with the sick? Will we be vaccinated again with the oldest vaccine in the world, all because the two latest generations to have grown up in the Western world are susceptible to all orthopoxviruses because this once common prophylaxis was suspended? What kind of measures should be used to curb the spread of monkeypox outbreaks among the MSM community and, at the same time, how do we go about stopping the media from describing monkeypox as another "gay plague”?

The niche left empty by a cousin

All these questions need to be answered soon. Especially since the resources of vaccines available here and now are not large enough, and certainly insufficient to immediately vaccinate the entire global population. Indeed, they are not even sufficient to vaccinate the Western population that missed out on being inoculated against smallpox. However, it is possible that there are sufficient vaccines to protect medical service personnel, especially those in contact with the virus.

Needless to say, the answers to these difficult questions must not be given to us by online dilettantes. They must be provided solely by orthopoxvirus experts. These experts exist and cooperate with each other. According to Wojciech Andrusiewicz, the spokesman of the Polish Ministry of Health, for example, the Polish National Institute of Public Health -- National Institute of Hygiene cooperates with Germany's Robert Koch Institute. According to scientists, epidemics of this type "generally die by themselves" because many infected people never infect anyone else. However, since the current monkeypox epidemic is geographically widespread, it cannot be ruled out that its spread stems from several independent sources (e.g. the index case in Portugal has nothing to do with the index case in the UK). Moreover, the number of cases in terms of the timeframe seems surprisingly high for non-African conditions. This epidemic is considered "really rare and unusual" so it is thought unlikely that it will become a major threat to the general population and develop along the lines of, for example, COVID-19.

Nonetheless, further questions have to be raised about the need to keep the global population vaccinated against smallpox despite its pronounced eradication since it seems obvious that nature abhors a vacuum. And certainly, it is high time to consider making this vaccine obligatory for travellers going to Africa or introduce compulsory vaccination against monkeypox.

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As the number of smallpox cases plummeted in the early 1970s, Western countries stopped making the vaccine compulsory because the risks outweighed the potential benefits. The vaccine contained a laboratory-weakened smallpox virus called vaccinia, which replicates inside the recipient, sometimes causing serious side effects, killing one in a million of those vaccinated. The WHO vaccination campaign ended in 1977. In 2021, a natural case of smallpox occurred but the virus did not spread. Also, it should be made clear that the monkeypox vaccine citeed above uses a non-replicating form of vaccinia, that was specifically designed to cause fewer side effects. It is the only vaccine expressly approved for monkeypox.

However, since we have huge populations unvaccinated against smallpox today, it cannot be ruled out that the much less virulent monkeypox might "enter a niche" abandoned by its cousin smallpox 40 years ago. This could be the natural course of things, so the situation has to be monitored closely in order that we can react speedily and adequately if needs be. And please rememeber, listen only to real experts and not to online dilettantes with "monkey brain".

– By Magdalena Kawalec-Segond

TVP WEEKLY. Editorial team and jornalists

–Translated by Agnieszka Rakoczy


[1] Traditional diagnostics is carried out by culturing the virus in chorioallantois (the vascularised biological membrane found in hen eggs). Unfortunately, this takes a long time and is unsuitable for routine testing. One can examine virus particles in the clinical specimen using special laboratories for electron microscopy of infectious diseases. Also serological diagnostics make use of specific antibodies to detect the virus.


[2] PCR (Polymerase Chain Reaction) is a method for duplicating DNA fragments. This test has been used in the diagnosis of many diseases, (e.g. it shows the presence of DNA of viruses or bacteria in the organism). On the other hand, rt-PCR is a real-time (rt) test that enables, for example, the determination of the exact number of copies of the relevant DNA in the tested biological material.


Main photo: Monkey pox detected in Indonesia in 2019. A health worker at Soekarno-Hatta International Airport in Tangerang, near Jakarta, stands in front of monitors showing information about the disease. Photo: Anton Raharjo / Anadolu Agency / Getty Images
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