Explained: How Current Monkeypox Outbreak Is Different, Its Varied Symptoms And Transmission

The number of Monkeypox worldwide has soared to over 47,000, with the United States alone reporting more than a third of all infections. 

Of the 99 countries that have reported Monkeypox infections this year, 92 have not historically reported Monkeypox cases before, according to the US Centers for Disease Control & Prevention (CDC), which highlights the extent of the viral spread this year. 

Just like the extent of the viral spread — from few countries in Africa to 99 countries in the world, the symptoms, transmission, and the general nature of the disease is also different this year. Experts have noted that the virus is spreading from people to people whereas it's historically known to spread to humans via animals which are Monkeypox virus reservoirs.

Here we explain what's Monkeypox virus, how it had spread historically, and how is the current global outbreak different than earlier ones in terms of symptoms, transmission, and other parametres. 

What's Monkeypox disease?

Monkeypox disease is caused by the Monkeypox virus. It's from the same family of viruses that also causes smallpox.

Monkeypox has historically been reported in central and western Africa where animals pass on the virus to humans. Though human-to-human transmission has also been historically known.

"The main disease carrier is unknown. It’s thought that African rodents are involved," notes Healthline.

Conventional understanding of transmission, symptoms

The Monkeypox virus spreads through close direct contact. Healthline lists the following ways of transmission: 

• blood
• bodily fluids
• skin or mucous lesions
• respiratory droplets, for human-to-human contact

It noted US CDC as saying that "person-to-person spread is very low" and "when it does occur, it’s usually through prolonged face-to-face contact and large respiratory droplets. This might happen if you’re within a 6-foot radius with someone who has it for 3 hours or longer".

It may take 5-21 days for symptoms to appear after being infected. Fever is usually the most common symptom, but there can also be aches, fatigue, and chills. Lesions typically on the face and limbs appear within one to three days of the onset of fever. Healthline notes that you could also have lesions in your mouth, genitalia, and eyes.

All of this understanding about transmission and symptoms of Monkeypox is conventional. However, the Monkeypox outbreak in 92 countries that have not historically reported Monkeypox infections is highly unconvetional which is spreading and affecting people in ways not known until now. 

How is current global Monkeypox spread different?

The current worldwide Monkeypox outbreak is different as it is spreading among humans from humans. Animals are not known to be causing these infections outside Africa, which is a marked departure from past outbreaks. 

Moreover, the overwhelming majority of infections are among men who have sex with men (MSM), according to the World Health Organization (WHO).

The WHO on Monday reported that males are 98.2 per cent Monkeypox patients are males and 95.2 per cent are from the MSM group. 

"Among cases with known data on sexual orientation, 95.2 per cent (11,046/11,602) identified as men who have sex with men. Of those identified as men who have sex with men, 174/11046 (1.6 per cent) were identified as bisexual men," reported WHO.

There are indications that Monkeypox virus is spreading through sexual contact, which would be an unconventional medium of spread. 

"Monkeypox epidemics most often arise from animal-to-human transmission...Close, intimate contact during intercourse may be behind the new increased frequency in interhuman transmission of Monkeypox," said infectious diseases expert Camille Besombes to The Conversation. 

However, it has nothing to do sexual orientation. Anyone, whether straight or gay, can be infected with Monkeypox. Experts say Monkeypox is spreading in the MSM group because the virus got into a network, meaning that MSM are a closely-knit people and the virus is circulating within the network of people. 

Johns Hopkins University expert Amesh Adalja told Buzzfeed News, "I think it’s really about the virus being able to exploit network effects and close contacts between individuals and use amplification events like raves — where many people might have had multiple close contacts with multiple partners, and some of them anonymous — and that allowed the virus to spread in a way that it really hadn’t had the opportunity to do so before. It probably always had that potential. It just needed to get into a network like this."

Indeed, the current understanding is that two rave parties in Europe likely triggered the Monkeypox outbreak in the West. Leading WHO advisor Dr David Heymann told Associated Press in May that two sex rave parties in Spain and Belgium likely led to the outbreak. 

While it is not yet known for sure if sex itself is spreading the virus but it's understood that the virus is spreading during sex as it's a very intimate act and people are exposed to skin and respiratory droplets of the persons. But there are signs that experts suspect that sex itself —semen— might spread the virus.

"Based on reports that the virus persists in semen for weeks, Britain recommended that men who recover from monkeypox use condoms for 12 weeks after infection, a tacit acknowledgment that this may be a transmission route," reported The New York Times. 

Different Monkeypox symptoms in current outbreak

The current Monkeypox outbreak's symptoms also deviate from the conventional understanding of the disease. 

The New York Times reported that doctors have reported Monkeypox cases without fever — often the first symptom. They have also reported cases without lesions that are otherwise a signature of the disease.

"Monkeypox patients have turned up with what looked like mosquito bites, pimples or ingrown hairs, not the large pustules usually associated with the infection. Some did not even have visible lesions but felt excruciating pain when swallowing, urinating or emptying their bowels," reported The Times.

It has also been learnt during the current worldwide outbreak that Monkeypox can spread without symptoms. Initially, it was believed that there is no asymptomatic spread but that's not the case anymore.

In a recent study of 200 asymptomatic people, 13 were found to be infected with Monkeypox, with just two of them later developing symptoms, according to Healthline, proving that people can have asymptomatic Monkeypox infections. 

Just like Covid-19, asymptomatic Monkeypox would be harder to contain simply because infected people don't know they are infected and can pass on the infection to others.

"Any virus that can spread by asymptomatic people is harder to contain because the people spreading it don’t know that they’re infected and don’t change their behavior,” said Dr Rachel Bruce of Long Island Jewish Forest Hills to Healthline.