Monkeypox – history repeating?

So, I am sure you will have been hearing about the spread of Monkeypox; we have notable cluster of cases here in Spain, also Portugal and the UK, and we are starting to see cases all around the world. (World Health Organisation DON 210522) Following on so soon after Covid I am sure there will be those that believe there to be some link, personally I don’t see this and let me explain a little.

Virology was always a bit of a ‘Cinderella science’ until the really big hitters in the virus world came along and I am talking about HIV and Hepatitis. Of course, they were knocked of their perch by Covid and since then we have all become a bit of an expert on viruses, epidemiology, and all the science around human interaction and behaviour. On the other hand, perhaps we are all sick and tired of it, and I couldn’t blame you. It is still much of my bedtime reading, and take it from me that we really have moved on and virology is now well-established centre stage. We do know, and understand, a great deal. Explaining it in the age of sixty second interviews is tricky, and using words and terms that sound OK, or are easy to understand, actually run the risk of not explaining at all.

First a little history. Monkeypox has been around for years, it was first observed in 1958 and usually we see it in central and west Africa. It belongs to the same family as smallpox. Now smallpox used to be a serious cause for concern, and for years all children were vaccinated in their first year. The massive global vaccination programme for smallpox ran until 1979 when the World Health Organisation declared the planet to be smallpox free. A couple of high security labs were allowed to keep samples of smallpox, in the USA and Russia, for anti-bioweaponry research and also in case some obscure outbreak ever occurred in the future. So, since the 1980s people have no longer needed to be vaccinated against smallpox.

So back to Monkeypox. The name actually comes from the fact that when it was first observed, back in 1958, the outbreak was actually in monkey colonies that were being used for research in Denmark, hence the name. Monkeypox is actually a viral zoonosis – a bit of a mouthful but it just means a virus that can be transmitted from animals to humans. We know that monkeys can act as reservoirs for the virus, we also know that some rodents can carry it. So, if you are bitten by an animal carrying the virus then you may become infected. It is also possible if you eat uncooked meat from an infected animal, you could become infected.

That’s fairly clear, and pretty easy to understand. So why the big fuss? We are a bit concerned because cases are popping up all over the place and there is no obvious link back to central and west Africa. Well apart from contact with an infected animal, human to human contact also spreads the disease as can coming into contact with soiled items. We all got very het up about disinfecting supermarket trolleys and beach chairs during Covid, which was utterly pointless and a complete and utter waste of time and money, but in this case, we are talking about something very different and transmission can occur from things like bedding.

So now we wade into the murky world of public health, an area of science that mingles with politics, and thus also opinions, prejudices and beliefs. We have been here several times before and we tend to make the same mistakes over and over again. It looks like history is going to repeat itself right now. Back in the 1980’s a strange new disease was being noticed and reported in the medical press. The cases all seemed to be in the US and they seemed to affect gey men. Very quickly medics started talking about gay-related immune disease, after all that is what they saw. Now, of course we know that HIV has absolutely nothing whatsoever to do with an individual’s sexual preference. But at the time valuable time, and money, was wasted looking for some link between sexual preference and the disease. It also fuelled discrimination and allowed hatred to grow towards sections of our society. Hollywood came up with a film about ‘Patient Zero’ the idea that someone could be traced as the one person who managed to introduce the virus to humanity. Truth, is we don’t know, back then people said HIV came from monkeys and parts of the world were blamed for unleashing HIV. Blaming people just gets us nowhere.

So back to today, yes, it is true that the clusters of cases are predominantly being found in gay men, or men who have sex with men but don’t describe themselves as gay. But let’s remember any close contact can spread this, so we must not let ourselves get side tracked as we did in the 1980s. When we look at the ages of those infected so far, all the cases are in people who were not vaccinated against smallpox. Does smallpox vaccination prevent monkeypox, well the answer seems to be yes. So, some good news there.

A school of thought that I happen to think is possibly going to give us more answers to what is happening right now goes like this. Never before in human history have, we had what amounted to a global lock down. That period of no international travel, as well as Covid has placed humankind in a very extraordinary position; add into that a section if the population that hasn’t ever had the smallpox vaccination so when you then open the doors and release everyone the previous natural balance, or natural order of things, has been upset – quite seriously it seems, and so unexpected occurrences like this monkeypox outbreak are not quite as unusual as you might have first thought.

It is not the same as Covid. There have been no reported deaths, and we have a good vaccine. That’s not to say we are not concerned about this, we are. But this is possibly more to do with having hit the global re-set switch and seeing everything come back on-line as it should, only to find actually there are a few glitches. Exactly what happens when you re-start your computer after your antivirus stuff has done its job.

Last time I told you about these strange, unexplained, cases of hepatitis in young children. Medically, there is no link between that and this outbreak. In time we might find out there is some geo-political-societal interaction brought about as a result of global confinement ending – who knows.

Dr Marcus Stephan

My views are entirely personal and do not reflect the view or position of any organisation. You should always consult your own medical practitioner regarding any concerns that you may have. Never stop taking any prescribed medication without first checking with your doctor.