In September 2018, a Belgian team affiliated with the research institution "Riga" published a study (1) in which it tried to investigate the prevalence of previous infections of monkeypox from the moment it was discovered about half a century ago until 2017, finally reaching the conclusion that Monkeypox is - and we quote them literally - “the most important smallpox virus in humans at all, whether in endemic areas or globally,” adding that monkeypox is “no longer a rare disease” as some scientists have long thought, but it is worth it. More attention.

The problem that drew the attention of researchers was not the number of infections during the period examined by the study, but the mechanism of the geographical distribution of the disease’s spread, and its path since it was called “monkeypox” in 1958 when it was discovered among a sample of monkeys in a laboratory in the Danish city of Copenhagen.

The same research observations were repeated in several other countries such as the United States of America, but until that point the injuries were only animal.

A short history of pimples

On 1 September 1970, a baby of only 9 months old, suspected of having smallpox, was admitted to Bassankoso Hospital, in the Equatorial Province of the Democratic Republic of the Congo.

The data of the sick child was sent to the WHO Smallpox Reference Center in Moscow, but the disease was not ordinary smallpox, it was something else. It took two years for a research team from this center to prove (2) that it was the first human case of monkeypox.

Since that moment, human cases of this disease have been observed in eleven African countries, ranging from a few fingers on one hand to several thousand, namely, Gabon, the Central African Republic, Liberia, the Republic of the Congo, Nigeria, Côte d'Ivoire, Sierra Leone, South Sudan, Benin, Cameroon and the Democratic Republic of the Congo, but everything changed in April 2003 When the disease was carried (3) with a consignment of small mammals, including six species of rodents, coming from Ghana, imported to Texas, monkeypox virus was introduced into the United States for the first time.

As you know, the emergence of the disease in Africa and its spread there is one thing, and its arrival in the United States of America or Europe is a completely different thing. From that moment on, researchers took care of the disease and followed its course, and with further tracing, more cases appeared (4), in 2018 it exceeded The disease barrier the United States to reach the occupying state of Israel and the United Kingdom.

In 2019, new infections appeared in the United Kingdom and Singapore, and in 2021, other injuries appeared in the United Kingdom and the United States of America.

european explosion

These leaps were a reason that called many scientists, along with the Belgian team previously mentioned, to sound the alarm bells that monkeypox was inevitably coming, but it seems that no one listened, here appeared the strongest blow so far, in May 2022, while writing These words, as more than 150 cases of infection were detected in 16 countries at once (5), namely, Australia, Belgium, Canada, France, the United Kingdom, the State of Israel, Austria, Switzerland, Italy, Germany, the United States, Sweden, Portugal, Spain, the Netherlands and Denmark (the highest injuries were in Britain, Spain and Portugal, with a total of 130 condition).

Worse, there is a new surprise in the form of the spread of the disease, as many of the new cases were community infections, meaning that these patients received the virus from a citizen in the same country, and this is an advanced level of infection, because it means that the virus has already spread within the country, unlike the case With previous infections, cases outside Africa were limited to people who traveled to Africa or dealt with infected imported animals, and rodents are usually the first suspect in this case, as this virus can be transmitted from animal to human or from one person to another.

It was this sudden widespread spread that surprised scientists, along with another problem is that monkeypox was discovered in people who had no clear connection to each other, which indicates that the virus may have been spreading silently for a longer period than we think, strange that monkeypox - Unlike "Covid-19", for example - it is a disease with clear skin symptoms that will push the patient to the doctor or hospital, but it seems that the lack of previous knowledge of the possibility of the disease spreading in Europe led doctors to other diagnoses that are already similar to the disease.

Symptoms (6) of monkeypox begin with fever, severe headache, swollen lymph nodes, back pain, muscle aches with severe fatigue, and symptoms similar to colds and flu are also observed, then the rash appears after 1-3 days and tends to focus on the face and extremities, develops The rash sequentially ranges from mere macules to solid papules that are slightly raised from the level of the skin, then to blisters filled with a clear liquid, then blisters filled with a yellow liquid with the appearance of crusts that dry and fall off.

The disease is usually limited and lasts from 2 to 4 weeks, but very serious developments (more common in children) can occur in a group of disorders such as bronchitis, sepsis, encephalitis, corneal infection with loss of vision, things that may lead to death.

Now we can come to a simple conclusion after all of the above developments: monkeypox came, not to stop, but to spread, and we don't think there is any way to stop it now, and new cases will continue to appear in separate places, not only because it has spread to an uncontainable level or Until you trace it to the number of "zero" cases, but also because no one expected the surprise (despite previous warnings), and therefore health systems, whether in European countries or around the world, are not sufficiently equipped to deal with an epidemic of this type.

Another "Covid-19"?

Well, after all this horrific news, you must be wondering about the fate of this new epidemic, but rather you must be thinking about “Covid-19” specifically and its escalating spread in the world during 2020, the closure procedures, the loss of loved ones and the disruption of the economy, but here specifically the optimism will begin, because smallpox Monkeys are definitely not “Covid-19”, for several reasons, the first of which is related to the nature of the virus itself. The first suspicions of scientists, with their astonishment at the sporadic infections in Europe, was that the virus had mutated from its first image that was seen in Africa, becoming more capable of spreading .

But on May 19, researchers from the National Health Foundation of Portugal published the first draft (7) of the genome of the monkeypox virus that was discovered in Portugal, and indicated that the detected virus is related to the West African viral strain, which causes less severe symptoms and has a lower mortality rate. (Only 1% and in a very weak health care system), compared to the relatively stronger Central African (Congo Basin) strain, this similarity indicates that the currently circulating virus is likely to be not different, that is, it has not mutated much compared to its predecessors.

Monkey pox under the electron microscope

This draft is of course insufficient, and we still need assurances in this regard, especially with possible fears of bioterrorism, but the nature of the virus itself indicates that this is likely, because - unlike the virus that causes "Covid-19" - monkeypox is one of the Deoxyribonucleic acid (DNA) virus, which means that its genetic material is copied on two opposite strands of DNA with the same information, if damage or deformation (mutation) occurs in one of them, the other helps to repair it (8).

As for RNA viruses, such as corona (SARS-CoV-2) or influenza, their genetic material is copied on only one strand of DNA, this opens a wider and faster opportunity for mutation, and this is the most important reason for our current problem with corona in the first place. With the advent of the omicron, for example, the strength of the shield that protects us from it, the vaccine or even the previous infection, is reduced to a minimum, because the new virus's mutations make it more cunning to infiltrate our cells.

This adds another reason for reassurance, as the well-known smallpox vaccine works with an efficacy of up to 85% against monkeypox (9), because both of them belong to the same species that do not mutate much with time, which means that even in the event of an outbreak of the disease, even in limited ranges , there is a previously studied and tried opportunity to stop it, and the World Health Organization had indicated that people under the age of 40 to 50 years may be more likely to contract monkeypox due to the discontinuation of vaccination campaigns against smallpox globally after the elimination of the disease in the seventies and eighties.

Small creature.. dangerous.. multiplies

Besides, one of the biggest reasons for the spread of “Covid-19” globally is that the virus can be transmitted from one person to another in the absence of any symptoms (a day or two before they start appearing), which means that it is easier to spread silently. Among people without anyone knowing. As for monkeypox, it does not spread until after symptoms appear, and therefore it can be detected more easily with a degree of awareness, especially since its skin symptoms are clearly visible, and they spread in visible areas of the body.

In addition, the disease does not spread from one patient to another easily “Covid-19”, which can be transmitted within an average of 15 minutes of being in the same room, while in the case of monkeypox, the transmission of the disease requires “close contact” between the infected person and the person who is infected. The infection will receive a minimum of about 3 hours, and is transmitted through saliva, nasal secretions, respiratory droplets and rash products resulting from the disease, as well as the use of common items such as bedding and towels.

For this reason, the British Health Security Agency had revealed from the beginning that the spread of the disease began significantly among “homosexuals and bisexuals” in both the United Kingdom and Europe, and this corresponds to the method of transmission of the disease, as it requires close contact between the infected, and in fact, one of the questions raised Currently, research is whether sexual contact is one of the causes of disease transmission, because it was not so earlier.

Therefore, the primary reproductive number (R0) calculated for monkeypox is less than 1, one study (10) estimated at 0.59, while the number in the case of “Covid-19” averages 3-4, the basic reproductive number represents the number of cases caused by one case during The incubation period of the disease, a measure that helps determine the form of disease spread among people.

If the basic reproduction number is greater than 1, this means that the disease is likely to spread more widely, because each person will infect on average a larger number, but if it is less than 1, this means that the circle will close one day, for example, if there are 100 infected people, they will be infected in The average is 60 people, they will in turn infect 36 people, and so the decrease continues.

Therefore, all previous viral outbreaks of 2022 since the discovery of the virus, and their number exceeds twenty times, stopped after a short period, and included a relatively small number of infections (an average of several thousand in Africa), and if the virus had the ability to expand like “Covid-19”, it would have launched a hand All over the world in a matter of months.

Note that monkeypox is not, after all, a new disease like COVID-19.

There is no need to panic then, even as the disease spreads further, which you will hear over the coming days and weeks.

Of course, there is always room for terrifying viral surprises, which we witnessed at the beginning of “Covid-19”, but until now, it is very likely that monkeypox will spread from time to time in limited ranges and then stop and retreat again.



* Poxviruses: Viruses that infect humans with diseases such as "smallpox", "camel pox", "cowpox" and others.


  • Emergence of Monkeypox as the Most Important Orthopoxvirus Infection in Humans

  • A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo*

  • Update: Multistate Outbreak of Monkeypox — Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003

  • Monkeybox Key facts

  • Multi-country monkeypox outbreak in non-endemic countries

  • Signs and Symptoms

  • First draft genome sequence of Monkeypox virus associated with the suspected multi-country outbreak, May 2022 (confirmed case in Portugal)

  • Monkeypox goes global: why scientists are on alert

  • Monkeybox Key facts

  • Modeling human-to-human transmission of monkeypox

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