NIAS Fortnightly on Science, Technology and International Relations (STIR)

NIAS Fortnightly on Science, Technology and International Relations (STIR)
Monkeypox: Mapping the outbreak and addressing misconceptions


16 August 2022
Photo Source: Telegraph UK

With the rapid transmission of monkeypox outside Africa, the disease finally receives the attention and resources required to address it.

 

Vol 2, No. 5 , 09 August 2022.

Cover Story

By Apoorva Sudhakar

In July 2022, the World Health Organization issued its highest alert by declaring monkeypox a “public health emergency of international concern” (PHEIC). However, the WHO assessed that the risk is moderate, except in Europe, and said that despite a risk of further international spread, the threat to international traffic is low.

I

Monkeypox outbreak 2022: A brief timeline

The first monkeypox case in 2022 was confirmed in May in a non-endemic country.

On 7 May, the United Kingdom confirmed a case of monkeypox in a person who had travelled to and returned from Nigeria. On 12 May, the UK Health Security Agency (UKHSA) confirmed two more cases; on 17 May, four more were confirmed. By 6 June, the UKHSA said the UK had 302 confirmed cases - 287 in England, ten in Scotland, three in Wales and two in Northern Ireland. On 5 August, the UKHSA said the spread had slowed down with 2,589 confirmed cases since May.

In the rest of Europe, monkeypox was detected immediately after the UK. On 25 May, the European Centre for Disease Prevention and Control (ECDC) said: “This is the first time that chains of transmission are reported in Europe without known epidemiological links to West or Central Africa, where this disease is endemic.” At the time, the confirmed number of cases stood at 71 in the UK, 51 in Spain and 37 in Portugal.

On 18 May, the United States confirmed its first case after the Massachusetts Department of Public Health completed tests on a man who had travelled to Canada. By 26 May, the Centers for Disease Control and Prevention (CDC) confirmed 19 cases across 10 states in the US; the CDC Director said it could be presumed that a certain degree of community spread was prevalent and therefore, not all patients had travelled to places which had monkeypox cases. On 5 August, the US, with 7,100 confirmed cases, declared monkeypox a public health emergency.

On 15 July, India recorded its first monkeypox case in a man who arrived from the Middle East, making it the first one in the WHO South-East Asia Region. On 24 July, the South-East Asia Region had four cases - three from India and one from Thailand.

As of 5 August, the CDC’s 2022 Monkeypox Outbreak Global Map shows there are 28,220 confirmed cases globally; of these, 27,875 cases are in 81 countries that have not reported monkeypox previously, and 345 in seven countries which have had monkeypox cases earlier. The countries with the highest number of cases are the US (7,509), followed by Spain (4,942), Germany (2,887), the UK (2,859), and France (2,423). As of 2 August, four people had died from the disease - one in India, two in Spain and one in Brazil.

II

Tracing monkeypox

What is monkeypox?

Monkeypox is a zoonotic disease, transmitted from animals to humans, caused by the monkeypox virus (MPXV), a part of the Orthopoxvirus genus of the Poxviridae family, that also causes smallpox. It was first observed among colonies of monkeys under research in the Statens Serum Institute, Copenhagen. Later research on African animals showed that several rodents were infected with monkeypox. The disease was commonly detected in the tropical rainforests in the region, especially in the Congo Basin, and among people who are vulnerable to being exposed to infected animals.

There are two clades of MPXV, the West African clade and the Congo Basin (Central African) clade; a clade is defined as “a group of organisms that all originate from a common ancestor.” The Congo Basin clade has a high case fatality ratio (CFR) estimated at 10 per cent. The West African clade has a lower CFR estimated at one per cent. The 2022 outbreak is classified under the West African clade, common in Cameroon and Sierra Leone.

Where is monkeypox commonly detected?

In 1970, the first human case was detected in the Democratic Republic of the Congo (DRC, then known as Zaire) in a child. Historically, monkeypox has been endemic to central and west African countries. Several cases were documented between 1981 and 1986; the largest outbreak in the region spanned from 1996 to 1997 with 71 cases recorded between February to August 1996, including six deaths, and 170 cases between March and May 1997. In a 1997 study sponsored by the WHO and Zaire’s Ministry of Health, revealed that the strain collected from a 1996 patient was not different from the strains studied between 1970 and 1979. However, there was an increase in infection through secondary contact in the 1996-97 epidemic, compared to the outbreak between 1981 and 1986.

Globally, between 1970 and 2018, monkeypox had been detected in the DRC, Cameroon, Central African Republic, Nigeria, Ivory Coast, Liberia, Sierra Leone, Gabon, Republic of Congo and the US. In the US, the first monkeypox case was detected in 2003 in a three-year-old child and 71 cases were reported during the outbreak. The outbreak was linked to prairie dogs in Illinois who were likely infected by Gambian giant rats and dormice purchased from Ghana. Meanwhile, Nigeria has reported frequent outbreaks of monkeypox since 2017 with about 200 cases. In 2018, 2019 and 2021, cases were recorded in travelers from Nigeria to Israel, the UK, Singapore and the US.

How common are monkeypox deaths?

Listed below are the CFRs over the years from Africa.

Year(s)

Number of case reported/documented

Number of deaths

CFR

1981-1986

338

33

9.8 per cent

 

Year(s)

Number of case reported/documented

Number of deaths

CFR

2013

104 (in Bokungu Health Zone, DRC)

10

9.6 per cent

 

Year(s)

Number of case reported/documented

Number of deaths

CFR

2013

88 (in Likuoala province, ROC)

6

6.8 per cent

 

Year(s)

Number of case reported/documented

Number of deaths

CFR

2017-2018

244 (multiple regions in Nigeria)

6

2.5 per cent

 

Year(s)

Number of case reported/documented

Number of deaths

CFR

2018

2845 suspected cases (multiple regions in DRC)

36

1.3 per cent

*The above data are tabulated from multiple studies quoted in a journal article.

 

Year

Number of cases reported

Number of deaths

CFR

2020

7,376 

203

2.8 per cent

2021

3,050

87

2.9 per cent

2022

2,031

75

3.1 per cent

Total

12,457

365

2.9 per cent

Source: Africa Centres for Disease Control and Prevention

III

Transmission, Symptoms and Vaccination

Monkeypox is transmitted from animals to humans by direct contact with an infected animal’s blood, bodily fluids, and cutaneous or mucosal lesions. The transmission also takes place during the consumption of inadequately cooked meat or other products of the infected animal.

Among humans, the transmission occurs through close contact with an infected person’s respiratory secretions, skin lesions or any other contaminated object. The virus can also be transmitted from the mother to a fetus through the placenta, or by being in contact immediately after giving birth.

Once infected, the symptoms displayed by a person can be divided into two phases. The first phase lasts between zero to five days. This phase includes fever, severe headaches, swelling of lymph nodes, back pain, muscle aches and an overpowering lack of energy. The second phase begins once the fever sets in. This phase is characterised by the increasing severity of rashes on the face, palms and soles; it could also infect the oral mucous membranes, genital organs and the cornea. The symptoms span from two to four weeks. Suspected cases of monkeypox are confirmed through a polymerase chain reaction (PCR) of the samples collected from the skin lesions.

Apart from the treatment of symptoms, there is no cure for monkeypox; most people recover without treatment in a few weeks. Traditionally, smallpox vaccines have been effectively administered for monkeypox cases. However, the eradication of smallpox in the late 1970s and the cessation of vaccination against the same resulted in a fall in immunity against the Orthopoxviruses.

Currently, the WHO has urged suspected patients and close contacts to be administered the vaccine for the prevention of monkeypox. This vaccine is drawn from the strain of vaccinia virus, also known as the modified vaccinia Ankara Bavarian Nordic strain (MVA-BN). In 2013, the MVA-BN was approved as a smallpox vaccine in Europe and Canada; in 2019, the same was approved as the smallpox and monkeypox vaccine in the US. Different countries have different names for the vaccine - Jynneos in the US, Imvamune in Canada. Imvanex in the UK and Europe. These vaccines are also bought globally by India, Brazil, the DRC and so on.

IV

Misconceptions about monkeypox

Shortly after the initial few cases were confirmed in non-endemic countries, the United Nations noted reporting on the outbreak was stigmatised. For example, pictures of African children with monkeypox were frequently used in media reports; Foreign Press Association, Africa (FPAA) condemned the same saying the stereotype “assigns calamity to the African race and privilege or immunity to other races.” Similarly, it was widely speculated that monkeypox was common among men who had sex with men (MSM). The UNAIDS Deputy Executive Director called for rights and evidence-based approach to addressing the outbreak, saying: “Stigma and blame undermine trust and capacity to respond effectively during outbreaks like this one.”

Scientists also noted the need for a “non-discriminatory and non-stigmatizing” name for MPXV stating that the current outbreak is sustained by human-to-human transmission, unlike the previous outbreaks in Africa caused by spillover events to humans from infection among animals. Therefore, the scientists believed “a continued reference to, and nomenclature of this virus being African is not only inaccurate but is also discriminatory and stigmatizing.” The WHO agreed with the above; in June, the WHO Director-General said the organisation was working on changing the name and the clades of the disease.

Experts at the International Aids Conference 2022 observed that monkeypox was not a health issue of concern when it was confined to Africa. The WHO Assistant Director-Deneral for Emergencies said: “We have been working on monkeypox in Africa for several years, but nobody was interested.” The declaration of PHEIC testifies this claim; since the COVID-19 outbreak in 2020, the death of 365 Africans in three years and hundreds more since 1970 did not instil the urgency to address monkeypox as a global threat.

The above misconceptions are similar to the ones propagated about Zika and the HIV-AIDS cases in the late 20th century. It took decades of education to address these misconceptions; the world may have to do the same again, with monkeypox.

References

More than 300 monkeypox cases now found in UK,” BBC, 6 June 2022

Aria Bendix, “19 monkeypox cases identified in U.S.: What we know about the patients,” NBC News, 26 May 2022

More than 215 confirmed monekypox cases worldwide, says EU's disease agency; know symptoms here,” Firstpost, 26 May 2022

2022 Monkeypox Outbreak Global Map,” Centers for Disease Control and Prevention, 2022

Jose Devasia and Chris Thomas, “India confirms Asia's first monkeypox death,” Reuters, 2 August 2022

Lois Zoppi, “Viral Clades of SARS-CoV-2,” News Medical & Life Sciences, 3 June 2021

Update: Multistate Outbreak of Monkeypox --- Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003,”  Centers for Disease Control and Prevention, 11 July 2003

Multi-country monkeypox outbreak in non-endemic countries: Update,” World Health Organization, 29 May 2022

Monkeypox: waiting for your vaccination,UK Health Security Agency, 1 August 2022

Nikola Sklenovská and Marc Van Ranst, “Emergence of Monkeypox as the Most Important Orthopoxvirus Infection in Humans,” Front Public Health. September 2018

Scott Parker and R Mark Buller, “A review of experimental and natural infections of animals with monkeypox virus between 1958 and 2012,”  Future Virol, February 2013

Monkeypox,” World Health Organization, 19 May 2022

Apoorva Mandavilli, “Three Pressing Questions About Monkeypox: Spread, Vaccination, Treatment,” The New York Times, 29 July 2022

Ian Sample, “WHO to rename monkeypox virus to avoid discrimination,The Guardian, 15 June 2022

Rachel Treisman, “As monkeypox spreads, know the difference between warning and stigmatizing people,NPR, 26 July 2022

Monkeypox: When it was an African problem nobody cared, say experts,News24, 4 August 2022

Multi-country monkeypox outbreak declared a global Public Health Emergency of International Concern,Africa Centres for Disease Control and Prevention, 25 July 2022)

About the author

Apoorva Sudhakar is a Project Associate at the School of Conflict and Security Studies at the National Institute of Advanced Studies.

 


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January 2026 | CWA # 1941

Brighty Ann Sarah

January 2026 | CWA # 1940

IPRI Team

January 2026 | CWA # 1939

Lekshmi MK

January 2026 | CWA # 1937

Anu Maria Joseph

December 2025 | CWA # 1931

Padmashree Anandhan

NATO Summit 2025
December 2025 | CWA # 1930

Aparna A Nair

December 2025 | CWA # 1924

Padmashree Anandhan

NATO Summit 2025
December 2025 | CWA # 1914

Preetha Renganarayanan

December 2025 | CWA # 1913

Rohini Reenum

December 2025 | CWA # 1912

Lekshmi MK

December 2025 | CWA # 1911

Swati Sood

December 2025 | CWA # 1905

Femy Francis

December 2025 | CWA # 1902

Brighty Ann Sarah

December 2025 | CWA # 1893

Lekshmi MK

December 2025 | CWA # 1889

Femy Francis

December 2025 | CWA # 1881

Sunidhi Sampige

December 2025 | CWA # 1864

Femy Francis

Ten Takeaways of a SCMP Interview with a former PLA Colonel
December 2025 | CWA # 1861

Femy Francis

China Reader
November 2025 | CWA # 1859

Brighty Ann Sarah

November 2025 | CWA # 1858

Padmashree Anandhan

August 2025 | CWA # 1801

R Preetha

28 August 1963
Martin Luther King's "I Have a Dream" speech and the Civil Rights Movement in the US
August 2025 | CWA # 1790

GP Team

The World This Week#323-324
The Trump-Putin meeting & the US-China tariff extension
August 2025 | CWA # 1780

Abhiruchi Chowdhury

Trump tariffs:
Weaponization of access to the US economy
August 2025 | CWA # 1779

GP Team

The World This Week#322
US tariffs on India, Brazil and Canada & the EU-US trade deal
August 2025 | CWA # 1778

Lekshmi MK

28 July 1914
Austria-Hungary declares war on Serbia, starting the First World War
July 2025 | CWA # 1770

Abhiruchi Chowdhury

Pakistan-Afghanistan relations:
Why the focus on terrorism, refugees, and Uzbekistan as the third partner?
July 2025 | CWA # 1769

GP Team

The World This Week#321
Indian PM Modi's visit to the Maldives I Elections to the Upper House in Japan
July 2025 | CWA # 1762

Lekshmi MK

Ocean Darkening: 
What is the phenomenon? What are its effects? And who are more vulnerable?
July 2025 | CWA # 1749

R Preetha

Africa as the Hunger Epicenter
Of the 13 Global Hunger Hotspots, 8 are in Africa: Five reasons why
July 2025 | CWA # 1748

GP Team

The World This Week #318
PM Modi’s Visit to Trinidad and Tobago & Ghana, One big beautiful bill, and Quad Foreign Ministers Meeting
July 2025 | CWA # 1744

Chittrothu Vaihali

EU-Canada Summit 2025
What is security and defence partnership all about?
July 2025 | CWA # 1742

IPRI Team

Conflict Weekly # 287-88
The 12 Day War and the Congo-Rwanda Peace Deal
July 2025 | CWA # 1738

Fleur Elizabeth Philip

Thailand and Cambodia
What was the phone call between PM Shinawatra and President of Senate Hun Sen? What is the border dispute between the two? Why has this become an issue?
June 2025 | CWA # 1735

Padmashree Anandhan

NATO Summit 2025:
Trump making Europe great again
June 2025 | CWA # 1734

GP Team

The World This Week #317
NATO Summit 2025 and Russia-Mali bilateral agreements
June 2025 | CWA # 1733

Ananya Dinesh

China and the Pacific Islands 
What was the recent China-PIC joint statement about? What it says, and what it means?
June 2025 | CWA # 1728

M Kejia

G7 Summit 2025:
The Focus on the Middle East and Trade negotiations
June 2025 | CWA # 1726

GP Team

The World This Week #316
China-Central Asia Summit in Kazakhstan, and the G7 Summit in Canada
June 2025 | CWA # 1725

Brighty Ann Sarah, R Preetha, Santhiya M, Aparna A Nair & M Kejia

Operation Midnight Hammer: US bombs three nuclear sites in Iran
What were the three Iranian nuclear sites that were targeted? What are the B2 Bombers and Bunker Buster Bombs? What do these attacks mean? What Next?
June 2025 | CWA # 1724

IPRI Team

Conflict Weekly #286
The Spiralling Israel-Iran Crisis, and the Dangerous Hunger Hotspots
June 2025 | CWA # 1721

Rizwana Banu S and Santhiya M

Who are the Afrikaners?
Why is Trump interested in the Afrikaner question in South Africa?
June 2025 | CWA # 1720

Lekshmi MK

New WMO Report on Arctic Warming
What are the social, economic and environmental implications of Arctic warming
June 2025 | CWA # 1719

J Yamini  

China’s EV Surge
What contributes to the rise of BYD
June 2025 | CWA # 1717

J Yamini

Gender Violence in Pakistan:
What are the larger issues in the Noor Mukadam case?
June 2025 | CWA # 1715

Femy Francis

The US-China:
On Tariffs, Rare Earths and Visas
June 2025 | CWA # 1713

GP Team

The World This Week #315
The UN Ocean Conference in France and the US-China Meeting in London
June 2025 | CWA # 1712

R Preetha

June 2025 | CWA # 1705

GP Team

The World This Week #314
Elections in South Korea and Poland I China and the Pacific Island Countries I Bangladesh Election Announcement 2026
June 2025 | CWA # 1703

M Kejia 

Sagarmatha Sambaad in Nepal
Kathmandu’s Global Agenda for the Himalayas
June 2025 | CWA # 1700

R Preetha

Ethiopia bans the TPLF
What does the TPLF ban mean for the Pretoria agreement? What next for Ethiopia?
June 2025 | CWA # 1694

Aashish Ganeshan

The US:
Harvard vs Trump Administration
June 2025 | CWA # 1691

GP Team

The World This Week #313
China-ASEAN-GCC Summit I President Macron's visit to South East Asia I Trump Vs Harvard
May 2025 | CWA # 1690

GP Team

The World This Week #312
Elections in Romania, Portugal & Poland I UK-EU Summit
May 2025 | CWA # 1689

Padmashree Anandhan

Ukraine
Continuing Russia’s Aerial Attacks, despite exchange of prisoners
May 2025 | CWA # 1688

Ayan Datta

Gaza
The Humanitarian Crisis and Israel’s Renewed Offensive
May 2025 | CWA # 1685

Aparna A Nair

UK-EU Summit:
First step towards a reset
May 2025 | CWA # 1683

Aashish Ganeshan

Elections in Portugal:
The Rise of Chega Party and the Search for Political Stability
May 2025 | CWA # 1679

Aashish Ganeshan

US in the Middle Easr
Trump’s visit to Saudi Arabia, Qatar and UAE
May 2025 | CWA # 1678

Gauri Gupta

China in Latin America
China-CELAC forum: Strengthening ties with Latin America and Caribbean
May 2025 | CWA # 1677

GP Team

The World This Week #310-311
China in Latin America and the Carribbean I Trump's Middle East Visit I Denmark as the new Arctic Chair
May 2025 | CWA # 1675

Lekshmi MK

Turkey:
PKK disbands after 40 years of armed insurgency
May 2025 | CWA # 1673

Padmashree Anandhan

Ukraine:
The Discussion in Turkiye and the Elusive Ceasefire
May 2025 | CWA # 1671

Abhiruchi Chowdhury

US, Ukraine and Russia:
Air attacks amidst a Minerals deal and Ceasefire Proposals
May 2025 | CWA # 1670

Fleur Elizabeth Philip

Singapore Elections in 2025:
People’s Action Party (PAP) Wins, Again
May 2025 | CWA # 1667

R Preetha and Brighty Ann Sarah

East Asia:
Tough Tariff Negotiations with the US
May 2025 | CWA # 1666

Padmashree Anandhan

The US-Ukraine
The mineral deal with the US
May 2025 | CWA # 1665
Conflict Weekly # 280-81
India-Pakistan De-escalation I Ukraine Discussion in Istanbul I The Battle over Port Sudan I Disbanding of PKK in Turkiye I France-Algeria Diplomatic Tensions
May 2025 | CWA # 1663

R Preetha

Canada Elections 2025:
What do the results convey? What next for Mark Carney?
October 2024 | CWA # 1480

IPRI Team

July 2024 | CWA # 1413

Ramya B

May 2024 | CWA # 1336

Femy Francis

April 2024 | CWA # 1275

Ramya B

March 2024 | CWA # 1251

NIAS Africa Team

Africa This Week
March 2024 | CWA # 1246

Sivasubramanian K

February 2024 | CWA # 1226

NIAS Africa Team

Africa This Week
November 2023 | CWA # 1148

GP Team

October 2023 | CWA # 1091

Annem Naga Bindhu Madhuri

Issues for Europe
October 2023 | CWA # 1087

PR Team

October 2023 | CWA # 1083

GP Team

August 2023 | CWA # 1049

IPRI Team

July 2023 | CWA # 1012

Bibhu Prasad Routray

Myanmar continues to burn
July 2023 | CWA # 1009

GP Team

December 2022 | CWA # 879

Padmashree Anandhan

The Ukraine War
December 2022 | CWA # 872

Sapna Elsa Abraham

November 2022 | CWA # 838

Rishma Banerjee

Tracing Europe's droughts
March 2022 | CWA # 705

NIAS Africa Team

In Focus: Libya
December 2021 | CWA # 630

GP Team

Europe in 2021
October 2021 | CWA # 588

Abigail Miriam Fernandez

TLP is back again
August 2021 | CWA # 528

STIR Team

Space Tourism
September 2020 | CWA # 337

Anju Annie Mammen

February 2020 | CWA # 235

Lakshmi V Menon

September 2019 | CWA # 162

Lakshman Chakravarthy N

5G: A Primer
December 2018 | CWA # 71

Mahesh Bhatta

Nepal
December 2018 | CWA # 70

Nasima Khatoon

The Maldives
December 2018 | CWA # 69

Harini Madhusudan

India
December 2018 | CWA # 68

Sourina Bej

Bangladesh
December 2018 | CWA # 67

Seetha Lakshmi Dinesh Iyer

Afghanistan
July 2018 | CWA # 47

Rahul Arockiaraj

June 2018 | CWA # 26

Siddhatti Mehta