Monkeypox cases are making their way around the world and while most infections may be mild, an infectious disease expert said the silent spread is making it harder to eradicate the disease.
Cases of the viral disease are growing in the West among people who have not travelled to Africa - a phenomenon not seen before.
The current outbreak has caused over 5000 cases worldwide and while the bulk of the outbreak is in Europe, the disease is creeping closer to New Zealand with 15 confirmed cases in Australia.
Experts are saying it is a matter of time before cases pop up in New Zealand and the Ministry of Health is monitoring the outbreak overseas, with a team ready to establish a response if cases are identified in NZ.
While the good news is monkeypox cases from this particular outbreak are a lot milder than usual, this does come with its complications.
Infectious diseases physician and University of Otago biochemistry professor Kurt Krause told Newshub that the mildness of the outbreak could be making it harder to eliminate the disease.
"The weird thing that we're finding is the monkeypox cases that people receive are quite a bit different from the monkeypox cases that were typical in central Africa," Prof Krause said.
He said the "classic outbreak", common to west and central Africa, saw people develop a fever, swollen glands, muscular pain and a stiff neck, which was then followed by a large outbreak of pox lesions.
However, Prof Krause said the outbreak of the disease in Western countries is causing relatively mild rashes in most people, with one or two lesions that don't look "particularly threatening".
"That's what's tricky about this monkeypox is a lot of people don't have much in the way of symptoms," he said.
Prof Krause also said there might be some transmission during the prodromal period, when there are no lesions present on the skin, while the typical outbreak in Africa was transmitted through lesions.
These two factors are both contributing to the spread of monkeypox worldwide.
"I think that's what's been behind this, kind of amazing persistence of this outbreak," he said.
The virus spreads through close contact, commonly by direct contact with infectious lesions and contaminated objects like clothing or bedding. Studies also suggest it could be passed by inhaling infected droplets such as coughing close to somebody.
Monkeypox is most commonly found in men who have sex with men (MSM), but a small number of cases have been reported among close contacts including children.
Should parents be worried their child could catch monkeypox?
Prof Krause said the disease is "rare" in kids, with only three cases of monkeypox having been detected in children. Monkeypox would be unlikely in children unless there was a strong known contact and timeline favouring the virus.
He said monkeypox is not something parents should be concerned about, but while it is unlikely, cases could appear in children so it is important to know what to look for.
Like chickenpox, monkeypox causes rashes on the infected person and while symptoms of the illness initially appear similar to chickenpox there are several key differences between the two.
Prof Krause said chickenpox lesions are superficial and appear centrally on the body while monkeypox lesions are deeper and more peripheral, mostly appearing on the face, hands, feet and arms.
Swollen lymph nodes are also a distinctive feature of monkeypox that does not occur with chickenpox.
Kiwi doctors are being asked to look out for signs and symptoms of the disease, particularly in people who have travelled recently.
Prof Krause said he thinks it is more likely than not New Zealand will get cases of monkeypox, but it will be unlikely we will see many cases in the country.
There is no specific vaccine for monkeypox, but overseas a vaccine called Jynneos from the company Bavarian Nordic is being used to prevent the disease. It has been shown to be around 85 percent effective.
Authorities have found Jynneos to be safe for the general population including immunocompromised people.
The Ministry of Health said it is working with Pharmac to explore options for access to Smallpox vaccines that can be considered for the targeted prevention of monkeypox and PCR testing for monkeypox will be available soon.
