What exactly is monkeypox and how worried should I be about it?

While no cases have been reported in SA, the spread of the virus to our shores is a possibility

10 June 2022 - 16:24
By Sanet Oberholzer
The sudden and unexpected appearance of monkeypox in many countries suggests there has been undetected transmission for some time.
Image: 123RF/katmoy The sudden and unexpected appearance of monkeypox in many countries suggests there has been undetected transmission for some time.

At the beginning of May reports started circulating of a confirmed case of monkeypox in the UK. The infected person had reportedly travelled from Nigeria, where the virus is endemic. Then more cases were reported globally — without any travel links to African countries.

For the most part, cases of monkeypox have been rare outside Central and Western Africa where the virus is rife. Since 2018 and up until the recent confirmed reports, only eight cases had been confirmed in countries where the virus is not widespread — all related to travel.

The World Health Organisation’s director-general Dr Tedros Adhanom Ghebreyesus confirmed in a press briefing held on June 8 that more than 1,000 confirmed cases of monkeypox from 29 countries that are not localised to the virus have been confirmed to the WHO.

Ghebreyesus said the sudden and unexpected appearance of monkeypox in these countries suggests there has been undetected transmission for some time.


The first case of human infection with monkeypox was recorded in 1970 in the Democratic Republic of the Congo.

According to the National Institute for Communicable Diseases, “monkeypox is caused by infection with the monkeypox virus, a member of the genus Orthopoxvirus in the family Poxviridae”. 

Monkeypox causes less severe illness and is less contagious than smallpox

Infection of the virus resembles that of smallpox which also forms part of the Orthopoxvirus genus and was declared eradicated worldwide in 1980 as a result of successful mass vaccination programmes. Luckily, monkeypox causes less severe illness and is less contagious than smallpox.

According to the US Centers for Disease Control and Prevention, symptoms usually last between two to four weeks and may manifest as fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.

“Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body,” the CDC says.


According to the CDC, monkeypox has been shown to cause death in as many as one in 10 people who have contracted the disease in parts of Africa but the WHO reports this figure to be about 3%-6% recently, with higher chance of fatality in young children.

The virus is transmitted on contact with animals, humans or objects that have been contaminated as it enters the body through broken skin, the respiratory tract or mucous membranes.

According to an article by Pro Felicity Burt, an expert in medical virology from the University of the Free State (UFS) and the National Health Laboratory Service (NHLS); Prof Dominique Goedhals, head of the division of virology at UFS and NHLS; and Dr Charles Kotzé from the NHLS and Universitas Academic Hospital, vaccination against the smallpox virus should offer 85% protection against monkeypox. As such, older people who have been vaccinated for smallpox should have some protection.

In his recent statement, Ghebreyesus reiterated that certain antivirals and vaccines have been approved for monkeypox but are limited in supply.


No confirmed cases of monkeypox have been reported in SA but the NICD warns that monkeypox may be a reality: “Lessons learnt from Covid-19 have illustrated that outbreaks in another part of the world can fast become a global concern.”

Burt, Goedhals and Kotzé also point out that the spread of the virus to SA is a definite possibility given that SA is a “significant economic and travel hub for Africa”.

At the moment, the WHO does not recommend mass vaccination against monkeypox and the organisation has not recommended travel restrictions but some experts have called on the health body to act to curb the virus.

The NICD has urged people who have travelled to countries with current outbreaks to report any illness and information regarding recent travel to a healthcare professional.

“Residents and travellers to endemic countries should avoid contact with sick animals that could harbour monkeypox virus such as rodents, marsupials, primates and should refrain from eating or handling wild game.”

The good news according to Burt, Goedhals and Kotzé is that monkeypox is less contagious than Covid-19, as close contact is required for longer periods for transmission to occur.

That said, the same hygiene rules apply to keep yourself safe and the NICD has emphasised the importance of washing your hands regularly with soap and water or using alcohol-based sanitiser.