Monkeypox is a less severe cousin to smallpox

Q: We are from Boston, and someone who lives very near here has tested positive for monkeypox. I have never heard of this disease before, but now it's all over the news. What is monkeypox? How did it get here, and what are the symptoms?

A: Monkeypox is a rare viral disease caused by the monkeypox virus. It's a member of the orthopoxvirus group of viruses and is endemic to the rainforest countries of central and west Africa.

Although monkeypox is a cousin to smallpox, it is far less severe. Symptoms of the disease include fever, chills, headache, muscle aches and exhaustion. People with monkeypox also develop swollen lymph nodes, which does not occur in smallpox. A few days after the onset of fever, a distinctive rash begins to appear on the hands, face, feet or mouth. The rash starts out as flat, red markings on the skin and gradually evolves into raised, fluid-filled lesions. Monkeypox lasts from two to four weeks.

The disease is transmitted person-to-person and through close contact. This can be via respiratory droplets or physical contact with infectious sores, body fluids or scabs. Symptoms typically begin one to two weeks after exposure to the virus. However, they can begin as soon as five days, or they may take as long as three weeks to appear.

Cases are usually mild, and most people recover without specific treatment. In cases of severe disease, antivirals developed to treat smallpox may be beneficial.

The disease was first reported in laboratory monkeys in 1958, thus the name. Scientists soon learned the virus infects other animals, including many types of rodents, pigs and anteaters. The virus can also jump from animals to humans. This is known as a zoonotic disease.

The first reports of monkeypox in humans occurred in 1970 among people living in remote locations in Africa. In 2003, the virus made its first known appearance in the United States. At that time, an outbreak in about 70 adults and children was traced to close contact with a group of prairie dogs, which had been sold as pets. Those prairie dogs became infected with the virus after exposure to infected imported rodents. That outbreak was contained with the use of the smallpox vaccine, medical care and an education campaign. No deaths occurred. Since then, several isolated cases, each travel-related, have occurred.

The current outbreak of monkeypox is affecting hundreds people in more than a dozen countries, including the U.S. and Canada. The exact source is not yet clear, but international health authorities suspect a link to a pair of large gatherings held in Europe earlier this spring.

Here in the U.S., a network of labs is gearing up to make testing for the virus available. The U.S. Food and Drug Administration has also approved the use of smallpox vaccines, as well as certain antiviral treatments, to control outbreaks. Because monkeypox is closely related to smallpox, the smallpox vaccine is highly effective against the disease. Immunity conferred by the smallpox vaccine, which was routinely administered in the U.S. until 1972, persists for decades. While vaccinated individuals are believed to be protected from severe disease with monkeypox, it's still important to be careful.

New studies on long COVID-19 provide no definitive answers

Q: I get why people are totally over dealing with COVID-19, but I don't have that luxury. I'm 31 years old, and I thought I was lucky when my case of COVID-19 only felt like a bad cold. But it's been six months now, and I'm still sick. Have we learned anything new about what causes long COVID-19?

A: As most of us probably know by now, "long COVID-19" refers to the long-lasting health problems that affect a sizable number of those who have been ill with COVID-19.

The official name for the syndrome is "post-acute sequelae of SARS-CoV-2 infection," or PASC. It consists of a shifting constellation of a wide range of symptoms. These include fever, headache, chronic cough, shortness of breath, a racing or disordered heartbeat, stomach pain, gastroenteritis, changes to menstrual cycle, dizziness, brain fog, insomnia, changes to mood and persistent fatigue or exhaustion. Symptoms last for weeks, and often for many months, after the initial illness has passed.

When long COVID-19 first emerged, it appeared to occur mainly in those who experienced severe illness. We now know that anyone who becomes infected with SARS-CoV-2, which is the name of the coronavirus that causes COVID-19, can go on to develop the syndrome.

Data from several new studies into long COVID-19 have just been released. While there has not yet been a definitive breakthrough regarding the cause, the results of the research continue to chip away at this baffling illness.

One study, conducted by the Centers for Disease Control and Prevention, found that long COVID-19 occurs in about 20% of adult COVID-19 survivors under the age of 65, and up to one-fourth of those over the age of 65. In the older group, risk of developing long COVID-19 increased with age.

For some long COVID-19 patients, like yourself, symptoms of the initial disease never fully resolve. In others, who have recovered from their illness, symptoms return, sometimes as long as six months later. Another study found that having been vaccinated produced a mild protective effect against long COVID-19 but did not eliminate the risk of developing the disease.

Research conducted by the National Institutes of Health looked into whether the syndrome might be caused by lingering fragments of virus, whose presence could trigger the immune system to fight the disease all over again. Unfortunately for those hoping for a definitive answer to the mystery of what causes long COVID, the study did not find evidence of that.

Now researchers are looking to the intense immune response that occurs in some individuals as a potential factor in the cause of lingering disease. It is possible that, after revving up to such a high level, the immune system never fully settles back down. Meanwhile, a seasonal pattern of COVID-19 infections has emerged. As with the flu, the disease is always present. But epidemiologists, including colleagues here at UCLA, have begun referring to COVID-19 as a seasonal illness, with surges occurring in summer and winter.

We know we're repeating ourselves here, but we urge our readers to please remain vigilant in protecting themselves and their loved ones from infection.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.