Opinion: Understanding Monkeypox
Monkeypox is one variation in a “family” of poxes. Some are very harmful to human beings; others are benign or relatively benign. To understand how this is possible, it is necessary to have at least a superficial understanding of evolution. Things that are alive today evolved from other things that were once present on the earth millions of years ago, from the largest of elephants to microscopic viruses. And today’s living things that evolved from a common ancestor may exist in a “family” that has a wide range of forms.
That cute cocker spaniel that just wants to please you and cuddle up with you in front of the fireplace on a cold night is one of many modern canines that can trace an ancestry back to the Paleocene, about 50 million years ago, when carnivorans split into two major divisions: caniforms (dog-like creatures) and feliforms (cat-like creatures). Modern members of the canidae family include wolves, jackals, foxes, and domestic dogs, including that cute little cocker spaniel.
Just as modern elephants can be traced back to woolly mammoths, modern viruses probably originated with some molecular combination of protein and nucleic acid that united long before observable animal life existed on earth. However, tracing the ancestry of viruses, like those that we now identify as poxes, is extremely difficult because viruses typically have very short life spans, mutate quickly, and — when they die out — leave no fossil remains to be studied.
Poxviruses are double-stranded (or complex) viruses that pose a significant health threat to fish, birds, and mammals. In order to survive, poxviruses require a host to “feed” the nucleus (specifically a nucleoprotein, enclosed within an “envelope” of other genetic matter). The natural hosts of poxviruses are usually rodents. However, rodents can transmit the virus to other species, and some can travel up the food chain to infect human beings.
According to a paper written by Christopher J. Burrell and associates, “All poxvirus infections are associated with lesions of the skin, which may be either localized or widespread.” The poxviruses with which we are most familiar are chickenpox, cowpox, smallpox, and — now — monkeypox. Initial symptoms are similar: fever, headache, muscle aches, swollen lymph nodes, chills, fatigue, cough, and a rash that may start as pustules (like small blisters) and eventually become scabs. But infected people may not experience all of the symptoms, and the symptoms may occur in any order.
History of poxviruses
There is a story, perhaps only a myth, that Edward Jenner learned that milkmaids who had been exposed to cowpox (which is usually not fatal to human beings) developed an immunity to smallpox (which killed hundreds of millions of people worldwide and decimated North American Natives, Maya on the Yucatan Peninsula, Aztecs of Tenochtitlan (now Mexico City), and Inca of Peru. Jenner reasoned that if people were deliberately infected with an injection from cowpox pustules, they would not contract smallpox. Whether or not that’s a true story, Jenner did develop the first vaccination program, and it was derived from a cowpox-infected milkmaid.
There is another story that is a myth: People who once had chickenpox are immune to monkeypox. That is definitely false. Recovery from chickenpox (a discomfort that affected me and nearly every kid I knew) provides no protection from monkeypox because of a difference in the genetic structure of the viral mutation. However, people who once had chickenpox are susceptible to shingles, and should be vaccinated against that painful disease.
People who were vaccinated against smallpox, may have some degree of protection against monkeypox because of the similar construction of the viruses. This means that, when a vaccination for monkeypox is available, it will likely be given first to the youngest among us, while people over age 50 will be served last. The reason that the priority is opposite that of the COVID-19 vaccine is that most Americans who were born before the 1970s received smallpox vaccinations. As a result, WHO declared in 1979 that smallpox had been wiped out worldwide.
When my son was born in 1972, we had a hard time finding a pediatrician who would give him a smallpox vaccination because it was felt that the vaccination was more likely to cause problems than was the chance that people in the United States would ever contract smallpox. However, my ex and I enjoyed traveling to the Yucatan and visiting the ancient Maya cities, and we intended to take our son with us. So, we searched until we found a physician who was willing to administer the vaccine to our son. Poxviruses, as you can see, are tricky, and it’s important for us to know all that we can about them.
Monkeypox, for example, is generally spread by skin-to-skin contact, but it may also be transmitted via respiratory secretions. And, it can cross the placenta to infect a fetus. Its symptoms mimic those for other pox infections, and certain antiviral drugs may be effective. However, the best protection is to avoid contact with people who have obvious skin lesions, practice safe sex, and maintain social distance, as we’ve been doing during the COVID-19 pandemic. Personally, I think it’s still a good idea for several reason to continue to wear a face mask in enclosed public places.
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Jim Glynn is Professor Emeritus of Sociology. He may be contacted at firstname.lastname@example.org.