The World Health Organization (WHO) has decided not to declare monkeypox a public health emergency of international concern. This may change in the future.

However, WHO Director-General Tedros Adhanom Ghebreyesus said he was “deeply concerned” about the evolving threat of monkeypox, which he said had reached more than 50 countries.

There have been more than 4,100 confirmed cases globally, including at least 13 in Australia.

The WHO also acknowledged there were many unknowns about the outbreak.

Here are three things we know about monkeypox and three things we want to find out.

Read more: At what point is a disease deemed to be a global threat? Here’s the answer

3 things we know

1. Monkeypox is caused by a virus

Monkeypox is a large DNA virus belonging to the orthopoxvirus family. Unlike the related smallpox virus, variola, which only affected humans, monkeypox virus is found in rodents and other animals in parts of Africa.

We know of two clades (virus groupings), and it is the less severe of the two currently circulating outside Africa.

Orthopoxviruses are stable viruses that do not mutate much. Multiple mutations, however, have been described in the virus causing the current outbreak.

In the United States, at least two separate strains have been circulating, suggesting multiple introductions into the country.

Read more: Monkeypox in Australia: what is it and how can we prevent the spread?

2. You can be infected for more than a week and not know

It takes an average 8.5 days from infection to showing symptoms, such as enlarged lymph nodes, fever and a rash, which usually looks like fluid-filled blisters that erupt. People are infectious while they have the rash, and are usually infectious for about two weeks.

The European epidemic is mostly in adult males, so this, together with better access to care, may explain the low rate of deaths in these countries.

Children are most severely affected and have a higher risk of dying from the disease. Historically, in the endemic countries of Africa, almost all deaths have been in children.

The European epidemic is mostly in adult males, so this, together with better access to care, may explain the low rate of deaths in these countries.

Read more: What’s in a name? Why giving monkeypox a new one is a good idea

3. We have vaccines and treatments

Vaccines work. Past vaccination against smallpox provides 85% protection against monkeypox. Smallpox was declared eradicated in 1980, so most mass vaccination programs ceased in the 1970s.

Australia never had mass smallpox vaccination. However, an estimated 10% of Australians have been vaccinated in the past, mostly migrants.

Vaccines protect for many years but immunity wanes. So declining population-level protection is likely responsible for the resurgence of monkeypox seen since 2017 in Nigeria, one of seven endemic hot spots in Africa.

Mass vaccination is not recommended. But vaccines can be given to contacts of confirmed cases (known as post-exposure prophylaxis) and people at high risk of contracting the virus, such as some lab or health workers (pre-exposure prophylaxis).

There are also treatments, such as vaccinia immune globulin and antivirals. These were developed against smallpox.

Read more: Monkeypox: we have vaccines and drugs to treat it

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Article originally published by The Conversation on June 26, 2022.