At the time of writing, suspected Monkeypox cases are in the hundreds and on the rise around the globe. It’s still unclear whether its re-emergence and transmission outside of Africa is of concern. However, given the dramatic effect Coronavirus had on hair shedding, what potential impact does Monkeypox, or its vaccine, have on our hair? We’ll take a closer look and see what we can learn from its close cousin, Smallpox.
What we're going to cover in this article
What is Monkeypox?
Monkeypox is a virus belonging to the Orthopox family of viruses which also includes Smallpox and Cowpox amongst others. It was first detected in a group of lab monkeys in 1958 in Copenhagen, Denmark, but first detection in humans occurred in The Democratic Republic of Congo in 1970.
It has largely remained endemic to Central and Western Africa, but a handful of notable outbreaks have occurred outside of the region:
- US (2003), 71 Cases: Cause traced back to a pet store importing rodents from Ghana
- Nigeria (2017 – ongoing), 558 Cases: An outbreak which is still occurring in the country and has seen 8 deaths
- UK (2018), 4 Cases: Suspectedly brought into the UK by a Nigerian national travelling back to the UK
- Singapore (2019), 1 Case: A man became hospitalised after return from travel in Nigeria
Regarding the danger Monkeypox presents, there are two main genetic variants with differing average mortality rates:
- West African Clade: Milder disease, ~1% Mortality Rate
- Congo Basic: More severe disease, ~10% Mortality Rate, thought to be more transmissible, endemic to DRC
Symptoms and Transmission of Monkeypox
The symptoms of Monkeypox typically develop as follows over a period of 0-21 days:
- Invasion Period (0-5 Days): Fever, Headaches, Swollen Lymphnodes
- Rash/Skin Eruption Period (1-3 Days): A rash which typically develops on the face in 95% of cases and at the extremities (hands and feet). Ranges from slight red coloured rash to raised lesions which eventually scab and fall off.
The good news is that, unlike Coronavirus, Monkeypox isn’t transmitted at the pre-symptomatic stage of the disease. Meaning no symptoms, no transmission. However, once contagious, there are several ways the virus transmits itself from host to host.
Monkeypox is a zoonotic virus meaning that it is transmitted from animals to humans. This normally occurs through exposure to bodily fluids or the skin rashes of an infected animal. Human-to-human transmission occurs in much the same way: through exposure to bodily fluids, skin lesions, or through inhalation of infected droplets exhaled by an infected person.
It appears that, as with Coronavirus, if Monkeypox were to spread, mask mandates would likely come into force to limit the spread, as well as self-isolation for suspected or confirmed cases. We have already seen those who have come into contact with infected persons of the most recent outbreak being asked to self-isolate for 21-days.
Which Vaccines Currently Exist?
Two Smallpox vaccines are typically used to prevent Monkeypox infection: Imvanex (Jynneos), the most commonly used, and is claimed to be 85% effective against Smallpox, and ACAM2000. Imvanex is also specifically licensed to treat Monkeypox.
Both vaccines consist of two injection doses and should be given before exposure to either virus, but if given after exposure, the sooner the vaccine is delivered the better. The Centre for Disease Control (CDC) in the United States recommends giving the vaccine within 4 days after exposure in order to prevent the onset of the disease.
The CDC estimates that between 1-2 people per 1 million will die as a result of complications from vaccination.
As can be seen in Figure 2 below, Smallpox was widely eradicated in the 1960s thanks to global vaccination programmes from the World Health Organisation. However, with the eventual eradication of the disease came the cessation of vaccine programmes, meaning that today, younger people (aged below 40-50 years old), are more likely to be at risk from Monkeypox.
What does the Evidence Say about Monkeypox and Hair Loss? Does Monkeypox Cause Hair Fall?
Little research currently exists regarding Monkeypox’s exact effects on hair loss, most likely due to the lack of global cases, and especially the lack of cases outside of Africa.
Infected animals, including rabbits and small rodents, have exhibited patchy hair loss primarily due to the skin lesions that form, however, there are no confirmed medical observations of hair loss in humans or non-human primates.
Famously Queen Elizabeth I had Smallpox and was said to have suffered from sparse (or no) hair for most of her adult life. It is said that she had lost most of her hair by the time of her death aged 69! It remains unknown whether her hair loss was a direct result of the virus or another medical condition, or whether it was a result of her body’s physiological response to infection, namely telegen effluvium.
Although Monkeypox doesn’t appear to have hair loss as a primary symptom, the body’s response to stress more generally appears to be the important factor at play here and is something we will explore in further detail.
How Do Viruses Affect Hair Loss More Generally?
Our hair is sensitive to any changes in our normal bodily conditions, including illness, injury, or infection. One stress response of the body, expressed in our hair follicles to an external shock, is a condition called telegen effluvium.
Our hair follows a distinct Growth Cycle (Figure 3 below) consisting of four stages, each lasting for a different length of time:
- Anagen (2-6 Years): The active phase of hair growth. Hair cells grow rapidly and new hair is formed and pushed out of the follicle
- Catagen (2-3 Weeks): The transitional stage where growth starts coming to an end. ‘Club hairs’ begin to form during this stage. These are the hairs with a small white blob of keratin at the end.
- Telegen (3-4 Months): The resting stage during which hairs don’t grow and shedding begins to occur (the club hair is fully formed and ready to be separated from the follicle)
- Exogen (2-5 Months): The full shedding part of the hair growth cycle. During this stage, it is typical to lose between 50-100 hairs per day
Telegen Effluvium is a condition whereby, in response to stress, illness, or injury, more hairs than usual move to the Telegen stage of the Growth Cycle. As a result, a temporary period of excess hair shedding is experienced by sufferers.
As we saw during COVID-19, infection with covid was a major cause of acute telogen effluvium in both males and females, with pull tests (tests for telogen effluvium by pulling the hair) resulting in 35% of hair coming away in some cases. Furthermore, excess hair shedding was observed anywhere between 3 and 6 months post-infection. So although temporary, this is a long enough period of time to be distressing for sufferers.
What is important to note is that it doesn’t appear to be the virus per sé affecting our underlying hair-growth biology, but more the physiological response in the body as a result of becoming infected (e.g. trauma, illness) that results in some biological processes, such as hair growth, becoming curtailed or less active.
Monkeypox is likely to fall into this bucket, with no direct impact on hair loss, but a high likelihood of it triggering a stress response in the body which can manifest itself, amongst other symptoms, as hair loss.
Little is known about the exact effects of Monkeypox on hair loss. In small mammals that contracted the virus, hair loss has occurred, but this was mainly due to the skin rashes and wounds caused by the virus. Its a relief to note that similar symptoms have not been observed in humans. Given the wider lack of Monkeypox cases, it is also useful to look at the symptoms of its genetic cousin, Smallpox, where we also do not see any specific hair loss related symptoms.
What is clear, however, is that viruses are stressful events for our biology. As was widely documented with the Coronavirus pandemic, numerous cases of telegen effluvium, increased hair shedding, occurred in patients. Although the hair loss was temporary in the vast majority of cases, lasting a period of a few months, distressing hair loss nonetheless occurred.
Given these findings, we should do what we can to ensure our holistic health is in as good condition as possible given the risk of possible infection if the virus spreads. This means but is not limited to: getting enough sleep, drinking enough water, ensuring we are properly nourished, and meditating and undertaking other relaxation techniques to look after our mental health.
Our bodies are fragile biological ecosystems and we should respect and care for them regardless of any external virus threats. Our hair will thank us regardless of infection or not!
References Used in this Article