What is monkeypox?
Monkeypox is an infection caused by the monkeypox virus. This virus is part of the poxvirus family, which is the same family that smallpox (Variola virus) comes from. It is called monkeypox because it was first isolated in 1958 in monkeys; however, rodents are the primary carriers. The first confirmed human case was in 1970 in a child located in the Democratic Republic of Congo. There are two types of monkeypox: Clade I and Clade II. Clade I causes a more severe and lethal disease. Currently, infections in this current outbreak are Clade II infections.
Monkeypox is endemic to Central and West Africa, although with high rates of international travel, the United States and other countries have begun to see increased rates of cases. In 2022, the World Health Organization declared monkeypox a global health emergency.
How do you get monkeypox?
Monkeypox is contracted through skin-to-skin contact, large, respiratory droplets, bodily fluids, or contaminated items from someone who has an active infection. It can be transmitted both human-to-human and animal-to-human. Contact during sex can spread monkeypox. Monkeypox is suspected in someone who meets one out of four criteria within 21 days of the onset of their symptoms: men who have sex with men (MSWM), history of travel to a country where monkeyvirus is endemic, contact with a person suspected of having monkeypox, or contact with animals (dead or alive) that are endemic to Africa.
Although rates of monkeypox transmission are higher in men who have sex with men, this is virus is not exclusively restricted to this population and this stigma must be acknowledged and taken into consideration with public health strategies to create awareness. People who are sexually active are not considered to be at risk for monkeypox unless their sexual partners have monkeypox or they have had multiple sexual partners within the last 14 days.
What are the symptoms of monkeypox?
Patients with monkeypox report a rash of deep-seated, well-circumscribed lesions with central umbilication. Lesions progress sequentially through a phase of macule, papule, vesicle, pustule, scab, crust. The rash usually starts on the face and extremities (including palms and soles) and then spreads to other parts of the body. Lesions may appear in the oral mucous membranes, conjunctiva, cornea, groin, and anogenital area. Lesions are described as painful until the crust phase when they become itchy. Symptoms vary from patient to patient and some may have milder symptoms than others.
The incubation period for monkeypox is 3-17 days and initial presentation includes fever, headache, enlarged lymph nodes (in neck and groin area), back pain, muscle aches, sore throat, cough, and fatigue. A rash will appear 1-3 days after the fever begins. The duration of monkeypox infection is usually 2-4 weeks.
On histology, focal, full-thickness epidermal necrosis and multinucleated keratinocytes will be seen along with a dense dermal inflammatory infiltrate.
How do you test for monkeypox?
If you are experiencing symptoms of monkeypox, see a physician to obtain a test for monkeypox and to rule out other rash illnesses, such as measles or chickenpox. A polymerase chain reaction (PCR) test is used to diagnose an active infection. A swab is taken from an open sore and sent to the lab for confirmation.
If you have a confirmed case of monkeypox, you should isolate until lesions have formed a crust and a fresh layer of intact skin beneath. Once the crusts have fallen off, you are no longer considered to be contagious.
How do you treat monkeypox?
Currently, there is no specific treatment for monkeypox infections but severe cases may be treated with antiviral medications. Most cases are self-limited and resolve on their own within 2-4 weeks. Mild to moderate cases should be monitored and treated supportively to prevent dehydration and secondary bacterial infections. Pain relievers, such as ibuprofen and acetaminophen can be used along with oatmeal baths to soothe dry skin.
Smallpox therapies, such as Tecovirimat (TPOXX), may be effective and should be considered in patients with severe cases, immunocompromised patients, children <8 years old, and pregnant women.
There are two vaccines, JYNNEOS and ACAM2000, that have been approved to prevent monkeypox in people exposed to the virus. The vaccine should be given within four days of exposure. Since smallpox comes from the same family as monkeypox, individuals who are vaccinated for smallpox may be at reduced risk for monkeypox infection.
How do I avoid getting monkeypox?
Avoid close contact with people who are infected or with people who have a rash that looks like monkeypox
Avoid contact with belongings of a person with monkeypox
Wash your hands frequently and thoroughly with soap and water or an alcohol-based hand sanitizer
Wear a N-95 mask, gown, gloves, and eye protection if caring for someone with monkeypox
Limit the number of sexual partners
If you plan to attend a crowded event, consider how much close, skin-to-skin contact is likely to occur there
If exposed, monitor your health for three weeks after exposure and do not donate blood, cells, tissue, breast milk, semen, or organs during this period. Take your temperature twice daily and if you develop a fever (>100.4), swollen lymph nodes, or a rash, self-isolate and contact your local health department for further guidance.
References:
https://www.cdc.gov/poxvirus/monkeypox/about/faq.html
https://www.jaadcasereports.org/article/S2352-5126(22)00348-4/fulltext
https://www.aad.org/member/clinical-quality/clinical-care/monkeypox
https://my.clevelandclinic.org/health/diseases/22371-monkeypox#diagnosis-and-tests
https://www.hopkinsmedicine.org/health/conditions-and-diseases/monkeypox
https://www-sciencedirect-com.proxy.westernu.edu/science/article/pii/S0891552019300170?via%3Dihub
https://academic.oup.com/cid/article/58/2/260/335791?login=true
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