MonkeyPox
Written by Barbara Hoefener, FNP, May 30, 2022 updated 8/12/22.
Monkeypox was declared a public health emergency in the USA on Aug 4 2022 as national cases topped 7,100. For reference, May 21, the WHO- World Health Organization confirmed monkeypox cases to 92 people across 12 countries, where it is not endemic and some cases had no travel history.
Monkey pox is a rare disease caused by infection of monkeypox virus, within the same family of viruses that cause smallpox. It is rarely fatal, <99% for Western Africa and 90% for Congo type, however can be painful and can leave scaring from the rash. People that are immuno-compromised including <8yr, persons with eczema hx, and persons who are pregnant bay be at increased risk for severe illness or death.
Monkeypox is a zoonotic virus, typically transmitted via close contact between rodent/ animal and human, often through bite, scratch or rash contact. When human to human transmission happens, it is through to be related to direct contact w the lesion, rash, scab or body fluids. There is some spread with respiratory secretions with prolonged, face to face contact or during intimate physical contact including kissing. Monkeypox is not a sexually transmitted illness, as it spreads mostly through infected skin/ fabric. Pregnant persons can spread the virus to their fetus through the placenta.
There are 2 clades of monkeypox virus: West African and Congo Basin. The current outbreak is from the West Africian type.
Monkeypox is endemic to these 2 regions, it becomes concerning to public health when a virus spreads to outside the known endemic area, countries of central and western Africa.
Monkey pox has been around for years, and there is decades of research on this subject (unlike COVID). The virus was first isolated form monkeys in 1958, and first recognized among humans in 1970s. Like smallpox and cowpox virus, the monkeypox virus is part of the Orthopoxvirus genus. Compared with smallpox, monkeypox has a relatively low case fatality rate, less than 4-11%. Smallpox has a fatality rate of 30%. There is no current evidence of viral mutation, but with the increase in cases, continued demonic surveillance is crucial.
Monkeypox has been increasing since smallpox was declared eradicated in 1980, and this has increased over the past decade. Experts suggest that the upward trend is due in part to the decline in smallpox vaccination, 40 years ago 80% of the population was vaccinated and in 2022 approx 30% of the population is vaccinated against smallpox. There is also increasing travel, trade, and expanding populations which provide more opportunities for human- infected animal reservoirs.
Early symptoms develop 1-2 weeks after a person is infected with the virus.
Symptoms can include fever, headache, muscle aches, chills, exhaustion swollen lymph nodes, respiratory systems like sore throat, congestion or cough, and a few days later a rash develops. The rash looks similar to pimples or blisters characterized by firm, round lesions sometimes with a fissure in the middle, typically lasting 2-4 weeks.
Monkeypox lesions progress form blister-like lesions to scabs, each stage lasting 1-2 days. Once the lesion scab falls off and reveals healthy tissue, approx. 2-4 weeks, the individual is no longer infectious.
This new outbreak is presenting differently among the population via Dr Rao, infectious disease MD and medical officer of CDC. Newer cases have more mild symptoms to no sickness and the rash is the first indication an individual is sick. The spread pattern seems to start at the head or genitals then progressing out to the trunk and extremities.
There are no specific treatments, however there are antiviral drugs used to treat smallpox, that can be used because of genetic similarities in the virus. Tecovirimat may be recommended for persons with severe illness or weak immune system. The best method to avoid sickness is to avoid touching lesions.
Currently there are 100 million vaccine doses available in the USA, used predominantly to those close with the infected person to help prevent exposure. The smallpox vaccine is no longer available to the general public, but as limited supply. The local health department works with the CDC to get vaccines to patients and close contacts who could benefit.
Patients should be placed in a negative pressure room and healthcare workers should use droplet precautions.
Reference:
JAMA, published May 27 2022.
Full article:
https://jamanetwork.com/journals/jama/fullarticle/2793012?guestAccessKey=be62b746-6f50-4de5-b841-baa4efcd86f3&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=052722
PatientCare published Aug 5 2022 https://www.patientcareonline.com/view/monkeypox-7-questions-patients-may-ask-answers-to-help-prepare