Monkeypox—what is it? What is being done about it?

Monkeypox is a viral disease that was identified within laboratory monkeys after an outbreak in the 1950s, thus the name. It is actually unknown where the virus originated, and to date it is rarely fatal if contracted. 

Interestingly, it is more common in rats, mice, rabbits and squirrels, all of which may possess the virus and infect humans. This virus, which is specifically an orthopoxvirus, is related to smallpox, and anyone is susceptible to contracting the virus. 

Within tropical rainforest areas of central and western Africa, this family of viruses is prevalent and common, also known as endemic, but it has spread to other areas of the world. The first human case was identified in 1970’s Africa with an early presentation very similar to flu symptoms and then a progression to smallpox-like illness. 

Most human cases thereafter were due to international travel to or from the endemic area or due to the import of animals from that area. An outbreak within the United States was first seen in 2003 and linked to contact with infected pet prairie dogs that had been imported.

Symptoms 

The timing of symptoms varies. Time from exposure to onset of symptoms is five to 21 days. Symptoms that last 14 to 30 days include:

• fever 
• malaise
• headache 
• sore throat with cough
• swollen Lymph nodes 
• blistering rash on any part of the body (face, hands, feet, chest, genitals, inside the mouth, etc.)
• muscle pains

The swollen lymph nodes (anywhere on the body) usually present after a fever, followed one to two days later by the rash. The swollen glands indicate a clinical difference from smallpox that includes all of the above symptoms but usually does not have the swelling of lymph nodes.

The rash is visible to others and presents as a lesion that evolves to a fluid-filled blister eventually crusting over. This rash can be very painful initially, but as it heals it may itch extremely.

Transmission 

Transmission occurs during the two to four weeks of symptoms through:

• direct contact with rash, likely the fluid from within a blister or lesion; 
• respiratory secretions especially when the contact is prolonged such as during kissing or repeated face-to-face contact;
• contact with items  that were in contact with the rash or fluids of an infected person;
• transmission from infected animals via bite, scratch, or consuming infected animal meat.

Diagnosis

1. A sample is taken from a lesion and a (PCR) test is done to identify the virus.
2. Blood test to check for virus particles or antibodies to the pox virus.

Complications

• secondary skin infections at the open sores
• eye infections 
• pneumonia 
• encephalitis (brain inflammation)

Prevention—what can one do?

• Do not touch the lesions. wear PPE when caring for infected individuals.
• Avoid close contact with symptomatic individuals.
• Do not touch the bedding, towels or clothing of symptomatic individuals without gloves.
• Disinfect surfaces that infected individuals come in contact with.
• Hand wash frequently with soap and water as well as alcohol-based products 
• Avoid contact with rodents and primates if traveling to central or western Africa. 

Since it is a virus, there are differing strains, and most have limited human-to-human spread, while others are quite contagious. An individual is most contagious during the rash presentation, but also potentially during the symptoms prior to the rash appearance. For instance, when a patient has fever, headache, or sore throat without rash, one should be cautious if an outbreak is noted.

Treatment 

Fortunately, most people get better without any treatment. Treatment can include:

• comfort measures for the painful rash and other symptoms 
• hydration 
• pain relievers for headaches and flu-like symptoms
• antibiotics for secondary infections
• future antiviral medications may become available

Vaccines for smallpox historically also prevented monkeypox, but these vaccines are not in ample supply. As a result, they are recommended for immunocompromised at-risk individuals.

One such vaccine the FDA has approved is made by Jynneos. It is effective in preventing  disease four days after exposure and may reduce severity of symptoms if given up to two weeks after exposure. The production of this vaccine is being increased, but supply increase will take time.

Sean J. Ennevor, M.D. graduated with a B.A.S. in biology and economics from Stanford University, and as a Dean’s Scholar from UCLA School of Medicine where he received his MD. He completed his medical residency and fellowship in anesthesiology at Yale University, where he was chief resident and on staff. He practiced medicine in the Twin Cities for over 14 years, and presently serves as an advisor and investor for medical technology companies throughout the country.