Monkeypox: What You Should Know

You may have been hearing information regarding a rare disease called monkeypox.  This, however, is not a new virus.  In fact, it was first discovered in 1958, when a pox-like disease began to appear in colonies of monkeys that were being contained for research. Monkeypox was first detected and recorded in a human in 1970 in Africa. It is in the same family as smallpox, but monkeypox illness is usually less severe than a smallpox infection

More recently there have been multiple cases of monkeypox in countries that do not usually report cases.  This includes the United States; but it is not the first time that monkeypox has been reported in the U.S.  There were incidences of 47 people in the Midwest, stemming from infected animals imported from Ghana to Texas in 2003 and one person in 2021 who had traveled to Africa from the U.S.

Signs and Symptoms of Monkeypox

The time of infection to symptoms or the “incubation period” is generally 7-14 days but can also range from 5-21 days. The illness usually lasts 2-4 weeks. The disease is generally mild, but can cause complications such as pneumonia, vision loss due to eye infection and a life-threatening infection known as sepsis.

Initially the illness begins with:

• Fever
• Headache
• Muscle aches
• Backache
• Swollen lymph nodes
• Chills
• Exhaustion

Progression of the rash

After the appearance of fever (generally 1-3 days but can be longer) a rash forms often starting on the face and spreading to other areas of the body. Below are the stages of the lesions which occur before they fall off:

First macules (flat spots) appear and then become papules, small, raised areas that are inflamed, which then form vesicles, fluid filled blisters similar to chickenpox, that in turn enlarge and become pustules (larger pus-filled blisters) which will eventually scab over. This process can take several weeks and until the time that the skin has healed the person is still able to spread the disease.

Diagnosis

Monkeypox can look similar to other rashes and illness.  The healthcare provider may take a tissue sample or run blood tests to make the diagnosis.

Treatment

Most cases of monkeypox will go away without treatment. Currently there is no specific treatment approved for monkeypox infection, but antivirals that have been used to treat smallpox infections might be beneficial.  Additionally, there are some factors that should be taken into consideration when someone is infected with monkeypox including people with severe diseases, people who are immunocompromised, pediatric populations, pregnant or breastfeeding women, people with certain skin conditions, as well as people with one or more complications such as a co-occurring disease or other comorbidities. The physician should be contacted for anyone with these factors developing a rash as they may need treatment with antivirals.

Transmission- How is Monkeypox Spread?

Monkeypox is spread through various ways. While anyone can contract monkeypox, it does not appear to be easily transferred from person to person.

• It is most commonly spread through direct contact with the monkeypox rash, sore or scabs. 
• It can be contracted though contact with bedding, fabrics, and towels that have been used by someone with monkeypox.
• It can be spread by contact through respiratory secretions from kissing and other face-to-face contact.
• Oral, anal, and vaginal sex or touching of the genitals of someone who is infected.

Prevention of Transmission

Monkeypox can be spread from the time symptoms start until all sores, including scabs, have healed and a fresh layer of skin has formed.  This can take several weeks. The rash can develop on the genitals but can also be in other areas like hands, feet, and face.  Sore can also develop inside the mouth, vagina, or anus.

The following can help with prevention of transmission

• Wear gloves when giving personal care and when doing laundry.
• Wash hands frequently and thoroughly
• Continue to wear a mask when preforming oral hygiene.
• Keep restrooms clean and disinfected. Any bodily fluid should be cleaned immediately.
• Be aware of the symptoms. The first symptoms could be a fever, headache, muscle aches, swollen lymph nodes, chills exhaustion. (flu like symptoms)
• Skin lesions should be covered as much as possible to reduce contact with others.

• Persons infected with monkeypox:
  • Should not leave the home except as required for follow-up medical care
  • With extensive lesions that cannot be easily covered, draining lesions, respiratory symptoms such as cough, sore throat, or runny nose, should be isolated in a room or separate area from others
  • Should avoid contact with animals including pets

What is undetermined at this time is whether an infected person can spread the virus if there are no symptoms.  Also unknown is If the virus is present in bodily fluids or feces.

As we have seen with the COVID-19 pandemic, things can change as new information is received and data is collected. It is still early in the outbreak of monkeypox, so there are still things that are uncertain, and questions that will need to be answered. What remains clear is that being aware of the signs and symptoms of the disease, how it is transmitted and following the necessary procedures to protect ourselves and those that we support still is the best option for decreasing the impact and spread of disease.