Monkeypox is a very rare disease caused by infection with the monkeypox virus and spreads through close contact with infected people or animals. It typically occurs in Central and West Africa, although cases in the U.S. have been on the rise.
- The monkeypox virus belongs to the orthopoxvirus genus, which includes the variola virus that causes smallpox.
- The first monkeypox epidemic in the U.S. was reported in 2003. People fell ill after coming into contact with infected pet prairie dogs. Historically, most monkeypox cases have occurred after a human came into touch with an infected wild animal or animal product.
- The virus enters the body through damaged skin (even if it is not apparent), the respiratory tract, or mucus membranes (eyes, nose, or mouth). Symptoms can appear anywhere between 5-21 days after being exposed to the monkeypox virus.
- The World Health Organization renamed "monkeypox" as "mpox" in November 2022.
How does monkeypox spread?
Monkeypox is transmitted in the following ways:
- Direct skin contact with a monkeypox rash or scabs
- Contact with materials (clothes, beds, or towels) and surfaces used by someone infected with monkeypox
- Exposure to secretions from an infected person
- Oral, anal, and vaginal sex with an infected person
- Hugging, massaging, kissing, or talking closely with an infected person
People who have been immunized against smallpox are likely to be immune to monkeypox infection. However, younger people are unlikely to have had the smallpox vaccine because smallpox immunization was discontinued globally when smallpox was declared the first human illness to be eliminated in 1980.
According to the World Health Organization, most infections have been transferred through intercourse, with a specific concentration of cases happening within the homosexual and bisexual populations. Healthcare staff workers are also more vulnerable owing to prolonged viral contact.
What are the signs and symptoms of monkeypox?
Several monkeypox-infected individuals exhibit mild and self-limiting symptoms. Monkeypox often begins with flu-like symptoms with swollen lymph nodes before progressing to a rash on the face and body. The disease normally lasts 2-4 weeks.
Symptoms of monkeypox may include:
- Muscle aches
- Swollen lymph nodes
- Cough or sore throat (sometimes)
- Runny nose
- Rash with blisters
Rash with blisters can appear 1-3 days after or before fever. The rash often begins as flat red patches, progresses to blisters, and finally forms a crust. In some cases, the rash occurs around the mouth, genitals, or anorectal regions. The bumps then go through many phases before falling off. The rash may have the following characteristics:
- Fat, discolored bumps (macules)
- Raised areas of skin (papules)
- Blisters or vesicles
- Small pus-filled bumps (pustules)
- Dry, crusty bumps (scabs)
The prognosis of the infection may be influenced by initial health status, previous vaccination status, and concurrent comorbidities. Therefore, researchers believe that developing personalized treatments based on an individual's risk of experiencing severe infection symptoms is the most logical approach.
How is monkeypox diagnosed?
Experts advise labs to screen swabs and lesion tissue specimens for monkeypox. Currently, if it is assumed that an individual has monkeypox, they are asked to isolate for up to 21 days. If the number of cases increases dramatically, further specific testing will be required to determine that the virus is indeed monkeypox and not one of its cousins.
Diagnostic methods to detect monkeypox include:
- A swab from the crust or the discharge of a lesion may be collected. In the lack of cold storage in resource-limited settings, the samples can be kept in a cool, dark room.
- Technical methods for confirming the diagnosis include immunohistochemistry and electron microscopy. Quantitative polymerase chain reaction methods can effectively detect the virus.
- A novel approach called Tetracore Orthopox Biothreat Alert allows for the capability of growing and detecting the virus on culture plates. This will be beneficial in resource-limited areas of infection because it does not require a large deal of experience.
Currently, monkeypox testing capacity is limited but sufficient to satisfy the current demand. In the U.S. about 70 labs in 46 states are equipped to test for orthopoxviruses using a test approved by the FDA. These labs can process about 7,000 tests each week. Hopefully, test kits for use outside of a lab will not be required to cope with the present outbreak, but they might be useful in places where monkeypox continues to be prevalent.
How is monkeypox treated?
Although many cases of monkeypox resolve on their own, antiviral treatment may be considered for people who are more likely to get severely ill, such as the immunocompromised. The smallpox vaccine can prevent monkeypox disease approximately 85% of the time.
The FDA has not approved any treatments for monkeypox. However, the Centers for Disease Control and Prevention (CDC) suggests using antiviral medications during an outbreak and for patients who are at high risk of severe illness. Vaccines including Jynneos and ACAM2000 may be used to lessen the severity of the disease.
Although there are no specific treatments for monkeypox infection now, outbreaks can be managed with the following measures.
Though most monkeypox patients recover without needing medical attention, those with gastrointestinal symptoms require oral or intravenous rehydration to prevent fluid loss.
Medications to treat pain, fever, and other symptoms may be prescribed as part of supportive care.
Rashes and affected areas should be kept dry if possible or covered with a moist dressing. Patients are advised to avoid touching sores in the mouth or eyes and avoid products containing cortisone when rinsing the mouth or using eye drops.
- Tecovirimat: Tecovirimat is the first FDA-approved antiviral treatment for smallpox in adults and children, and it is being considered for the treatment of monkeypox. Tecovirimat works by inhibiting the viral envelope protein, which blocks the final steps of viral maturation and subsequent release from the infected cell, preventing viral spread within the infected host.
- Brincidofovir and cidofovir: These disrupt viral multiplication by inhibiting viral DNA polymerase that is involved in virus multiplication. Studies have shown that they could be effective against monkeypox infections. However, research is limited.
Vaccinia vaccine (smallpox vaccine) and vaccinia immune globulin (VIG)
VIG, a hyperimmune globulin, is FDA-authorized as a treatment approach against monkeypox. However, there is limited data regarding the efficacy of VIG against smallpox and monkeypox. Smallpox vaccines could provide limited protection and help progress symptoms. There is no specific monkeypox vaccine.
Is monkeypox a fatal disease?
Monkeypox symptoms usually go away after a few weeks but can cause complications and even death in newborns, toddlers, and those with underlying immune disorders.
Potential complications of monkeypox may include:
In recent years, about 3%-6% of reported cases in endemic countries have resulted in mortality, most commonly in young people or people with underlying health issues.
How can you avoid getting monkeypox?
Infection can be prevented with the following measures:
Avoid close contact with animals that could be infected with the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).
- Avoid contact with any materials that have been touched by a sick animal, such as bedding.
- Isolate infected patients from those who could be contaminated.
- After coming into contact with diseased animals or humans, practice good hand hygiene; wash or disinfect the hands with soap and water or an alcohol-based hand sanitizer.
- Wear personal protective equipment (PPE) when caring for someone who is infected, and encourage the individual to cover their rashes and wounds as much as possible (e.g., wearing a long sleeve shirt and long pants).
- Practice safe sex.
People who are suspected of having monkeypox or who have come into contact with an infected person should seek medical treatment to prevent the virus from spreading.
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