The Monkeypox B1 variant is a virus from the non-variola (smallpox) orthopox viral class. So, it is not smallpox and cannot give you smallpox. It causes painful blisters or rashes around the anal, rectal, perirectal, genital or mouth. Prolonged close exposure with the genital sores or lesions of a symptomatic individual, (such as receptive anal intercourse), is how it is most often transmitted. However, it may be transmitted by droplets and from surfaces containing the virus (fomites). It has not been categorized as an STI (sexually transmitted infection) but often occurs in conjunction with such STI’s as syphilis. Patients should be tested for both. When someone has Monkeypox they should be treated for syphilis and when positive for syphilis they should be tested for monkeypox. Testing involves a swab of a lesion (blister or sore) or a rash and healthcare providers must get permission for the test from the Department of Health before sending it to the lab. If the test is positive for an orthopox virus, the sample receives additional testing at the CDC to verify Monkeypox. Syphilis does not require permission for testing from public health officials and currently requires a blood test.
Gowns, gloves, N95 mask and plenty of alcohol-based sanitizer are recommended for those treating or in close contact with a positive patient.
The Department of Health and Medscape state the following: For post-exposure prophylaxis (PEP) , which should be done as soon as possible after exposure, people ages 18 years and older can be vaccinated with the JYNNEOS vaccine following intermediate- or high-risk exposures to monkeypox to prevent illness from monkeypox virus.
o CDC recommends the vaccine be given within 4 days of exposure in order to prevent the onset of disease. Given between 4-14 days after exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease.
o Potential vaccines should be educated on the risks versus benefits of vaccination, as well as the potential adverse effects of the vaccine. The most common of these are redness, soreness, swelling and itching at the injection site and fatigue, headache, and muscle ache.
o People are considered fully vaccinated 2 weeks after their second shot of JYNNEOS. However, people who get vaccinated should continue to take steps to protect themselves from infection by avoiding close, skin-to-skin contact, including intimate contact, with someone who has monkeypox.
o The effectiveness of JYNNEOS against monkeypox is supported by animal studies and there are no data on the efficacy of JYNNEOS for PEP or pre-exposure prophylaxis (PrEP) for the current outbreak.
Monkeypox Testing:
· Labcorp, Mayo Clinic and Aegis laboratories are now offering Monkeypox Virus testing using CDC’s orthopoxvirus test, which detects most non-smallpox related orthopoxviruses, including monkeypox.
· Quest Diagnostics announced that it will begin testing for monkeypox. The company has developed a real-time polymerase chain reaction (PCR) test that uses patient swab specimens to qualitatively detect non-variola orthopoxviruses and monkeypox virus DNA.
Monkeypox Treatment with Tecovirimat:
· CDC holds a non-research, expanded access Investigational New Drug (EA-IND) protocol that allows for the use of Tecovirimat for treatment of monkeypox in adults and children of all ages.
· Tecovirimat is only available through the federal Strategic National Stockpile and must be requested via the Department of Public Health.
· Your healthcare provider will contact the Department of Health to order Tecovirimat.
· Monkeypox Infection Prevention:
· Healthcare Settings: A patient with suspected or confirmed monkeypox infection that requires hospitalization should be placed in a single-person room; no special air handling is required. PPE used by HCP entering the patient’s room should include gown, gloves, eye protection, and NIOSH-approved N95 or higher-level respirator.
· Isolation at home: Healthcare Professionals should advise people with monkeypox who do not require hospitalization to isolate at home away from others. Isolation precautions should continue until all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed.
Transmission
Generally, monkeypox is not easily spread between humans. According to the CDC, human-to-human transmission is thought to primarily occur through large respiratory droplets.
Other means of transmission include direct contact with body fluids or lesions, and indirect contact with lesion material through contaminated clothing or bedding, also known as fomites.
While there’s some preliminary evidence of aerosolization, that’s not a major route of spread. Thus, spread should be slower than for an airborne virus, contact tracing should be easier, and social distancing should be more effective.
While the reservoir host of monkeypox is still unknown, it’s thought that African rodents play a role in transmission.
Incubation
The CDC says the typical incubation period for monkeypox is 7 to 14 days, but can range from 5 to 21 days.
Symptoms
Among the first symptoms to appear are flu-like symptoms, including fever, aches, and fatigue. Monkeypox infection also involves swelling of the lymph nodes.
Then, typically 1 to 3 days later — though sometimes longer — a rash develops, according to the CDC. It often starts on the face before spreading to other parts of the body.
Illness typically lasts about 2 to 4 weeks.
Fatality Rate
While the Congo Basin strain of monkeypox is thought to have a fatality rate of 10%, the West African strain — which was confirmed in the U.K. outbreak — has a fatality rate of about 1%.
Past U.S. Outbreaks
In 2003, there were 47 confirmed and probable cases of monkeypox in people in the Midwest. All had become ill after coming into contact with pet prairie dogs that had been infected after being housed near animals imported from Ghana.
There were also two travel-related cases in the U.S. in July and November 2021.
