IN THE NEWS – MONKEYPOX

CHRIS CHAO, MD

What is monkeypox?
Monkeypox is an infectious disease in human beings that is caused by the monkeypox virus. The monkeypox virus is closely related to the smallpox and cowpox virus. It was first identified in 1958 during an outbreak among monkeys in research laboratories and recognized as a human pathogen in the 1970s. It has recently made headlines due to unexplained case clusters in Europe and North America. Historically, monkeypox cases in the United States have been related to international travel or exposure to infected mammals.

The largest outbreak in the United States occurred in 2003 when a child became infected from a prairie dog bite that was purchased at a swap meet in Wisconsin. Investigators determined that the source of the monkeypox was imported rodents from Gambia that were housed with prairie dogs prior to shipping for sale. In the 2003 outbreak, a total of 71 cases were reported, no human-to-human transmission was documented, and all infected individuals recovered.

Symptoms of monkeypox
Initial symptoms of monkeypox infection are non-specific and include fever, chills, headache, body aches, lymphadenopathy, and fatigue. Within 1 to 3 days, a rash develops, commonly on the face, which will then spread to the entire body. Lesions will progress in different stages – macules, papules, vesicles, pustules, and scabs over the next 2-4 weeks. Lesions typically will develop simultaneously and evolve together on any given part of the body. Lesions are contagious until scabs have fallen off.

Figure 1. Source: Clinical Recognition | Monkeypox | Poxvirus | CDC

Transmission
Transmission of monkeypox is from direct contact with the virus through broken skin, mucosa membranes or the respiratory tract. There is epidemiological evidence that respiratory droplets may play a role in human-to-human transmission though primary transmission is thought to be close contact with an infected subject.

Treatment
There is currently no approved treatment for monkeypox infection. Investigational treatment includes varicella immunoglobulin (VIG) as well as antiviral agents. Monkeypox is generally a self-limited disease with case fatality rates of 1 to 10% depending on the specific strain.

Recommendations for Urgent Care providers
Stay informed. Urgent Care providers are on the front-line for emerging infectious disease. Familiarize yourself with the rash associated with monkeypox and maintain an index of suspicion when patients present with febrile illness with rash if there is recent travel to areas with reported monkeypox cases. Become familiar with the characteristics which define a monkeypox “Person Under Investigation” (PUI) and ask about these risk factors if patients present with nonspecific infectious symptoms. Become familiar with the criteria and procedure for testing. Counsel patients with nonspecific infectious illnesses, regardless of PUI status, to seek care if a typical rash develops after discharge.

If monkeypox is suspected, contact your local or state health department or the CDC Emergency Operations Center at 770-488-7100.