Monkeypox

Unfortunately, as with any piece of health news, there are lots of social media posts, articles, and opinions. The purpose here is to set the record straight and hopefully be concise and informative for my readers. So here it goes:

WHAT THE HECK IS "MONKEYPOX"? 
No, it does not come from monkeys and the planet of the apes will not become a reality. Stop it. 

Monkeypox is a viral zoonotic infection that results in a rash similar to smallpox. It is an orthopoxvirus that is in the same genus as variola (causative agent of smallpox) and vaccinia viruses (virus used in smallpox vaccine). 

TELL ME A LITTLE MORE ABOUT THIS LITTLE GUY...
Monkeypox was first isolated in Denmark in the late 1950s from a colony of monkeys from Singapore that were going to be used for polio virus research. In the decades that followed, there were more outbreaks in lab animals in the US. The first disease in humans was identified in 1970s in the Democratic Republic of the Congo.
 
Since the discontinuation of smallpox immunization, which does protect against monkeypox, most cases have occurred in Central and West Africa. In the US, the first cases were seen in 2003. Since that time, there were a few cases popping up here and there which were mostly due to travel. 

SO...WHAT IS ALL THE EXCITEMENT ABOUT?
Between 2018 and 2021, 7 cases were diagnosed in the United Kingdom. 4 of these cases were related to travel to endemic countries and 2 cases resulted from household transmission from one of the travelers and 1 health care worker acquired it through contact.
 
Fast forward to 2022. Let’s go to Europe where we see the reported case. By July 2023 World Health Organization (WHO) declared a public health emergency of international concern. Thousands of confirmed cases in dozens of countries were reported. 

HOW DO WE GET INFECTED?

1. Animal to human transmission – Contact with an infected animal’s bodily fluid or through a bite. Raw meat consumption from an infected animal will obviously increase risk of transmission. Some examples of infected animals include squirrels, rats, and prairie dogs.
2. Human to human transmission – Direct contact may occur with infectious sores, scabs, or bodily fluids. The port of entry is mucous membranes and micro abrasions; so very close contact would have to happen. Transmission can also happen through shaking infected linens and other infected materials. Prolonged face to face contact is how respiratory secretions can transmit this virus to another human. Finally, the virus can cross the placenta from mother to fetus. Therefore, this virus may cause congenital monkeypox.

Once lesions are scabbed over and new tissue is being produced, the infectivity risk is reduced. 

WHAT ARE THE SIGNS OF ACUTE INFECTION?
Every bug likes to “cook” for a bit in the human body – otherwise known as incubation period. This is the time period from exposure to onset of symptoms. Monkeypox ranges from 5-13 days but can also range 4-21 days.

1. Fevers, headaches, lymph nodes swelling, muscle aches, back pain, fatigue – lasts up to 5 days
2. Rash – within 1-4 days after fever onset. This will continue for 2-3 weeks. Usually concentrated to the face, but can occur on palms of hands, soles of feet, eyes, and other parts of the body. 
3. Secondary infections may occur – pneumonia, encephalitis (inflammation of brain), loss of vision
4. Blood work abnormalities – Abnormal liver enzymes, elevated WBC, low platelets, and low albumin (vague)

WHO IS AT MOST RISK FOR INFECTION AND POOR PROGNOSIS?**Immunocompromised individuals. These include anyone with history of active cancer, on active chemotherapy, taking medications that suppress their immune system. 

RISK OF DEATH?
Very low, especially in the US. Hospitalizations occurred due to pain control, secondary infections, and had favorable outcomes.
 
WHEN SHOULD AN INFECTION BE SUSPECTED?
Rash WITH other symptoms AND exposure history. Since this virus is transmitted through close human contact with respiratory secretions, any genital lesions with exposure history must be investigated.
 
WHAT LAB TESTS SHOULD BE ORDERED?
​Viral testing – Polymerase chain reaction (PCR) test. Skin lesions or abscesses can be cultured as well. Throat swabs are available but not used to confirm diagnosis.

HOW CAN WE PREVENT THIS?
Isolation and standard precautions. PPE use in health care settings helps spread of the virus in the hospital. 

1. Home isolation from family members and pets, cover skin lesions, facemask, gloves if addressing lesions directly, and hand hygiene
2. Consistent condom use 12 weeks after recovery recommended by WHO

 
ANY TREATMENT OPTIONS?
No Ivermectin please. Tecovirimat is the first antiviral indicated for the treatment of smallpox that was approved in 2018. Brincidofovir, analog of cidofovir, was approved in US 2021. Both of these agents are not available for commercial sale.
 
Vaccination for smallpox eradicated this from the world. Now with growing cases of Monkeypox, vaccinations are starting again. But again, these are not readily available at this time. US has 2 vaccines in its stockpiles: JYNNEOS and ACAM2000. CDC does not recommend widespread vaccination against monkeypox at this time
 
Here is a list of phone numbers for KS health departments:

• Kansas City Health Department number for communicable disease and prevention: 816-513-6152
• Jackson County Health Department: 816-404-6415
• Clay County Health Department: 816-595-4200
• Platte County Health Department: 816-858-2412
• Johnson County Health Department: 913-715-2819
• Wyandotte County Health Department: 913-573-8855

 
Currently, no widespread vaccination programs in MO and KS, but both states have stored vaccines.

​Please review CDC website for more information. 

Cheers, 
Dr Ahmed