I am an ER Doctor and This Is What You Should Know About Monkeypox
Monkeypox is an orthopoxvirus related to smallpox. It was first identified in humans in Africa in 1970. Currently, there is a global outbreak and spread of the virus in the US. The first case in the US was identified in May 2022. As of today, August 16, 2022, there are 12,689 cases in the US and 38,019 worldwide. The majority of the US cases are in urban areas like New York City, and greater than 98% are in men.
The monkeypox virus spreads via close skin to skin contact. The current outbreak is predominantly seen in men who have sex with men. The most common vector is via exposure (i.e., skin-to-skin contact) with infected skin rashes. However, the virus can transmit via fomites, viral particles, on linens and towels as well. The virus can also spread via respiratory droplets. However, it requires prolonged face to face contact with an infected and symptomatic individual.
The virus has a prodrome after infection of 4 days up to 3 weeks. After the prodrome, the initial symptoms include fever, headache, lymphedema (swollen lymph nodes), sore throat, muscle ache and fatigue. A characteristic rash appears 1-4 days after the initial symptoms. Patients are considered infectious from the time symptoms begin and transmission is via intimate sexual and skin-to-skin contact. The virus can transmit through spit droplets and skin contact but the contact must be significant. It is much harder to spread the disease in this manner. So, to dispel any misinformation, Monkeypox does not spread easily like covid-19 or influenza. It is much more difficult to spread and unlikely to spread via casual contact. Currently, the most at-risk group is men who have sex with men and engage in sexual activities with multiple partners.
Patients with monkeypox will remain infectious for 3-4 weeks and must isolate until all the rashes have healed fully. The good news is that monkeypox is rarely fatal and we have both vaccines and antiviral medication that appears effective. The mortality rate for monkeypox is low over 99% survive their course. At-risk individuals include immunocompromised patients, children under 8 years of age and pregnant women.
Currently, there is limited supply of smallpox vaccine that is being distributed by the federal government. These vaccines can be administered within 2 weeks after an exposure to monkeypox. They can be used to vaccinate high risk populations. The regimen is a 2-injection course 4 weeks apart, and some data has indicated that the vaccine is 85% effective in preventing monkeypox.
For individuals who have monkeypox and a significant course or risks of progression, they can receive a 2 week course of Tpoxx. This antiviral medication is approved for the treatment of smallpox and is being used to treat monkeypox cases as well.
What can you do to protect yourself?
The majority of the population is not currently at high risk of contracting monkeypox. For the general public, exercise reasonable caution. If you know of individuals with fever/rash, avoid skin to skin contact, prolonged exposure or intercourse. Use caution when engaging in sexual activity and avoid contact with individuals who exhibit viral symptoms and rash.
What are the current CDC quarantine recommendations?
People with monkeypox should follow these recommendations (posted on the CDC website) until cleared by state or local public health officials:
- Friends, family or others without an essential need to be in the home should not visit.
- Avoid close contact with others.
- Avoid close contact with pets in the home and with other animals.
- Do not engage in sexual activity that involves direct physical contact.
- Do not share potentially contaminated items, such as bed linens, clothing, towels, wash cloths, drinking glasses or eating utensils.
- Routinely clean and disinfect commonly touched surfaces and items, such as counters or light switches.
- Wear well-fitting source control (e.g., medical mask) when in close contact with others at home.
- Avoid use of contact lenses to prevent inadvertent infection of the eye.
- Avoid shaving rash-covered areas of the body as this can lead to spread of the virus.
- Bathroom usage:
- If possible, use a separate bathroom if there are others who live in the same household.
- If there is not a separate bathroom in the home, the patient should clean and disinfect surfaces such as counters, toilet seats, faucets, using an EPA-registered disinfectant after using a shared space. This may include during activities like showering, using the toilet, or changing bandages that cover the rash. Consider disposable glove use while cleaning if rash is present on the hands.
Limit exposure to others:
- Avoid contact with unaffected individuals until the rash has resolved, the scabs have fallen off, and a fresh layer of intact skin has formed.
- Isolate in a room or area separate from other household members and pets when possible.
- Do not share dishes and other eating utensils. It is not necessary for the infected person to use separate utensils if properly washed. Wash soiled dishes and eating utensils in a dishwasher or by hand with warm water and soap.
Considerations for isolating with animals in the home:
- People with monkeypox should avoid contact with animals (specifically mammals), including pets.
- If possible, friends or family members should care for healthy animals until the owner has fully recovered.
- Keep any potentially infectious bandages, textiles (such as clothes, bedding) and other items away from pets, other domestic animals, and wildlife.
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