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Monkeypox - What You Need to Know

What is monkeypox?

Monkeypox is a previously rare disease caused by the monkeypox virus which is in the same family of viruses as variola virus, the virus that causes smallpox. While symptoms are similar to smallpox, they are also typically more mild and rarely fatal. This is not a new virus; it was first detected in Africa 50 years ago, and there was a small outbreak in the midwestern United States associated with infected imported animals in 2003.

This current outbreak is different, however. While still relatively rare, clusters of cases have never been this widespread, and are spreading through direct close contact from person to person. As of August 18, 2022, monkeypox has not yet been found in North Central Washington. (Learn more by visiting the CDC page.)

What are the symptoms?

Symptoms typically include a painful rash, which can be located on or near the genitals, anus, hands, feet, chest, face, or mouth. In this current outbreak, there have occasionally been instances of painful internal rectal lesions without visible skin lesions. This rash often goes through a series of stages, initially looking like pimples or blisters that may be painful or itchy and then scabbing over before healing. Some will also experience flu-like symptoms either before or during the rash with symptoms such as fever, swollen lymph nodes, exhaustion, muscle or headaches, and respiratory symptoms (e.g., sore throat, nasal congestion, or cough).

Monkeypox symptoms usually start within 3 weeks of exposure to the virus. If someone has flu-like symptoms, they will usually develop a rash 1 – 4 days later. (Learn more by visiting the CDC page.)

How does monkeypox spread?

Monkeypox can be spread from person-to-person by direct skin contact, especially during intimate or sexual contact. While less common, it can also be spread by touching objects used by someone with monkeypox or through close contact with respiratory secretions (e.g., kissing, cuddling, or sexual contact). It can be spread from the time symptoms start until the rash is healed fully and a new layer of skin has formed. The illness typically lasts 2 – 4 weeks. (Learn more by visiting the CDC page.)

Is there a vaccine?

Currently vaccines are not available for general or common use. Supply is exceedingly limited and currently only available for extremely specific cases and for those with very specific exposure risks. At this time, most persons are not at risk of exposure to monkeypox through regular day-to-day activities.

Two different vaccines exist: the JYNNEOS vaccine (also known as Imvamune or Imvanex) and the ACAM2000 vaccine. Currently licensed primarily to prevent smallpox, these vaccines are mainly used for monkeypox in post-exposure prophylaxis in people who are at a higher risk of severe disease within 4 days of exposure. Vaccines are not currently being used for pre-exposure prophylaxis and are not available for general preventative usage at this time. (Learn more by visiting the CDC page.)

If you believe you are at high risk for exposure to monkeypox/MPV, please contact your provider to discuss possible vaccination options. While supplies of the vaccine are currently extremely limited, we would urge those with elevated risk of exposure to consult with their provider to determine if vaccination would be appropriate and available.

What should a patient do if they have an exposure or have symptoms consistent with monkeypox?

If a patient has been exposed to a person with monkeypox, or has symptoms consistent with the disease, they should stay home and self-isolate but contact their provider as soon as possible to coordinate testing and discuss treatment options, including requesting a vaccine for post-exposure prophylaxis when deemed necessary. Only certain immunocompromised patients or those with severe disease might be considered for antiviral treatment.

Most importantly, a patient who believes they may have monkeypox should, after contacting their provider, isolate and stay home until the monkeypox rash has healed and a new layer of skin has formed. To the greatest extent possible, they should avoid other people and animals, attempting to not share living space, bathrooms, bedding, or other areas while they recover.

While most people with monkeypox will recover fully within 2 – 4 weeks without the need for medical treatment, patients should nevertheless discuss their care options with their provider and keep isolated until fully recovered. (Learn more by visiting the CDC page.)

What does treatment look like?

Treatments developed for smallpox can be used to help prevent and treat severe monkeypox virus infections. In addition to the vaccines, antivirals such as tecovirimat (TPOXX) or treatment with IV Vaccinia Immune Globulin may be recommended by our infectious diseases physicians for those severely ill or those with weakened immune systems.

Treatment for patients who do not require hospitalization or are not at higher levels of risk should be to isolate while treating and managing symptoms. Itching and rash can be treated by using topical benzocaine/lidocaine gels, oral antihistamines such as Benadryl, or topical creams like calamine lotion or petroleum jelly. Soaking in warm baths, in particular a sitz-bath for rashes in the anal or genital regions of the body, may also provide relief. Over the counter pain medications such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can also be used to help with pain. (Learn more by visiting the CDC page.)

Patients should discuss treatment options with their provider when needed. (Learn more by visiting the CDC page.)

What is the infection control procedure for suspected/confirmed cases of monkeypox?

Spread is primarily through skin-to-skin contact so touching sores or lesions directly should be strictly avoided. Monkeypox can also spread through large droplets or body fluids. Exposure via large respiratory droplets appears uncommon but may occur during prolonged, face-to-face contact. While less common, it can also spread through contaminated clothing or linens.

Medical staff should ensure that patients are masked and triage them to a private exam room as soon as possible and use contact and droplet precautions (e.g., gown, gloves, mask, and eye protection).

For extended contact in the inpatient setting, medical staff should add a fit-tested respirator, PAPR, or CAPR because of the theoretical risk of airborne transmission. A negative airflow room is not indicated.

Where can I learn more?

Several reputable institutions have published information, but here are a few you may find helpful:

To learn more about the current spread of monkeypox in the United States, please visit the CDC’s monitoring page here.