Monkey Pox

Monkey Pox

What is Monkey pox?

Monkey pox is a contagious viral disease. The monkey pox virus is closely related to the one that causes smallpox, but the disease is generally less severe and less contagious. The World Health Organization has declared monkey pox a public health emergency of international concern, and the U.S. Department of Health and Human Services (HHS) declared a Public Health Emergency on August 4, 2022. In the United States, almost 14,000 cases have been identified in 49 states, the District of Columbia and Puerto Rico.


What are the symptoms of monkey pox?


Symptoms usually start between 5 and 13 days after a person is infected with the virus. Some people have a few days of feeling sick, similar to the flu. Symptoms might include fever, headache, feeling very tired and achy, and swollen lymph nodes. Then, a few days after these symptoms start, a rash appears.
●The monkey pox rash can look like pimples or blisters. It starts as a few small spots, then more appear.
●During the 2022 outbreak, some people have first noticed the rash in their genital or anal area.
●The rash can also affect the face, inside of the mouth, hands, feet, and other parts of the body.
●The bumps swell with fluid, then pop. Then, they dry up and form scabs, which eventually fall off.
●The rash can be painful, although it might become itchy when scabs start to form.
For some people, the rash is the first or only symptom they have, and they do not know they are sick until it appears. The rash usually lasts for about 2 to 3 weeks.

These pictures show examples of the sores that appear in people with monkeypox. They can be spread out or clustered. They start out as small spots, then swell with fluid. Eventually, they pop and form scabs, which fall off as they heal.

How does monkey pox spread?

In the past, the most common way for monkey pox to spread was from an infected animal to a person. This could happen from touching the animal’s body fluids or through a bite or scratch.
During the 2022 outbreak, the infection has been spreading from person to person. This can happen through:
●Touching an infected person’s rash, scabs, or body fluids – This seems to be the main way the infection is spreading during this outbreak. In many cases, this has happened through sexual activity. Experts are studying whether the infection can also spread through semen or vaginal fluids.
●Touching something that has touched an infected person – For example, if fluid from a person’s rash gets on clothing, bedding, or sex toys, it is possible for the infection to spread to others who touch these items.
●Through tiny droplets from the lungs – The infection can spread in this way if people are face-to-face, for example kissing or cuddling, for a long time.
It is also possible for a pregnant person to pass the infection to their baby.
A person is most likely to spread monkey pox while they have the rash. Experts do not yet know if a person is contagious before the rash appears.
Monkey pox is not as contagious as the virus that causes COVID-19. You are not likely to get it by being near someone unless you have direct contact with their skin or are face-to-face for a long time.

What is the outlook/prognosis of someone who contracts monkey pox?

Monkey pox normally takes about 2 to 4 weeks to run its course. The rash may be painful and leave scars. Most people will recover on their own and will not need hospitalization or specific treatment. A small proportion of patients, mostly those with multiple preexisting conditions or with weakened immune systems, may develop a more severe disease that could result in death. As of September 5, 2022, there have one death reported in the United States, some people have died in other countries.

There are currently no antiviral therapies approved by the Food and Drug Administration for the treatment of monkey pox; however, antiviral therapies developed against smallpox are available from the CDC as investigational drugs.

The only vaccine currently licensed against monkey pox, called JYNNEOS™, is in very short supply and is currently only available from HHS.

For some people, the rash is the first or only symptom they have, and they do not know they are sick until it appears. The rash usually lasts for about 2 to 3 weeks.


Who is at risk for monkey pox?


Anyone can get monkey pox if they have close contact with someone who is infected. During the 2022 outbreak, many of the people who have been infected are men who have sex with men. But it’s important to know that anyone can get the infection, no matter their gender identity, sexual orientation, or sex practices. Thinking of monkey pox as something that only affects certain people or groups is inaccurate and harmful.


What should I do if I have symptoms?


If you have any symptoms of monkey pox, call your doctor or nurse. They will ask you questions and schedule an exam. If possible, avoid close contact or sex with others until you have been seen by a doctor or nurse.


What should I do if I think I was exposed?


If you had close contact with someone who had monkey pox, you should also tell your doctor or nurse, even if you don’t have any symptoms. They can tell you what to do next.
If you were exposed to monkey pox, you will need to monitor yourself for symptoms for 21 days. You should then call your doctor or nurse if you notice any symptoms such as fever, swollen lymph nodes, or any rash or sores.
In some cases, experts recommend vaccination in addition to monitoring. People who might benefit from the vaccine include those who:
●Were exposed to the virus – If you recently had close contact with someone who had monkey pox, getting the vaccine might lower the chances that you will get infected. Your doctor or nurse will help you figure out if you should get the vaccine. The decision is based on how and when you were exposed.
●Are at risk for being exposed – The vaccine might be an option for people who are at high risk for getting monkey pox. For example, your risk is higher if you had a sex partner who later found out they had monkey pox. It is also higher if you have had multiple sex partners and are in an area with a lot of monkey pox cases.
The goal of vaccination is to control the current outbreak. Your doctor, nurse, or local public health office can talk to you about the vaccine and your options.


Is there a test for monkey pox?


Yes. If your doctor or nurse thinks you might have monkey pox, they will use a swab to take a sample of fluid from your rash. They will look at the sample under a microscope and send it to a special lab for testing. In some cases, they might do blood tests, too.
How is monkey pox treated?
Most people with monkey pox will not get seriously ill and will be able to stay home while they get better. This usually takes a few weeks.
In some cases, doctors might recommend treatment with “antiviral” medicines.


How can I avoid spreading monkey pox to others?


If you have monkey pox, there are things you can do to lower the risk of spreading the infection to other people.
The best way to avoid spreading the infection to others is to self-isolate:
●This means staying away from other people as much as possible, even the people you live with.
●Continue to self-isolate until your rash has fully healed. This means the scabs have fallen off and new skin has formed.
To protect others, you can also:
●Wash any clothing, bedding, or other items that have touched your rash. Do not shake out clothing or bedding around other people. If someone else needs to touch these items, or help care for you, they should wear gloves.
●Wash your hands often. Others in your home should also wash their hands often.
●Be extra careful if you do need to be around other people. Cover any parts of your skin that have a rash and wear a face mask.


How can I avoid being exposed to monkey pox?


The best way to prevent monkey pox is to avoid close contact with anyone who might have it.
To lower your risk of being exposed:
●If a family member, friend, or partner has monkey pox, they should self-isolate until their rash has healed completely.
●Avoid close contact with anyone who has symptoms of monkey pox.
●If a partner has monkey pox, avoid sex until their rash is completely healed. This includes anal, oral, or vaginal sex. Virtual or phone sex are safe ways to be intimate without physical contact.
●Using condoms any time you have sex might help. But condoms probably cannot completely prevent the spread of monkey pox. This is because it can spread in a few different ways, as discussed above.


Where can I go to learn more?


As we learn more about monkey pox, expert recommendations will continue to change.
You can find more information at the US Centers for Disease Control and Prevention (CDC) website (www.cdc.gov/poxvirus/monkeypox).


Compiled courtesy of VHA and Up To Date Basic
Tarun Kothari MD,FACG,FACP

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