Monkeypox

• Monkeypox

  A viral zoonotic disease caused by an orthopoxvirus that causes human mpox

  
• Monkeypox


  • Emerged as the most significant orthopoxvirus infection in humans following the worldwide eradication of smallpox in 1980
  • Usually affects rodents, such as rats or mice, or nonhuman primates, such as monkeys, but can occur in people

  
• Transmission of monkeypox


  1. Spread to people when they come into physical contact with an infected animal such as a non-human primate

  2. Spreads from person-to-person through close contact with someone who has a monkeypox rash

  3. Possible mechanisms of transmission through the air are not yet well understood

  4. Patients are considered infectious until all of their sores have crusted over, the scabs have fallen off and a new layer of skin has formed underneath

  5. Can spread during pregnancy to the fetus, during or after birth through skin-to-skin contact

  6. Past evidence of someone catching monkeypox after touching contaminated objects

  
• First confirmed cases of monkeypox in humans were recorded

  1970

  
• Many countries where monkeypox is not typically found have reported cases of monkeypox in 2022

  
• In the current outbreak, most (but not all) cases are among men, particularly men who have sex with men
• Clinical features of monkeypox


  1. Average incubation period is 1 to 2 weeks before symptoms appear

  2. Early features include flu-like symptoms such as chills, exhaustion, fever, headache, muscle aches, backache, and swollen lymph nodes

  3. Flu-like symptoms are then typically followed by the development of a rash that can look like pimples or blisters and can be painful

  4. Lesions can appear on the face, in the mouth, and on the hands, feet, chest, genitals, or anus

  5. Some people get the rash first, followed by other flu-like symptoms, while some experience only a rash

  6. The rash goes through different stages, including pimple-like bumps and blisters that crust and fall off before healing completely

  7. The illness caused by monkeypox typically lasts 2 to 4 weeks

  
• Diagnosis of monkeypox

  • By culture, polymerase chain reaction (PCR), immunohistochemistry, or electron microscopy
  • PCR assays using skin lesions (roof or fluid from vesicles and pustules and/or dry crusts) are the optimal sample

  
• Management of monkeypox


  1. Focuses on infection prevention and control, symptomatic treatment, optimized supportive care, management of skin lesions, management of complications, and antiviral therapy

  2. The disease is usually self-limited with resolution in 2-4 weeks

  3. In African cases, the mortality rate was 1-10% and death was related to the patients' health status and other comorbidities

  4. CDC recommends the monkeypox vaccine be given within 4 days from the date of exposure to prevent onset of the disease, or between 4-14 days to reduce symptoms but may not prevent the disease

  5. Consider admission to a health facility for patients at higher risk of severe disease (e.g., children, pregnant women, immunocompromised people)

  6. Antiviral agents developed for smallpox treatment (e.g., tecovirimat, brincidofovir, cidofovir) have activity against mpox and may be beneficial, especially for severe disease, high-risk patients, or those with involvement of anatomic areas that might result in serious sequelae

  
• Prevention of monkeypox


  If a person is exposed and has not received smallpox vaccination within the last 3 years, the CDC recommends administration of Jynneos vaccine within 4 days of exposure (0.5 mL SC x2 doses 4 weeks apart)