Talk to patients about: monkeypox

(Originally published in the TMA October 2022 issue)

Why am I hearing about monkeypox? I thought smallpox was eradicated.

Monkeypox is a rare viral disease linked to the same family of viruses as smallpox. The World Health Organization declared smallpox eradicated in 1980 because of widespread vaccination. The U.S. stopped routine smallpox vaccination even earlier, in 1972, just two years after the first monkeypox case was recorded in humans. Because the two viruses are closely related, the smallpox vaccine can protect people from getting monkeypox, and stockpiled vaccines and treatments are proving useful amid the current outbreak.

The Centers for Disease Control and Prevention (CDC) began investigating monkeypox cases in the U.S. in mid-May. Before then, it was uncommon to see monkeypox outside of countries in Africa. The current outbreak is concerning because of the way it’s spreading – largely from person to person, whereas previous outbreaks have been linked to travel or infected animals – and because of the fast growth in new cases.

What are the symptoms?

Monkeypox can look similar to smallpox, with a rash that may look like pimples or blisters. The rash usually comes with fever, headaches, muscle aches, swollen lymph nodes, chills, and exhaustion. But monkeypox is usually milder than smallpox and rarely fatal. Symptoms usually start one to two weeks after you’re exposed, with a rash appearing one to three days later. Lately, monkeypox cases often have included a rash in the genital region, which may be confused with common sexually transmitted diseases, and which sometimes appears without any symptoms.

How does monkeypox spread? Will a handshake put me at risk?

Monkeypox spreads through direct contact with infected people or animals, primarily through skin-to-skin contact. That means contact with the lesions. Any infected person can spread monkeypox from the time symptoms start to when any scabs heal and fall off. Most cases in the current outbreak have developed after continuous skin-to-skin contact among sexual partners or people in the same household.

How does monkeypox compare with COVID-19?

There are key differences between the two viruses. Monkeypox does not spread the same way as COVID-19, which is through the air. In cases where people with monkeypox have traveled by plane, they have not spread the disease to those sitting around them. Still, CDC recommends people with monkeypox wear a mask when in close contact with others because the virus can be found in their saliva and mucus.

Also unlike COVID, it’s unlikely patients can get monkeypox more than once, since pox viruses typically give you lifelong immunity. Effective vaccines also can protect against monkeypox infections, an important resource that wasn’t available during the first year of the COVID pandemic.

Who’s most at risk of contracting monkeypox? Can I prevent it?

Anyone can get monkeypox. But as of this writing, nearly all monkeypox cases in the U.S. related to the current outbreak have been in cisgender men who have sex with men. To prevent it, CDC recommends avoiding close, skin-to-skin contact with people who have a rash that resembles monkeypox. This includes intimate and sexual activity as well as contact with bedding, towels, clothing, eating utensils, and other personal items.

People who develop a new rash or symptoms associated with monkeypox should avoid close contact with others and visit their physician or health care clinic as soon as possible.

Is there a vaccine? How can I get one?

There are two vaccines licensed by the Food and Drug Administration (FDA) for the prevention of monkeypox: JYNNEOS and ACAM2000. Texas received a shipment of the JYNNEOS vaccine from the federal government in the summer and anticipates a second shipment in the fall. As of this writing, doses were being reserved largely for people already exposed to or with a confirmed case of monkeypox. There is a large supply of ACAM2000, but it’s not recommended for people with weakened immune systems or certain health conditions.

Are there treatments for monkeypox?

Most people with monkeypox experience mild disease that can be treated with over-the-counter and topical medications. There are no pharmaceutical treatments specifically for monkeypox, but antiviral drugs developed to treat smallpox may be used for high-risk patients, such as people with weak immune systems or who may be pregnant, children under 8 years old, and those with severe pain from infection.

Should I be worried this monkeypox outbreak is going to turn into another pandemic like COVID?

As of mid-August, monkeypox was largely contained to certain high-risk groups. There is a risk that it could spread into other groups of people if health authorities don’t respond quickly enough, but experts say the fact that federal and state agencies are taking action is a good sign.

Sources: Centers for Disease Control and Prevention; Texas Department of State Health Services; Trish Perl, MD; John Carlo, MD