The WHO has given monkeypox its highest international alert. There are two versions of monkeypox, the West African and the Congo Basin. The Congo Basin form is the severe form with a fatality rate around 10%. The West African version is less severe (fatality rate around 1%)-- but can be severe in certain groups. The type of monkeypox spreading in the United States and globally is the less severe West African form.
What Does This Mean for Us?
So far, 99% of the cases in the United States have been concentrated among men who have sex with men. But, this does not mean that monkeypox is just a sexually transmitted disease. You can also contract monkeypox from kissing or any prolonged intimate contact, like hugging. Additionally, you can contract monkeypox by casually touching the scabs and wounds that appear when you have the virus. You can also get the virus indirectly by touching a surface which has touched the scabs or wounds from someone (or an animal) infected with monkeypox. Symptoms other than the blisters (I won’t include a picture because you may not want to open my newsletters anymore) include flu-like symptoms such as fatigue, malaise, fever, swollen lymph nodes and sometimes you will also get a sore throat and cough. The incubation period for this virus is approximately 1-2 weeks. Generally, you will get sick with these flu-like symptoms (particularly fever) a day or so BEFORE the distinguishing rash appears. The rash looks like a blister--first flat then raised, which is well-defined and sometimes with a dot on top. The rash is more likely to appear on extremities and on the face (great, right?)--and you may be left with scars. Pictures HERE
It is possible for someone to be infectious during the prodrome period (feeling ill) before the rash appears. This (sneaky) transmission feature is most likely responsible for a lot of the undetected community spread we are seeing.
Monkeypox virus can live on surfaces for a whopping 15 days. Cleaning with an EPA approved disinfectant is recommended if you are in a high exposure area.
Properly disinfecting can help kill the virus on surfaces. Hand hygiene is also important and per the CDC it is recommended you disinfect with a solution with at least 60% alcohol content. You can find more information HERE.
There is a test that can confirm a monkeypox infection— it is called a non-variola orthopoxvirus test, and the test is conducted through the use of a swab that takes material from a monkeypox blister/wound. The sample is then processed in a special laboratory.
Who Is At Risk?
Monkeypox can impact certain groups much more severely than other groups-- resulting in serious complications. These groups are children under 8, pregnant women (who can pass the virus to the fetus through the placenta), breastfeeding women and those with eczema. Currently, only 2 children within the United States (although one child was just traveling through) have been reported infected by monkeypox.
Currently there are two vaccines for monkeypox. One vaccine (ACAM2000) contains a live replicating virus which can pose a health hazard to some groups with certain chronic conditions and weakened immune systems. This vaccine (because it contains live replicating virus--unlike the covid-19 vaccine) can cause the person receiving the vaccine to become contagious under certain conditions. ACAM2000 also has a much higher potential to cause myocarditis and other complications. Some populations (like pregnant women) cannot receive this vaccine at all due to the risks. We have a decent supply of ACAM2000 in the United States, but for the reasons previously listed, this vaccine is not ideal.
The second vaccine is called JYNNEOS, this vaccine contains weakened live virus that is not replicating, so you don’t get as sick from it and you cannot become contagious after receiving it. JYNNEOS is two vaccines four weeks apart. This vaccine will likely be available for expanded use in pediatric populations for emergency situations, but it has not been tested via clinical trials in the under 18 age group. The issue with JYNNEOS is that it is in very short supply. For this reason, we are currently only prophylactically vaccinating eligible populations (those that are high risk for contracting monkeypox or those exposed) and those that have contracted monkeypox. These vaccines actually reduce symptoms of monkeypox if taken within ~4 days of infection onset.
The other available treatment is an antiviral medication called TPOXX (tecovirimat) which can be given to children (over a certain weight) with monkeypox, since they are at higher risk.
The increase in cases thus far has been exponential, but that exponential growth curve is beginning to flatten out. However, we do not yet know if this flattening pattern will be sustained.
Should we worry? Yes and no. Our public health response, in the United States, is again delayed. One of the most important steps we can take right now is contact tracing and we are not doing a great job at it. It is likely monkeypox cases are underreported, and the true number of cases is much higher. We also know that there is undetected community spread, which is what contributed to the quick spread of COVID-19.
What Can You Do Now?
Protocols, policies and plans for treatment need to be in place before an emergency, not during one. I would recommend speaking with your pediatrician about the plan for obtaining needed medication/treatment if your child is infected. I would also speak to your daycare or schools (particularly for children under 8) about their quarantine rules for monkeypox and how they plan to ensure that if there is an outbreak, the children are kept from infecting each other.
My advice in sum: Plan don’t panic.
I will keep you updated in regards to the severity of the situation, availability of treatment and what else you can to do to protect yourself and your family.
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**I am not a medical doctor, but a doctor of public health (DrPH) and I am not giving any clinical advice. My job is to help interpret leading research and make sense of the probable implications. Please consult your physician for any medical advice. Thank you.