Lisa Costello, MD
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What is Monkeypox? Information and Resources

Monkeypox (MPXV) is an orthopox virus that is emerging around the world and when infecting humans is known as MPX. Monkeypox can affect anyone regardless of gender or sexual orientation. Community Health Centers are actively educating patients about the risks. See examples from Callen Lorde and Whitman Walker.

Monkeypox is related to the smallpox virus, which has been eradicated worldwide. A history of smallpox vaccination and infection appears to be protective against infection. Cases of MPX have been seen in Africa for many years, but the current international outbreak was first detected in Europe, primarily in men who have sex with men. However, the largest outbreak in the US prior to this one was related to families owning infected guinea pigs imported from abroad. All of the routes of transmission and their relative risk of infection are not well established in the current outbreak, but men having sex with men is the most common risk factor, but close non-sexual contact has also been documented to transmit MPX.

Testing options are limited but increasing, and some treatment and vaccination options are available in the US but not approved for MPX. Anyone exposed to MPX are at risk, so there is a need to raise awareness, and prepare the community to take action. The CDC is leading the US response to the outbreak.

Clinical risk and features

CDC is urging healthcare providers in the U.S. to be alert for patients who have rash illnesses consistent with monkeypox, regardless of whether they have travel or specific risk factors for monkeypox and regardless of gender or sexual orientation

Symptoms* of concern include:

  • Fever ≥100.4°F (38°C)
  • Chills
  • New lymphadenopathy (periauricular, axillary, cervical, or inguinal)
  • New skin rash

*Fever and rash occur in nearly all people infected with monkeypox virus.

The rash can be disseminated or may be localized but generally not permanently disfiguring. Significant pain may result from local inflammation. According to the CDC, the mortality rate of strains in previous MPX outbreaks has been from 1-15% but the current outbreak is estimated to be 1% but may be higher for immunocompromised individuals.

High-risk exposure

Unprotected contact between a person’s skin or mucous membranes and the skin, lesions, or bodily fluids from a person (e.g., any sexual contact, sharing linens, being in close contact in a bath house).

Being inside the patient’s room or within 6 feet of a patient during any procedures that may create aerosols from oral secretions, skin lesions, or resuspension of dried exudates (e.g., shaking of soiled linens), without wearing an N95 or equivalent respirator (or higher) and eye protection.

Other contacts who remain asymptomatic can be permitted to continue routine daily activities (e.g., go to work, school).

Diagnosis criteria

Demonstration of the presence of Monkeypox virus DNA by polymerase chain reaction testing or Next-Generation sequencing of a clinical specimen OR isolation of Monkeypox virus in culture from a clinical specimen is diagnostic. MPX is not diagnosed until there is a lab positive specimen.

Testing for Monkeypox

As of July 5, 2022, the only way to access Monkeypox testing was through a state health department laboratory. Generally, a local health department is contacted to access the state lab and can be helpful in supporting organizations with suspected and confirmed cases.

As of July 7, 2022, the commercial laboratory Labcorp announced the release of a nationally available commercial MPXV test. This test can be accessed through regular Labcorp testing protocols and they are in the process of scaling up test capacity through a national lab. Current test capacity is 10,000 tests per week.

Treatment options and access

Currently there is no treatment approved specifically for monkeypox virus infections. However, antivirals developed for use in patients with smallpox and other conditions may prove beneficial against monkeypox. Some of these products are available through commercial pharmacies; however, others, like VIGIV or TPOXX may require contact with CDC and public health departments to access.

TPOXX is an antiviral medication that is approved by the United States Food and Drug Administration (FDA)  for the treatment of smallpox in adults and children. 

VIGIV is licensed by FDA for the treatment of complications due to vaccinia vaccination including eczema vaccinatum, progressive vaccinia, severe generalized vaccinia, vaccinia infections in individuals who have skin conditions, and aberrant infections induced by vaccinia virus (except in cases of isolated keratitis). CDC holds an expanded access protocol that allows the use of VIGIV for the treatment of orthopoxviruses (including monkeypox) in an outbreak.

Cidofovir is an antiviral medication that is approved by the FDA  for the treatment of cytomegalovirus (CMV) retinitis in patients with Acquired Immunodeficiency Syndrome (AIDS). 

Brincidofovir is an antiviral medication that was approved by the FDA on June 4, 2021 for the treatment of human smallpox disease in adult and pediatric patients, including neonates. 

Vaccination recommendations and access

The sooner an exposed person gets the vaccine, the better. Persons exposed to monkeypox virus and who have not received the smallpox vaccine within the last 3 years should consider getting vaccinated.

ACAM200 and JYNNEOSTM (also known as Imvamune or Imvanex) are the two currently licensed vaccines in the United States to prevent smallpox.

Past data from Africa suggests that the smallpox vaccine is at least 85% effective in preventing monkeypox.

CDC does not recommend widespread vaccination against monkeypox at this time. However, vaccination may be recommended for some people who:

  • Are close personal contacts of people with monkeypox or have known exposures
  • May have increased risk of being exposed to the virus, such as people who perform laboratory testing to diagnose monkeypox

Additional resources for Monkeypox information

  • Vaccine and Treatment information including eligibility, what vaccines are available, medications and more.
  • Definitions describing different cases of monkeypox including suspect cases, probable cases, confirmed cases and more.
  • Detailed guidelines for the recognition, investigation and prevention recommendations for Monkeypox provided by the Washington State Department of Health.
  • An interactive map containing downloadable data for various regions of the world being affected by Monkeypox.
  • The CDC’s website containing links to everything you need to know about Monkeypox.
  • Guidance and answers to frequently asked questions for clinicians working near Monkeypox.
  • More information for health care professionals on how to address Monkeypox, according to CDC guidelines.
  • Current guidelines for disinfecting and protecting your house to help prevent the spread of Monkeypox.
  • How to monitor people around you that have been exposed to Monkeypox, including health care professionals who have contracted the virus.
  • Monkeypox facts for people who are sexually active and how to prevent exposing your partner.
  • The basics and frequently asked questions about Monkeypox.
  • How to address and prevent Monkeypox when congregating with others.
  • How to prevent Monkeypox in other specific settings.
  • A downloadable document (also available in Arabic, Chinese, French, Russian, Spanish) offering advice for holding gatherings during the current Monkeypox outbreak, provided by the World Health Organization (WHO).
  • A downloadable document outlining risk communication and community engagement (RCCE) for Monkeypox outbreaks, provided by WHO.
  • How the CDC is reducing the stigma surrounding Monkeypox communication and community engagement.
  • More resources regarding safer sex practices and navigating social gatherings during the Monkeypox outbreak.
  • A recent report sharing findings related to the use of JYNNEOS to prevent Monkeypox.
  • A report investigating the outbreak of Monkeypox in various regions.
  • Some Summer 2022 health tips for Gay and Bisexual Men, provided by the CDC.
  • The Laboratory Response Network (LRN) partners with Prevention (CDC) to boost response effectiveness during health emergencies.
  • Five commercial laboratory companies that the Department of Human Health Services (HHS) has provided Monkeypox testing capacities for.
  • Updated case definitions from the Monkeypox outbreak with images included.
  • News from Clinical Outreach and Communication Activity (COCA) helping clinicians prepare for health emergencies.
  • A recent video posted by the American Medical Association (AMA) highlighting Monkeypox numbers, treatment and prevention as told by two CDC experts.
  • Signs and symptoms, with images, of Monkeypox.
  • How to report results from Monkeypox diagnostic laboratory testing.

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