May 26, 2022 12:00 PM

Author: University of Utah Health Communications


Información en español

The recent re-emergence of monkeypox in the United States is creating new worries about another potentially contagious virus as the nation continues to suffer from the COVID-19 pandemic. But infectious disease experts at University of Utah Health say this virus is different in several ways.

Monkeypox is a rare viral infection that is similar to the smallpox and cowpox viruses. How monkeypox developed is still unknown, although African rodents are suspected to play a part in transmission, according to the Centers for Diseases Control and Prevention (CDC). While monkeypox is not very common in the U.S., there have been small outbreaks in the past. However, the current outbreak is now a public health emergency in the United States. It’s not yet known why there has been an increase in transmission.

Symptoms

  • Fever
  • Headache
  • Muscle aches
  • Backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion
  • Rash (Papules, vesicles, pustules, and ulcers)

In past monkeypox outbreaks, flu-like symptoms were typically the first sign of the virus, followed by an unexplained rash with bumps. The 2022 outbreak is different with symptoms of illness being less common and a rash sometimes being the first or only symptom. 

A rash with bumps can occur one to three days after a fever and last up to four weeks. This rash resembles smallpox, with blister-like lesions forming and filling with pus. These evolve into pustules before scabbing over and falling off. The process can be painful and leave permanent scars.

Diagnosis

If a person is experiencing any symptoms of monkeypox or may have been exposed to the virus, they should contact their health care provider. 

Monkeypox is typically diagnosed by a rash with confirmation by a PCR test of lesion swabs. According to the CDC, the current outbreak is different from previous outbreaks: 

  • Lesions are most common in the genital and rectal areas or in the mouth
  • Rash may only contain one or a few lesions
  • Rash may not be widespread on the body

Transmission

Monkeypox is spread person to person by:

  • Making direct contact with an infected person’s rash, sores, or bodily fluids.
  • Having intimate contact or skin-to-skin contact with an infected person.
  • Prolonged face-to-face-contact with an infected person.
  • Touching and sharing objects such as bedding, furniture, clothing, or utensils used by an infected person.
  • Respiratory droplets from coughing or sneezing by an infected person.

A person with monkeypox can be contagious up to two to four weeks after their first symptoms and until their rash is healed. This means all lesions must scab, crust, fall off, and a new layer of skin is formed.

At-Risk Groups

  • People with weakened immune systems or immunocompromised conditions
  • Men (cisgender or transgender) who have sex with men
  • People with advanced HIV
  • People who recently had intimate contact with a new partner
  • People who’ve had prolonged exposure or face-to-face contact with an infected person
  • People who have recently gathered in large groups and have close contact with many people

Treatment

There are no treatments specifically for monkeypox virus infections. However, monkeypox and smallpox viruses are similar, which means that antiviral drugs and vaccines developed to protect against smallpox are available to treat monkeypox virus infections.

An antiviral drug, called tecovirimat (TPOXX), may be used for people who are more likely to get severely ill, like patients with weakened immune systems. It can also be used for patients who have severe disease and symptoms.

If you have symptoms of monkeypox, you should talk to your healthcare provider, even if you don’t think you had contact with someone who has monkeypox.

Prevention

Two vaccines may be used to prevent monkeypox virus infection:

Jynneos

  • Approved by the FDA for the prevention of monkeypox infection.
  • A two-dose vaccine administered 28 days apart.
  • The body mounts a maximal immune response starting two weeks after the second dose, although protection begins after the first dose.

ACAM2000

  • Approved by the FDA for prevention of smallpox but has been made available for use against monkeypox under an Expanded Access Investigational New Drug Application.
  • A single-dose vaccine.
  • It takes four weeks for the body to mount a maximal immune response.
  • Due to side effects, is not recommended for everyone.

Because of limited supply, monkeypox vaccination is currently available only for people who are at highest risk of infection and who meet all of the following criteria:

  • Men (cisgender or transgender) who have sex with men
  • Are not in a mutually exclusive, sexual relationship with only one person
  • Who are not currently experiencing monkeypox symptoms

Precautions

While the vaccine supply for monkeypox is limited, a person can take steps to prevent themselves from getting the virus. These include:

  • Avoid close and direct contact with an infected person.
  • Avoid sharing objects with infected individuals.
  • Wash your hands with soap and water.

The CDC recommends reducing or avoiding behaviors that can increase the risk of monkeypox exposure. It’s also important to consider changing behaviors to help slow the spread of monkeypox until a person is fully immunized.

monkeypox smallpox cowpox infectious disease virus

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