Fast facts about monkeypox

By Brian Ward

As of this writing, there is a single confirmed and six presumptive cases of monkeypox reported in the U.S. While everyone hopes this is not the start of another pandemic situation—knock on wood—it is better to start reviewing your facility’s PPE, sanitation, and infection control protocols now just in case. It’s also time to get the fast facts about monkeypox. For more detailed information, visit the CDC at https://www.cdc.gov/poxvirus/monkeypox/index.html or the World Health Organization (WHO) at https://www.who.int/news-room/fact-sheets/detail/monkeypox.

What is monkeypox?

Monkeypox is a virus in the same family as smallpox and cowpox. It got its name in 1958 when the disease was discovered in two colonies of monkeys being used for research. A zoonotic disease, the monkeypox virus can jump between species. In Africa, evidence of monkeypox virus infection has been found in rodents like squirrels and rats, as well as in human and non-human primates.

Is it fatal?

The WHO says that “in recent times, the case fatality ratio [for monkeypox] has been around 3–6%.”

However, there are different strains of the disease, some with fatality rates as low as 1% and others as high as 10%.

Symptoms

According to the CDC:

“The incubation period (time from infection to symptoms) for monkeypox is usually 7−14 days but can range from 5−21 days.

The illness begins with:

• Fever
• Headache
• Muscle aches
• Backache
• Swollen lymph nodes
• Chills
• Exhaustion

Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body.

Lesions progress through the following stages before falling off:

1. Macules
2. Papules
3. Vesicles
4. Pustules
5. Scabs

The illness typically lasts for 2−4 weeks.”

How long is a person contagious?

A person isn’t contagious during the incubation period. They become contagious as soon as symptoms develop and remain contagious until all the scabs from the pox fall off—or two to four weeks on average.

Transmission

Monkeypox is transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus. The virus enters the body through broken skin (even if not visible), respiratory tract, or the mucous membranes (eyes, nose, or mouth). Human-to-human transmission of the virus can result from close contact with lesions, body fluids, respiratory droplets, and contaminated materials such as bedding.

While it can be transmitted through respiration, it’s much harder to do so than for viruses like SARS-CoV-2. For respiratory transmission, The WHO notes that “transmission via droplet respiratory particles usually requires prolonged face-to-face contact, which puts health workers, household members and other close contacts of active cases at greater risk.”

Is it sexually transmittable?

Close physical contact is an established risk factor for transmission—however, both the WHO and the CDC say it’s unclear if monkeypox can be transmitted specifically through sexual transmission routes.

Is it as contagious as COVID-19?

No.

Prevention

There are several measures that can be taken to prevent monkeypox infection, the CDC writes:

• “Avoid contact with animals that could harbor the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).
• Avoid contact with any materials, such as bedding, that has been in contact with a sick animal.
• Isolate infected patients from others who could be at risk for infection.
• Practice good hand hygiene after contact with infected animals or humans. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer.
• Use personal protective equipment (PPE) when caring for patients.”

Treatment

According to the CDC, “At this time, there are no specific treatments available for monkeypox infection, but monkeypox outbreaks can be controlled. Smallpox vaccine, cidofovir, ST-246, and vaccinia immune globulin (VIG) can be used to control a monkeypox outbreak. CDC guidance was developed using the best available information about the benefits and risks of smallpox vaccination and drug use for the prevention and management of monkeypox and other orthopoxvirus infections.”

The CDC also writes “One vaccine, JYNNEOSTM (also known as Imvamune or Imvanex), has been licensed in the United States to prevent monkeypox and smallpox. Because monkeypox virus is closely related to the virus that causes smallpox, smallpox vaccine can also protect people from getting monkeypox.”

Where do I go for more information?

Visit https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-hospital.html to see the CDC’s recommendations for clinicians, laboratorians, and veterinarians in dealing with monkeypox.