The World Health Organization (WHO) has declared monkeypox public health emergency of international concern. Since 1970, the rare disease, caused by an infection of the monkeypox virus (a close relative of smallpox) was primarily found in central and western Africa, but in 2022, monkeypox has triggered outbreaks in many non-endemic countries. To help stop the spread, it’s critical for all health care providers to understand the signs and symptoms of monkeypox, how transmission works and who is vaccine eligible.
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According to the Centers for Disease Control and Prevention (CDC), monkeypox symptoms are similar to smallpox symptoms but tend to be milder. They may include fever, headache, back and muscle aches, swollen lymph nodes, chills and fatigue. Not all patients with monkeypox experience flu-like symptoms before developing a rash, however; some only experience a rash or sores. A monkeypox rash resembles pimples or blisters on or inside the genitals or anus, but the pox-like bumps may also appear on the face, hands, feet, chest or inside of the mouth. The rash goes through several phases—evolving, as the American Academy of Dermatology Association (AAD) explains, from macules to papules to vesicles to pustules before scabbing and then crusting over. The illness typically lasts about two to four weeks.
There are differences to these rashes. For example, the Infectious Diseases Society of America (IDSA) notes that in the case of monkeypox, “the skin eruptions are all at a given time, unlike chicken pox (varicella virus), which has vesicular lesions that erupt at different stages.” The AAD advises looking at the pattern on the skin and where the rash appears to narrow down which disease is causing the rash. If monkeypox is likely, the rash or skin lesion can be swabbed and the swab sent to a lab for a PCR (Polymerase Chain Reaction) test to determine whether the monkeypox virus is present. The CDC offers additional guidance on how to recognize monkeypox.
Anyone can develop monkeypox. It spreads from person to person through "close, personal, skin-to-skin contact": respiratory secretions, intimate activities (kissing, hugging, massage, sexual intercourse), and touching objects, fabrics or surfaces contaminated with the monkeypox virus (e.g., clothes, bedding or towels). As The Fenway Institute makes clear, although monkeypox is spreading among some networks of gay, bisexual and other men who have sex with men (MSM), “viruses and bacteria can and do infect anyone regardless of sexual orientation.” According to the CDC, those most at risk for severe outcomes include children eight years old and younger, people who are pregnant or have compromised immune systems, and those with a history of atopic dermatitis or eczema.
JYNNEOS™ and ACAM2000 can be administered before or after a recent exposure—the sooner, the better. The CDC currently recommends vaccination for people who have had a sexual partner in the past two weeks who has been diagnosed with monkeypox; have had multiple sexual partners in the past two weeks in an area with known monkeypox cases; are at occupational risk of monkeypox (e.g., lab workers who perform monkeypox testing). Information about vaccines, including planning considerations for health departments and providers, is constantly changing. Refer to the CDC website for the latest monkeypox vaccine info.
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