Beyond Borders: Monkeypox

by Jon Avery Go, MD

For almost three years, COVID-19 has had an enormous effect on the world. Lockdowns, social distancing and masks became the new normal. Just when we thought life was starting to return to the normal that we knew, monkeypox appears.

Monkeypox is a zoonotic (disease transmitted from animals to humans) viral disease caused by the monkeypox virus that belongs to the Poxviridaefamily.

The origin is unknown, but it was discovered in the 1950s in monkeys kept for research. Infected mammals such as prairie dogs, monkeys, hedgehogs, squirrels and dogs can transmit the virus to humans.

Transmission from infected animals happened through bites and scratches, handling animal products such as skin or fur, or consuming undercooked meat of the infected animals.

The first human case was reported in 1970 in the Democratic Republic of Congo and for decades it was a disease considered endemic in Central and West Africa.

Human transmission is most commonly caused by direct skin-to-skin contact with a monkeypox lesion or through contact with bodily fluids of an infected person. It can also spread through contact with fomites (fabric, sheets, towels, etc.) that have been in contact with the lesion, and it can also spread through a cough or sneeze from an infectious person.

An infected person usually develops symptoms within three weeks of exposure to the virus. The symptoms include flu-like symptoms, exhaustion, swollen lymph nodes, and rash. After the onset of flu-like symptoms, a rash appears between 1-4 days later.

The rash may be located on or near the hands, feet, chest, face, and genitalia. The rash will initially look like sores or pimples and transform into blisters. The lesions can be painful and/or itchy and go through several stages including scabs falling off before a fresh layer of skin will appear.

The disease appears similar to Varicella, or chickenpox, so it must be differentiated from chickenpox in order to help curb the spread.  Infected individuals can be infectious starting from the onset of symptoms until the rash disappears and new skin forms which will typically last between 2-4 weeks.

Monkeypox is highly infectious, and we are in the midst of an outbreak.

As of the end of August, there are a total of 23 monkeypox cases in Hawaii. Nationally, many of the cases from the outbreak have been among men who have sex with men. Individuals who have multiple or anonymous sex partners are also at high risk.

Vaccines are available to help prevent infection and can be given after exposure.

Monkeypox is a self-limiting disease but can last two to four weeks. Treatment is mostly symptomatic but for those who have severe disease, are immunocompromised, or are at high risk for complications, immunoglobulins or antivirals obtained through consultation with the Department of Health and CDC can be given.

Measures used for COVID-19 focus on contact and respiratory precautions such as frequent hand washing, wearing masks, and avoiding gatherings where close contact with an infected person can happen to help limit the spread.

If you think you have been exposed or are infected, isolate and call your healthcare provider immediately. Those around or who share a common living space with an infected person should take care not to get in contact with the skin lesions or any material that may have come in contact with the skin lesions.

Clean and disinfect frequently touched surfaces and do not share items with others.

An infected person should also avoid taking care of pets while sick, as they might spread the virus to the animal who then might spread it to other people.

In the midst of another threat, remember to stay vigilant, stay safe and stay healthy!