By William Kose, MD, JD
Vice President of Special Projects, Blanchard Valley Health System

Just when we think we are turning the corner on COVID-19, despite its numerous variants, another infection is causing headlines. Monkeypox … what is it? Where did it come from? How does it spread? Do I need to be worried?

Monkeypox is a virus similar to the smallpox germ, which has been eradicated by vaccines. It is endemic to western and central Africa and has been associated with outbreaks in other countries due to international travel and the exotic pet trade. Identified in 1958, the first human case was confirmed in a child in 1970. Vaccination for smallpox seems to have provided some immunity, but, with the worldwide smallpox eradication, vaccinations have been discontinued.

Transmission can occur through contact with bodily fluids, skin lesions or respiratory droplets. It may be transmitted by materials such as contaminated linens and sexual networking. The virus grows in the inoculation site and spreads to lymph nodes. The incubation period is normally seven to 14 days followed by fever, headache, aching, fatigue, gland swelling and lesions in the mouth that progress to the skin. Over the following two to four weeks, the lesions progress from being flat to raised, vesicular to pustular, then crusting. Sizes are a small bead size (1/8" to 3/8"). After crusts have disappeared, a patient is no longer considered infectious.  Laboratory tests can help make the diagnosis.

There is no clinically proven treatment available. Antiviral agents that have activity against similar viruses can be considered for high-risk patients. The patient should be isolated, wear a surgical mask and keep lesions covered as much as possible. The majority of patients recover completely within four weeks of symptom onset. Complications can include bacterial superinfections of the skin, scarring, pneumonia, dehydration from fluid loss or decreased intake and sepsis.

The virus' sudden spread across multiple countries suggests it has been spreading undetected for months or years. Investigations are underway to determine how long undetected spread may have been occurring.

After global monkeypox infections passed 1,000 cases across 29 countries with 30 confirmed in the US, the Centers for Disease Control advised to "practice enhanced precautions" on June 6, 2022.  The updated advisory recommends that travelers wear masks and avoid contact with sick people experiencing skin lesions. While the risk to the general public is low, the next level for the monkeypox outbreak is for people to avoid nonessential travel, according to the CDC.

Who should be concerned about monkey pox? Those living with others or working closely with a diagnosis of monkeypox, have visited a country where the virus is prevalent, have contact with imported animals or are exposed to an infected animal. Those with concerns should check with their practitioner.