What is monkeypox?
Monkeypox is an infection caused by a pox virus, the same pox family as chicken pox and smallpox, and it causes primarily skin infections. It's a zoonotic disease. The source is animals originally from central and western Africa.
We've known about monkeypox since 1958. There have been some well-described outbreaks where we've gotten experience with the disease, so we have a lot of information.
The most recent, about ten years ago, was associated with some animals that had been imported into the Midwest. There was an outbreak among about 40 individuals who had contact with these animals. So, we have seen it in the past, but it's been more sporadic.
This current outbreak, at least initially, was described in May. It’s been primarily transmitted by very close contact associated with certain events that have occurred worldwide - concerts, dances, and large gatherings of people.
Where a lot of skin-to-skin contact was possible?
Exactly. That is the primary way of transmission. But it requires more contact than you might think. It really means rubbing skin-to-skin - very similar to chickenpox where the lesions can have virus in them. If those rub you, and you have a break in your skin, you can get chickenpox from that. Monkeypox is very similar in that way.
As an example, could you get monkeypox merely from shaking hands?
If they have lesions on their hands, especially open lesions, that is possible. But, in general, if I just shook the hand of somebody who had monkeypox and they didn't have any lesions on their hand, it would be extremely unlikely. You need to be in contact with the virus.
What about, say, touching a hand railing after someone with monkeypox does?
This is not what we think is the primary mode of transmission with this particular group of organisms. I'm not going to say it's totally impossible, but what I would say is it's very unlikely and unusual.
However, we do worry about transmission from clothes, sheets, or fabrics where fluid from the vesicles can be unroofed or the scabs could be. It does turn out that scabs do contain live virus.
Respiratory transmission has been reported, but it requires close and more prolonged contact.
Symptoms of monkeypox?
Traditionally, monkeypox has been associated with a flu-like syndrome - sore throat, fever, aches and pains, and chills - before you develop the rash.
With this current outbreak, we have actually seen individuals who've had minimal, if any, symptoms and actually will present with the rash initially. The other thing that is different and unusual are more reports of intense pain associated with this. And some individuals are presenting with swollen lymph nodes
Do you need to isolate, as you would with COVID-19?
The incubation period for pox viruses is longer. In general, you’ll be told to isolate for 21 days from the onset of your symptoms. And we look for crusting of all the lesions. Unlike chickenpox, the lesions all pop up at once and they all crust at once. In general, the crusts are all gone within two weeks.
Say I'm exposed on Monday and I developed symptoms on Saturday. The malaise, the fatigue, the tiredness, and the sore throat will last one to three days and then the rash will occur. Once you have those blisters, about five to 10 days until they start scabbing, and then the scabs are usually gone within two weeks.
Do the lesions leave a scar of any type?
They can disappear and, in some cases, they do scar. It really depends on how severe the case is, but also whether or not individuals scratch the lesions. You have to be careful not to induce any kind of a reaction where you can cause more damage to the skin.
Treatment of monkeypox
It depends on where it's involved, how extensive the lesions are, and the host.
- In children under eight, we tend to be much more aggressive and may use an antiviral.
- In pregnant women, we would use an antiviral.
- In anybody who is immunocompromised, we may consider using an antiviral.
But in people who have relatively mild disease, we treat their symptoms. If they have pain, we may give them medications to control the pain, but we really don't necessarily need to use antivirals. So, it really depends on the severity of the disease, and if there are any kinds of conditions that would put them at risk of having a more severe case of monkeypox.
About the monkeypox vaccine
The vaccine is more effective if you get it before you're exposed or within four days of exposure. The earlier you get it, the more effective it is.
Overall, it's about 85% effective in preventing monkeypox and or smallpox
Does monkeypox mutate the way COVID-19 does?
At this point, we don't have a lot of data to suggest extensive mutations. All viruses can mutate, but some mutate much more than others. This is not one that mutates as commonly as the other viruses.
How worried are you about the public dismissing monkeypox as a “gay disease” because so many of the cases involve men having sex with men?
Just because it's currently in one population does not mean it cannot be transmitted to other populations. I would encourage everybody to understand they at this potential time or at this time are not necessarily at risk. But we do need to be very aggressive in terms of offering vaccines and prophylaxis to individuals who are at risk so it does not come into different populations and put the general population at risk.
What about possible public “virus fatigue” following West Nile virus, COVID-19, and now monkeypox?
I am a little bit worried that people are tired of different outbreaks and different pandemics, and that they've discounted a little bit some of the importance of health.
You know, with monkeypox as much as anything else, the simple act of washing your hands is an important thing. It's going to prevent the transmission of monkeypox, but it's also going to prevent the of transmission of influenza and other diseases.
As tired as we all are of hearing about infectious diseases, they are here to stay. It's important that we keep on educating the public about what we've learned about this disease and what the options are. We can absolutely intervene and prevent transmission.
RESOURCES:
State Health Services/Monkeypox
Infectious Disease Society of America
NPR: Monkeypox explained: How to protect yourself and what to watch out for
Interview highlights were lightly edited for clarity.
Got a tip? Email Sam Baker at sbaker@kera.org. You can follow Sam on Twitter @srbkera.
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