With clusters of monkeypox popping up across the nation – and with COVID-19 still a part of daily life – now is the time to be aware of this latest infectious disease. Here, Tara Palmore, MD, director of the Travelers’ Clinic at the George Washington University (GW) Medical Faculty Associates (MFA) and professor of medicine at the GW School of Medicine and Health Sciences, takes us through key information about monkeypox, including what to do if you suspect you may have contracted it.
What is monkeypox?
Palmore: Monkeypox is a virus in the Orthopoxvirus family. It is a milder relative of smallpox. Monkeypox was first discovered in the 1950s in monkeys, but its reservoir in nature is small mammals in Central and West Africa. For decades, monkeypox has caused infections in humans who had contact with animals and then spread it through person-to-person transmission.
How common is monkeypox?
Palmore: For many years, monkeypox has occurred in outbreaks and sporadic cases in Nigeria and other endemic countries, and it was identified infrequently among travelers to non-endemic countries, including the United States. In 2003, small animals imported from West Africa set off a monkeypox outbreak via infected prairie dogs, leading to 47 confirmed and possible cases in the Midwest. Starting this spring, an epidemic of monkeypox was detected in the United Kingdom and Europe, and has spread to 58 countries on all inhabited continents. As of July 12, 2022, the epidemic involves 10,020 individuals, including 864 in the United States.
How contagious is it, and how is it spread?
Palmore: The virus is not exceedingly infectious. There is no evidence of airborne spread, nor of spread from casual person-to-person contact or casual contact with surfaces. Monkeypox spreads via close skin-to-skin contact, mucous membrane contact, and contact with infectious body fluids. The virus can also spread via contact with infected items (such as bed linens) that have been used by an infected person. At this point, the epidemic has largely affected men who have sex with men. However, any individual who has close skin-to-skin or mucous membrane contact with a person who has monkeypox disease could become infected. Condom use will not prevent monkeypox transmission.
Should you quarantine after exposure?
Palmore: There is typically no need to quarantine after exposure to monkeypox. Because the infection does not spread prior to symptom onset, exposed persons should monitor themselves closely for symptoms. If any symptoms develop, they should immediately isolate from others, contact the health department, and seek testing for monkeypox. Exposed persons who develop symptoms should be certain to let health care providers know in advance that they have been exposed so that the correct infection control precautions are used and the correct tests are sent.
What are symptoms of monkeypox?
Palmore: Monkeypox disease may begin with fever and fatigue, but those symptoms do not necessarily occur at the onset and sometimes do not occur at all. Some patients develop swollen, tender glands in the head, neck, underarm, or groin. Skin lesions arise on almost any part of the body, including the limbs, trunk, genital and anal area, head and neck, and inside of the mouth. The skin lesions can look like small bumps, blisters (vesicles), or pimples (pustules), and they are frequently itchy, painful, or both. Some individuals develop proctitis, which is a painful inflammation of the rectum. These symptoms may occur in sequence or at the same time.
How are patients diagnosed?
Palmore: To make the diagnosis, a provider swabs multiple lesions and sends the sample for a PCR that detects all non-smallpox Orthopoxviruses, including monkeypox. A positive test is a presumptive diagnosis of monkeypox, and the patient is notified that they have a positive test. The sample then goes to the Centers for Disease Control and Prevention (CDC) for confirmatory testing. The virus is sequenced to verify that the sample indeed contains monkeypox. In addition, the CDC analyzes the sequences to study the genomic epidemiology of the outbreak and better understand the dynamics of transmission, and it monitors for important genetic mutations.
Which treatment options are available?
Palmore: Most individuals with monkeypox infection recover with symptomatic treatment and do not need specific antiviral medication. Symptomatic treatment includes topical creams to relieve itching and pain, anti-inflammatories such as ibuprofen, and pain medications if needed. An antiviral medication called tecovirimat (brand name TPOXX) is available through an expanded access protocol from the CDC for those who have severe monkeypox disease or infected persons with immune vulnerabilities that put them at risk of developing severe disease.
How can the GW MFA help people who suspect they may have monkeypox?
Palmore: Patients who suspect they have monkeypox infection should reach out to their primary care providers for guidance. If a provider determines that a patient would benefit from evaluation, the provider can refer the patient for an appointment in the Infectious Diseases Clinic. The provider needs to inform the Call Center that they are making an appointment for suspected monkeypox evaluation so that established infection control protocols can be followed. If we are notified of these concerns in advance, we are able to bring patients into the clinic, conduct testing, and escort patients out of the building without exposing other patients or staff.
What’s an important takeaway about monkeypox that more people should know?
Palmore: The media circus and public stigma surrounding monkeypox have already been very hurtful to the community most affected by the disease. It is important to be sensitive and avoid perpetuating stigma, and to encourage those with symptoms to seek testing and care.
Post-exposure prophylaxis with the smallpox vaccine is available through the health department to those who have had high-risk exposures to persons with confirmed monkeypox infection. Pre-exposure prophylaxis for high-risk groups will increasingly become available as vaccine supplies increase. The MFA does not currently have supplies of the smallpox vaccine.
To make an appointment with an infectious disease specialist, visit the Infectious Diseases Outpatient Clinic at the GW MFA or call 202-741-3000.