What is it?
Monkeypox (MPV) is caused the monkeypox virus. It has historically been a disease confined to parts of Africa, with occasional small outbreaks outside the area due to travel or linked to specific animals. The 2022 outbreak is unique in both it’s scope and it’s risk factors. As of this writing, more than 42,000 cases have been reported worldwide, including 143 in Michigan, the majority of which have been in the metro Detroit area.Who is at risk for illness?
In theory anyone can acquire MPV. With the current outbreak, as of now it has primarily been identified in men who have sex with men, though it’s likely to spread further as time goes by. It traditionally causes self-limited illness, though some patients may be at higher risk for severe disease, including immunocompromised patients, pregnant/breastfeeding women, children (particularly ≤ 8 years), and those with eczema or other exfoliative skin conditions. How is it spread?
MPV can spread from person-to-person through direct contact with the infectious rash, scabs, or body fluids. It also can be spread by respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex. It is not as contagious or spread as easily as more common respiratory viruses, like influenza or COVID-19. Touching items (e.g., clothing, linen, or towels) that previously touched the infectious rash or body fluids is another way monkeypox spreads. Monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. People who do not have monkeypox symptoms cannot spread the virus to others. What are the signs and symptoms of disease?
MPV symptoms usually start 1-2 weeks after exposure to the virus and can include fever, chills, malaise, headache, muscle aches, lymphadenopathy, and rash. Lymph nodes may swell in the neck (cervical & submandibular), armpits (axillary), or groin (inguinal) and occur on both sides of the body or just one. The rash often involves vesicles or pustules that are deep-seated, firm or hard, and well-circumscribed; the lesions may umbilicate or become confluent and progress over time to scabs. These lesions can appear on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. The illness typically lasts 2-4 weeks. What precautions need to be taken if I have a patient with suspected monkeypox?
All interactions with patients with suspected MPV should include use of personal protective equipment for contact and enhanced respiratory precautions (e.g. isolation gown, gloves, eye protection, and a fitted N-95 respirator). For details on how best to manage depending on your site of care can be found above under the link “Suspect Monkeypox Infection Prevention Guidance” How can I test for the illness?
If performed in your office/facility, specimens can be obtained using either one swab in viral transport media (pink liquid material) or two swabs placed in a dry sterile transport container. The order in Epic is listed as “Orthopox Virus DNA, PCR (aka Monkey).” If a patient calls your office/facility requesting testing, you can recommend they reach out to their local health department, or direct them to one of our Emergency Departments (in the case of the latter, contact the ED charge nurse to let them know when the patient will be arriving, remind the patient to wear a mask and cover all lesions, and provide the patient with the number of the ED for them to call upon their arrival). Further information can be found above under the link “Suspect Monkeypox Infection Prevention Guidance” What treatments are available for monkeypox?
No agents have been FDA approved for treatment of MPV. Tecovirimat is approved by the FDA for treatment of smallpox, and has been shown to be effective in non-human primates with MPV. It is currently only available directly from the CDC. For more information, please visit the CDC website
If you have an outpatient with suspected or confirmed monkeypox that you think warrants consideration for tecovirimat, please contact Dr. Paul Chittick (available via Mobile Heartbeat, pager 248-992-3450, or at 248-761-7029, and he can help arrange for receipt of medication. Do not attempt to order it on your own at this time. Beaumont is working on a process to try and help make this easier for providers, and to allow for more providers to be able to prescribe it, and will get this information to you as soon as the process is in place. Currently it’s recommended to consider use of tecovirimat in patients with severe disease, at high risk for severe disease (see above), or those with involvement of body sites where MPV may pose a special hazard (e.g. eyes, mouth, genitals, anus, etc). Is there a vaccine for monkeypox?
There is a vaccine available for prevention of both MPV and smallpox – the modified vaccinia Ankara vaccine (JYNNEOS). This vaccine is effective and safe, and can even be used in those who are immunocompromised or have skin disorders (unlike older versions of smallpox vaccines). Currently this vaccine is available in limited supplies at the discretion of public health authorities, and being deployed primarily for those with confirmed exposure to MPV patients (post-exposure prophylaxis, or PEP) or those with higher risk of potentially being exposed to MPV (PEP++). Beaumont does not currently have any vaccine supply and providers/patients are encouraged to contact their local health departments with questions. We hope to be able to have this vaccine to offer patients in the future.