Monkeypox is a rare disease that is caused by infection with monkeypox virus. Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkeypox.’ The first human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo (DRC) during a period of intensified effort to eliminate smallpox. Since then, monkeypox has been reported in people in several other central and western African countries. Monkeypox cases in people have occurred outside of Africa linked to international travel or imported animals. The natural reservoir of monkeypox remains unknown. However, African rodents and nonhuman primates (like monkeys) may harbor the virus and infect people.

Transmission

Transmission of monkeypox virus occurs when a person comes into contact with the virus from an animal, human, or materials contaminated with the virus. The virus enters the body through broken skin (even if not visible), respiratory tract, or the mucous membranes (eyes, nose, or mouth). Animal-to-human transmission may occur by bite or scratch, bush meat preparation, direct contact with body fluids or lesion material, or indirect contact with lesion material, such as through contaminated bedding. Human-to-human transmission is thought to occur primarily through large respiratory droplets. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required. Other human-to-human methods of transmission include direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens.

Signs and Symptoms

In humans, the symptoms of monkeypox are similar to but milder than the symptoms of smallpox. Monkeypox begins with fever, headache, muscle aches, and exhaustion. The main difference between symptoms of smallpox and monkeypox is that monkeypox causes lymphodes to swell (lymphadenopathy) while smallpox does not. The incubation period (time from infection to symptoms) for monkeypox is usually 7−14 days but can range from 5−21 days.

The illness begins with:

• Fever
• Headache
• Muscle aches
• Backache
• Swollen lymph nodes
• Chills
• Exhaustion

Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body.

Lesions progress through the following stages before falling off:

• Macules
• Papules
• Vesicles
• Pustules
• Scabs

The illness typically lasts for 2−4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease.

Prevention

There are number of measures that can be taken to prevent infection with monkeypox virus:

• Avoid contact with animals that could harbor the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).
• Avoid contact with any materials, such as bedding, that has been in contact with a sick animal.
• Isolate infected patients from others who could be at risk for infection.
• Practice good hand hygiene after contact with infected animals or humans. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer.
• Use personal protective equipment (PPE) when caring for patients.

Treatment / Antivirals

At present, there are no specific antivirals indicated in the U.S. for the treatment of monkeypox. However, based on best available information regarding the benefits and risks of certain treatments used in the management of smallpox (a related orthopoxvirus infection), the CDC has developed guidance on the following antiviral products for use in monkeypox: cidofovir, brincidofovir (Tembexa, or CMX001) and tecovirimat (Tpoxx, or ST-246).

Reference Links:

https://www.cdc.gov/poxvirus/monkeypox/index.html

https://www.who.int/health-topics/monkeypox#tab=tab_1

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