On July 23, 2022, the World Health Organization officially declared that the monkeypox outbreak, which has now affected over 17,000 people across 74 countries, is now a global health emergency. Since early May, there has been a rapid, unprecedented increase in monkeypox cases outside of the Central and West African nations where the virus has long been endemic.
Monkeypox is a viral infection in the same family as smallpox; it was first detected in humans in the 1970s. However, it is much less dangerous than smallpox, which had been eradicated in 1980. Monkeypox typically spreads via physical contact with fluid from the virus’s lesions, including direct and indirect contact; this means that individuals can be infected by handling a sick person’s linens or clothes, especially if they have been visibly soiled by the lesions.
Respiratory droplets are also believed to be a mode of transmission for monkeypox. While the majority of reported infections thus far have been gay or bisexual men, it is important to note that monkeypox is not considered a sexually transmitted infection (STI). It does not spread through vaginal or seminal fluids—but through contact with lesions. Any manner of physical proximity, including that of a sexual nature, can result in transmission and infection. According to health experts, anyone can contract the virus.
The international outbreak that started two months ago has so far resulted in more than 2,800 infections in the United States alone. Health officials have a limited amount of data on those who have been diagnosed with monkeypox, and the number of infected individuals unintentionally spreading the virus is currently unknown. Similarly, the efficacy of current treatment and immunization methods is unclear at this time.
A recent study published in The New England Journal of Medicine (NEJM) identifies new clinical symptoms of monkeypox infection, which will aid future diagnoses and slow the virus’s spread. Of the patients examined in this study, a number of infected individuals exhibited symptoms that had not been listed in the most recent medical criteria for monkeypox diagnosis.
Novel symptoms include ulcers on the mouth or anus, as well as isolated genital lesions. These clinical symptoms are similar to those of STIs and can easily lead to misdiagnosis. In some cases, anal and oral lesions have caused patients to be hospitalized for pain and swallowing issues. Therefore, it is crucial that healthcare professionals receive proper education on these symptoms. Misdiagnosis can delay identification and obstruct ongoing efforts to stop the infection’s spread.
It is crucial that these new symptoms are incorporated into the official monkeypox criteria; in many cases, these symptoms were severe and resulted in hospitalization.
- Muscle aches and backache
- Swollen lymph nodes
- Skin rash — lesions can appear on the face, mouth interior, hands, and other parts of the body, including feet, chest, genitals, and anus
The incubation period lasts for about 1-2 weeks. The development of fever, malaise, headache, weakness, and so on, marks the beginning of the prodromal period. The appearance of enlarged lymph nodes (lymphadenopathy) is a characteristic that separates monkeypox infection from smallpox infection. Lymphadenopathy may be generalized or localized to several areas (e.g., neck and armpits).
Rashes appear immediately after prodrome. Lesions begin to form and progress together on any given part of the body. The lesions progress through four stages—macular, papular, vesicular, to pustular—before scabbing over and resolving.
Generally, the sickness lasts 2-4 weeks. The severity of the virus may vary depending on the person's initial health, exposure route, and monkeypox strain.
Well-circumscribed, deep-seated lesions are seen, and they often develop umbilication.
- Lesions present on the same site of the body will be roughly the same size and in the same developmental stage. (For example, someone might have small papules on their hands and large vesicles on their face.)
- Fever occurs prior to the rash’s appearance
- Centrifugal disseminated rash (more lesions on extremities and face)
- Lesions on palms and soles
- Lesions can be painful until they “crust” over and begin to heal, at which point they will become itchy.
Stages of Lesion Development & Their Durations
Enanthem — 1-2 days
Macules — 1-2 days
Papules — 1-2 days
Vesicles — 1-2 days
Pustules — 5-7 days
Scabs — 14-17 days
After the scabs have resolved, pitted scars and/or patches of lighter or darker skin may still be present. However, once the scabs have completely fallen off, the patient is no longer contagious.
Atypical monkeypox cases include:
- Presentation of only a few or even a single lesion
- Total absence of skin lesions, with anal pain and bleeding
- Lesions in the genital or perineal/perianal area, which do not spread further
- Lesions appearing at different (asynchronous) stages of development
- Appearance of lesions before the onset of fever, malaise, and other constitutional symptoms (absence of prodromal period)
There is no specific treatment for monkeypox infection at this time. However, as monkeypox and smallpox viruses are genetically similar, antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat monkeypox virus infections.
Antivirals, like tecovirimat (TPOXX), may be recommended for people who are severely ill, such as patients with weakened immune systems.
- Avoid close physical contact with people who have a rash.
- Do not touch the rash or scabs of a person with monkeypox.
- Do not kiss, hug, cuddle, or have sex with someone with monkeypox.
- Do not share eating utensils or cups with someone who has monkeypox.
- Do not handle/touch the bedding, towels, or clothing of a person with monkeypox.
- Wash your hands often—with soap and water or an alcohol-based hand sanitizer.
- Avoid contact with animals that are visibly sick.
Two vaccines licensed by the U.S. Food and Drug Administration (FDA) are available for monkeypox infection – – JYNNEOS (also known as Imvamune or Imvanex) and ACAM2000. Approximately 2 weeks after the second shot of JYNNEOS and 4 weeks after receiving ACAM2000, individuals are considered fully vaccinated.
Currently, there is no information on the efficacy of these vaccinations in the ongoing outbreak. Therefore, vaccinated individuals should continue to take precautions against infection by avoiding close skin-to-skin contact, especially intimate contact, with those who are suffering from monkeypox.
While the WHO does not advise restrictions on international travel at this time, there are recommended precautions to bear in mind when traveling.
- Avoid non-essential travel, especially abroad, if you feel ill, have a fever and rash, or have been diagnosed with or are suspected of having monkeypox by your jurisdictional health authorities.
- Anyone who experiences a rash-like sickness while travelling or after returning home should contact a medical expert immediately and provide information on all recent travel and immunization history, including whether they have received a smallpox vaccine or other vaccines.
Public health measures—such as enhanced testing and improved awareness—are extremely important at this time, especially in the interest of protecting vulnerable groups from the stigmatizing repercussions that misinformation can entail.