Questions and answers about monkeypox

Predominant symptoms of monkeypox include fever, rash ,enlarged lymph nodes, muscle aches, and chills. Most patients with monkeypox have a mild illness. Symptom onset is 7-13 days after exposure, but can be as long as 3 weeks.

This week public health officials in Oklahoma, my home, confirmed a case of monkeypox. A disease usually only found in Africa, this smallpox related virus has been spreading throughout the United States and 34 other countries in 2022.

What is monkeypox?

 Monkeypox, an orthopoxvirus, was first isolated in the late 1950s from a colony of sick monkeys. The virus is related to the variola, smallpox, and vaccinia, coxpox, viruses.

Where is monkeypox found?

Since routine smallpox immunization ended, most cases have occurred in Central and West Africa. Sporadic cases have been reported in several non-endemic countries, typically in returning travelers.

Monkeypox is rare and does not spread easily between people without close contact. The threat of monkeypox to the general U.S. population remains LOW.  

Centers for Disease Control and Prevention
worldwide cases of monkeypox as of June 21, 2022

How does it spread?

The virus is typically acquired through contact with an infected animal’s bodily fluids or through a bite.

Human-to-human transmission can also occur through close contact with infectious skin lesions.

Transmission can also occur through large respiratory droplets, and prolonged face-to-face contact (eg, within 6 feet for ≥3 hours in the absence of personal protection equipment [PPE]).

What are the symptoms of monkeypox?

Predominant symptoms of monkeypox include fever, rash ,enlarged lymph nodes, muscle aches, and chills. Most patients with monkeypox have a mild illness. Symptom onset is 7-13 days after exposure, but can be as long as 3 weeks.

The rash is similar to that of smallpox or chickenpox. Click here to see

Examples of monkeypox rash.

How do doctors diagnose monkeypox?

Doctors usually suspect monkeypox based on symptoms, especially a suspicious rash. Testing is done on specimens collected by swabbing monkeypox lesions, but should only be obtained by professionals wearing appropriate PPE.

CDC is working with state and local health officials to identify people who may have been in contact with individuals who have tested positive for monkeypox, so they can monitor their health.

CDC website
This electron microscopic (EM) image depicted a monkeypox virion, obtained from a clinical sample associated with the 2003 prairie dog outbreak. It was a thin section image from of a human skin sample. On the left were mature, oval-shaped virus particles, and on the right were the crescents, and spherical particles of immature virions.

This electron microscopic (EM) image depicted a monkeypox virion, obtained from a clinical sample associated with the 2003 prairie dog outbreak. It was a thin section image from of a human skin sample. On the left were mature, oval-shaped virus particles, and on the right were the crescents, and spherical particles of immature virions. credit CDC, Cynthia S. Goldsmith, Russell Regnery

What treatments are available?

Most patients have mild disease and recover without home supportive care, similar to influenza, COVID, and other viral infections. For the seriously ill patient, medically supervised supportive care is necessary until recovery.

The antiviral agents, tecovirimat and brincidofovir, approved for treatment of smallpox in the United States, work for monkeypox in animals and are likely to work in humans.

Can monkeypox be prevented?

When a rash is present, persons with suspected monkeypox should be considered infectious and be isolated until all scabs separate and results of testing are negative.  

Detailed information on infection control precautions to reduce transmission of monkeypox in the home is on the CDC website.

Persons with close contact with an infected animal or person should be monitored for symptoms for 21 days after their last exposure .

Detailed information on the approach to monitoring after an exposure can be found on the CDC website.

The use of smallpox vaccination for pre-exposure and post-exposure prevention may be reasonable in select settings, after consultation with public health authorities.

Is monkeypox fatal?

In Central Africa, the fatality rate is approximately 10 percent, generally in the second week of illness.

In the 2003 outbreak in the United States, none of the 34 confirmed cases died, although a few became seriously ill, requiring hospitalization.

Exploring the HEART of international health

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Dr Aletha

cover image by Jerney Furman

Author: Aletha Cress Oglesby, M.D.

As a family physician, I explore the HEART of HEALTH in my work, recreation, community, and through writing. My blog, Watercress Words, informs and inspires us to live in health. I believe we can turn our health challenges into healthy opportunities. When we do, we can share the HEART of health with our families, communities, and the world. Come explore and share with me.

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