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.

updated October 1, 2022

Several poxviruses infect humans, ranging from the deadly smallpox to the contagious but not serious molluscum contagiosum. Now more than 30 countries, including the United States are experiencing an outbreak of monkeypox, which the World Health Organization is calling a”a public health emergency of international concern.”

What is monkeypox?

Monkeypox, an orthopoxvirus, was first isolated in the late 1950s from a colony of sick monkeys in Copenhagen Denmark. The virus is related to the variola, smallpox, and vaccinia, coxpox, viruses. The first known human case was found in the Democratic Republic of the Congo in 1970.

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.

A person with monkeypox can spread it to others from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2–4 weeks

Centers for Disease Control and Prevention
As of September 13, 2022 there are 59,000 global cases and 22,000 United States cases of monkeypox.
worldwide cases of monkeypox as of SEPTEMBER 13, 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. Direct contact with lesions that contain the virus can easily transmit the disease .

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?

Onset of monkeypox infection is 5 days to 3 weeks after exposure.

Predominant symptoms of monkeypox include

  • fever,
  • rash,
  • enlarged lymph nodes,
  • sore throat,
  • muscle aches,
  • chills,
  • headache

The rash is similar to that of smallpox or chickenpox. The illness usually lasts 2 to 4 weeks.

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 with 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.

Is there a vaccine?

The JYNNEOS vaccine is approved for prevention of smallpox and monkeypox. It is the primary vaccine being used during this outbreak in the U.S.

The ACAM2000 vaccine is an alternative to JYNNEOS. It is also approved to help protect against smallpox and monkeypox.

Facts about JYNNEOS vaccine 
2 dose vaccine, maximum immunity 14 days after dose 2

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

I appreciate all of you who are following Watercress Words, and if you aren’t I invite you to join the wonderful people who are. You can meet some of them in the sidebar, where you can click on their image and visit their blogs. Use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me.

a world globe with crossed bandaids

Dr Aletha

cover image by Jerney Furman

COVID-19 update- Using Community Levels to guide prevention

COVID-19 Community Levels are a new tool to help communities decide what prevention steps to take based on the latest data. Levels can be low, medium, or high and are determined by looking at hospital beds being used, hospital admissions, and the total number of new COVID-19 cases in an area. 

This information is current as of the publication date; it is general medical information that helps doctors and patients make decisions about what is right for them. Medical recommendations and practice changes as we learn new things. Discuss with your physician or appropriate healthcare provider .

There’s another COVID guideline update from the CDC, different from previous ones. The new guideline is community specific, and enables us to make smart, informed choices about what we do to mitigate viral spread.

Know Your COVID-19 Community Level

COVID-19 Community Levels are a new tool to help communities decide what prevention steps to take based on the latest data. Levels can be low, medium, or high and are determined by looking at hospital beds being used, hospital admissions, and the total number of new COVID-19 cases in an area. 

Take precautions to protect yourself and others from COVID-19 based on the COVID-19 Community Level in your area. Find your county’s numbers at this link.

COVID-19 County Check

What Prevention Steps Should You Take Based on Your COVID-19 Community Level?

LOW

MEDIUM

HIGH

People may choose to mask at any time. People with symptoms, a positive test, or exposure to someone with COVID-19 should wear a mask.

My thoughts

I usually post the CDC guidelines without comments but this time I will. These new guidelines should be welcome for those who don’t like wearing a mask (as if any of us do) and think it should be “personal preference”.

COVID-19 has not disappeared, and possibly never will.

So as it says above anyone may still wear a mask any time they prefer, and should be able to do so without being ridiculed, teased, criticized, or any other form of harrassment. Anyone should feel free to avoid large crowded events. And guests should respect their host’s preference for guidelines in their home or event.

Anyone with COVID symptoms or diagnosed COVID should avoid contact with other people, even if the others are immune.

DO NOT GO TO WORK SICK.

The previous guidelines concerning symptoms, testing, isolation, guarantine, and vaccination are still in place.

update January 5, 2022

CDC now recommends that adolescents age 12 to 17 years old should receive a booster shot 5 months after their initial Pfizer-BioNTech vaccination series.

Data show that COVID-19 boosters help broaden and strengthen protection against Omicron and other SARS-CoV-2 variants. ACIP reviewed the available safety data following the administration of over 25 million vaccine doses in adolescents; COVID-19 vaccines are safe and effective.

At this time, only the Pfizer-BioNTech COVID-19 vaccine is authorized and recommended for adolescents aged 12-17.

Isolation and Quarantine

Every time I’ve done a COVID-19 update I think it will be the last, but I should know better by now. Unlike the others about vaccination, this one is about isolation-what you do if you are infected, and quarantine-what you do if you are exposed.

If You Test Positive for COVID-19 (Isolate)

Everyone, regardless of vaccination status.

  • Stay home for 5 days.
  • If you have no symptoms or your symptoms are resolving after 5 days, you can leave your house.
  • Continue to wear a mask around others for 5 additional days.

If you have a fever, continue to stay home until your fever resolves.

If You Were Exposed to Someone with COVID-19 (Quarantine)

If you:

Have been boosted
OR
Completed the primary series of Pfizer or Moderna vaccine within the last 6 months
OR
Completed the primary series of J&J vaccine within the last 2 months

  • Wear a mask around others for 10 days.
  • Test on day 5, if possible.

If you develop symptoms get a test and stay home.

If you:

Completed the primary series of Pfizer or Moderna vaccine over 6 months ago and are not boosted
OR
Completed the primary series of J&J over 2 months ago and are not boosted
OR
Are unvaccinated

  • Stay home for 5 days. After that continue to wear a mask around others for 5 additional days.
  • If you can’t quarantine you must wear a mask for 10 days.
  • Test on day 5 if possible.

If you develop symptoms get a test and stay home

This one comes with some confusion, which is nothing new for the isolation/quarantine guidelines. It also comes with some controversy; was the CDC director influenced by corporate needs, specifically the airline industry? And are these guidelines safe, do they risk returning infectious people to work and social life too soon ?

I don’t know the answer to those questions but I can give you answers from the top two public health officials in the United States.

“getting people back in half the time that they would have been out so they can get back to the workplace doing things that are important to keep society running smoothly.”

Dr.Anthony Fauci

 “CDC’s updated recommendations for isolation and quarantine balance what we know about the spread of the virus and the protection provided by vaccination and booster doses. These updates ensure people can safely continue their daily lives.”

CDC Director Dr. Rochelle Walensky
updated November 29,2021

Everyone ages 18 and older should get a booster shot

You may choose which COVID-19 vaccine you receive as a booster shot. Some people may prefer the vaccine type that they originally received, and others may prefer to get a different booster. CDC’s recommendations now allow for this type of mix and match dosing for booster shots. 

Studies show after getting vaccinated against COVID-19, protection against the virus and the ability to prevent infection with variants may decrease over time.

update-November 2, 2021

Today, CDC Director Rochelle P. Walensky, M.D., M.P.H., endorsed the CDC Advisory Committee on Immunization Practices’ (ACIP) recommendation that children 5 to 11 years old be vaccinated against COVID-19 with the Pfizer-BioNTech pediatric vaccine. 

CDC now expands vaccine recommendations to about 28 million children in the United States in this age group and allows providers to begin vaccinating them as soon as possible.

“Together, with science leading the charge, we have taken another important step forward in our nation’s fight against the virus that causes COVID-19. We know millions of parents are eager to get their children vaccinated and with this decision, we now have recommended that about 28 million children receive a COVID-19 vaccine.

As a mom, I encourage parents with questions to talk to their pediatrician, school nurse or local pharmacist to learn more about the vaccine and the importance of getting their children vaccinated.” 

Dr. Rochelle Walensky , CDC Director
%d bloggers like this: