Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox virus is part of the same family of viruses as smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder; and monkeypox is rarely fatal. Monkeypox is not related to chickenpox.
What are the symptoms of monkeypox?
The most common symptoms of monkeypox are:
- Fever
- Headache
- Muscle aches and backache
- Swollen lymph nodes
- Chills
- Exhaustion
A rash usually develops within 1 to 3 days after the appearance of fever. The rash often begins on the face and then spreads to other parts of the body. The rash goes through different stages before healing completely.
Is there a vaccine for monkeypox?
Yes, there are two vaccines available for preventing monkeypox infection:
- MVA-BN – This is a newer vaccine approved in 2019 by the U.S. Food and Drug Administration for prevention of monkeypox disease in adults 18 years of age and older determined to be at high risk for monkeypox infection.
- ACAM2000 – This is an older smallpox vaccine that also provides protection against monkeypox. It is approved for prevention of smallpox and monkeypox in people determined to be at high risk for infection.
The U.S. Centers for Disease Control and Prevention (CDC) recommends vaccination with JYNNEOS (MVA-BN) for people who have been exposed to monkeypox but do not have symptoms.
What medicines are used to treat monkeypox?
There are no medicines specifically approved for treating monkeypox infections. However, antiviral drugs and vaccines developed for smallpox may be used as off-label treatments for monkeypox under appropriate circumstances, such as:
- Tecovirimat – This antiviral drug, also known as TPOXX, inhibits monkeypox virus from leaving the infected cells. It is approved for treating smallpox but may be used for severe monkeypox cases under an expanded access investigational new drug protocol.
- Cidofovir – This antiviral medication stops replication of the monkeypox virus. It is approved by the FDA to treat cytomegalovirus infections in people with AIDS but has been used for treating serious monkeypox and smallpox cases during outbreaks.
- Vaccinia immune globulin (VIG) – This is a medication made up of antibodies from people vaccinated against smallpox. VIG is used to treat severe complications of smallpox vaccination. It may also have benefit for severe monkeypox disease.
Hospitalization may be required for managing complications of monkeypox which can include:
- Secondary bacterial infections of skin lesions
- Pneumonia
- Sepsis
- Encephalitis
- Corneal ulcerations and vision loss
The CDC advises that smallpox vaccine, cidofovir, tecovirimat, and VIG all be stockpiled for use in a monkeypox emergency.
What is the treatment approach for monkeypox infection?
Most monkeypox cases are mild and can be managed with symptomatic care at home. Treatment focuses on relieving symptoms and preventing complications. Steps in monkeypox treatment may include:
- Antiviral medications like tecovirimat if given early in illness
- Pain relievers like acetaminophen
- Antihistamines to reduce itching
- Topical creams and ointments applied directly to rash and lesions
- Adequate fluids and nutrition
- Proper wound care for rash and skin lesions
- Medications to treat any secondary bacterial infections
- Vaccination after exposure to prevent disease progression
People with suspected or confirmed monkeypox infections should stay isolated from others until the rash has fully healed. Close contacts should be monitored for symptoms for 21 days after exposure.
What is the prognosis and recovery time for monkeypox?
In most cases, people recover from monkeypox within 2 to 4 weeks. However, in immunocompromised persons, children, and those with other health risk factors, the disease may be more severe or even life-threatening.
The monkeypox rash and lesions go through several stages before scabbing over and falling off. The stages are:
- Macules – flat red lesions
- Papules – raised firm lesions
- Vesicles – lesions filled with clear fluid
- Pustules – lesions filled with yellowish fluid
- Scabs – crusty dried fluid over lesions
The rash progresses through these stages before eventually scabbing over and resolving. Healing usually occurs in around 2-4 weeks. Scabs may leave permanent pitted scarring after falling off.
How is monkeypox transmitted between people?
Monkeypox spreads through close personal contact with an infected person. It can spread through:
- Direct contact with monkeypox rash, scabs, or body fluids
- Respiratory droplets during prolonged face-to-face contact
- Touching contaminated clothing or bedding
Pregnant women can spread the virus to their fetus through the placenta.
The following table summarizes the monkeypox transmission routes:
| Transmission route | Description |
|---|---|
| Droplet spread | Respiratory droplets transmitted during prolonged close contact, like living with or caring for someone with monkeypox. |
| Direct contact | Touching rash, scabs, body fluids, or contaminated objects like clothing or linens. |
| Congenital | Spread from mother to fetus across the placenta during pregnancy. |
Who is at risk of monkeypox infection?
Those at highest risk for monkeypox include:
- People who have had close physical contact with someone with confirmed or suspected monkeypox
- Healthcare workers caring for a monkeypox patient
- Laboratorians handling specimens from monkeypox patients
- Household members of infected persons
- People with a history of travel to areas where monkeypox occurs
- Children under age 8
- People with immunodeficiencies
Gay, bisexual and other men who have sex with men appear to currently be at higher risk for monkeypox in the 2022 outbreak. The reason is believed to be close-knit social networks and sexual interactions within this population. However, monkeypox can affect anyone.
What precautions help prevent monkeypox transmission?
Steps to avoid exposure to monkeypox include:
- Avoiding close contact with anyone showing symptoms of monkeypox
- Practicing good hand hygiene
- Using appropriate personal protective equipment (PPE) when caring for infected individuals
- Isolating infected patients from others
- Avoiding contact with contaminated materials
- Getting vaccinated if you have been exposed to monkeypox
If you develop symptoms of monkeypox, isolate yourself from others and promptly seek medical care for evaluation and testing.
Conclusion
There are no treatments specifically approved for monkeypox, but antiviral medications like tecovirimat, cidofovir, and vaccinia immune globulin can be used for severe cases. Most monkeypox cases are mild and can be managed with symptomatic treatment and prevention of complications. Recovery usually occurs within 2-4 weeks. Vaccination provides protection against monkeypox for those at high risk of exposure. With supportive care and prevention of further spread, the prognosis for monkeypox is generally good.