Monkeypox

What is Monkeypox?

Monkeypox appears similarly to ordinary discrete smallpox – it’s characterized by lesions that progress over time into pustules and then scabs. However, monkeypox will also feature swelling in the lymph nodes.

The incubation period of monkeypox can last 7-14 days, during which a patient is not contagious and may feel fine. Following this period, the progression of the virus is as follows:

• Prodromal period: First signs appear, including fever, malaise, headache, weakness, and sometimes sore throat and cough. The lymph nodes may swell in the neck (submandibular & cervical), armpits (axillary), or groin (inguinal) and can occur on both sides of the body or just one.
• Rash: Lesions will develop in the mouth and on the body. These lesions go through several stages and are considered contagious through scabbing.

Once lesions appear, they may progress as follows:

• Macules (1-2 days): A macular rash appears on the skin, starting on the face and spreading.
• Papules (1-2 days): Lesions have progressed to macular (flat) and papular (raised).
• Vesicles (1-2 days): Lesions become raised and filled with fluid.
• Pustules (5-7 days): Lesions become filled with opaque fluid, sharply raised, usually round, and firm to the touch.
• Scabs (7-14 days): Pustules have crusted and scabbed over before falling off.

When properly administered before exposure, existing smallpox vaccines are effective at protecting people against monkeypox. There are three currently licensed vaccines in the United States to prevent smallpox, which will be released by the CDC as needed for confirmed cases or exposure:

• ACAM2000: Administered as a live virus preparation that is inoculated into the skin by pricking the skin surface. Following a successful inoculation, a lesion will develop at the site of the vaccination. The virus growing at the site of this inoculation lesion can be spread to other parts of the body or even to other people, so individuals who receive vaccination with ACAM2000 must take precautions to prevent the spread of the vaccine virus.
• JYNNEOSTM: Administered as a live virus that is non-replicating. It is administered as two subcutaneous injections four weeks apart. There is no visible “take” and as a result, no risk for spread to other parts of the body or other people. People who receive JYNNEOS TM are not considered vaccinated until they receive both doses of the vaccine.
• Tecovirimat (ST-246): Central Outreach has partnered with the CDC and now is able to offer TPOXX(tecovirimat) for clients with presumed ocular risk, penile lesions, or peri-anal lesions. Studies indicate effectiveness in treating orthopoxvirus-induced disease.

While not much data is available on alternate treatment options for monkeypox in humans, several options are being researched for potential use:

• Cidofovir and Brincidofovir (CMX001): Data unavailable in humans. Both have been proven effective in vitro and in animal studies.
• Vaccinia Immune Globulin (VIG): data is not available for treatment of monkeypox complications. VIG can be considered for prophylactic use in an exposed person.