I am an ER Doctor and This Is What You Should Know About Monkeypox — Eat This Not That

Monkeypox is an orthopox virus related to smallpox. It was first identified in humans in Africa in 1970. Currently, there is a global outbreak and spread of the virus in the US. The first case in the US was identified in May 2022. Today, as of August 16, 2022, there are 12,689 cases in the US and 38,019 worldwide. The majority of US cases are in urban areas such as New York City, and more than 98% are in men.

The monkeypox virus is spread by close skin-to-skin contact. The current outbreak is mainly seen in men who have sex with men. The most common vector is through exposure (ie, skin-to-skin contact) with an infected skin rash. However, the virus can also be transmitted through fomites, viral particles, on linens and towels. The virus can also spread through respiratory droplets. However, it requires prolonged face-to-face contact with an infected and symptomatic person.

The virus has a prodrome after 4 days to 3 weeks of infection. After prodrome, early symptoms include fever, headache, lymphedema (swollen lymph nodes), sore throat, muscle aches, and fatigue. A typical rash appears 1-4 days after the initial symptoms. Patients are considered contagious from the time symptom onset and transmission occurs through intimate sex and skin-to-skin contact. The virus can be transmitted through sputum droplets and skin contact but contact should be significant. It is more difficult to spread the disease in this way. So, to clear up any misinformation, monkeypox does not spread as easily as COVID-19 or influenza. It is more difficult to spread and is unlikely to spread through casual contact. Currently, the most at-risk group are men who have sex with men and engage in sexual activity with multiple partners.6254a4d1642c605c54bf1cab17d50f1e

Patients with monkeypox will remain contagious for 3-4 weeks and should be isolated until all rashes have completely healed. The good news is that monkeypox is rarely fatal and we have both vaccines and antiviral drugs that appear to be effective. The mortality rate for monkeypox is less than 99% if it survives its course. Persons at risk include immunocompromised patients, children below 8 years of age and pregnant women.

Currently, there is a limited supply of smallpox vaccine that is being distributed by the federal government. These vaccines can be administered within 2 weeks of exposure to monkeypox. They can be used to vaccinate high-risk populations. The regimen is a 2-injection course spaced 4 weeks apart, and some data has indicated that the vaccine is 85% effective in preventing monkeypox.

For individuals who have monkeypox and are at risk of a significant course or progression, they may receive a 2-week course of tapox. This antiviral drug is approved for the treatment of smallpox and is also being used to treat cases of monkeypox.

What can you do to protect yourself?

Most of the population is not currently at high risk of contracting monkeypox. Take proper precautions for general public. If you know people who have fever/rash, avoid skin-to-skin contact, prolonged contact, or sexual intercourse. Use caution when engaging in sexual activity and avoid contact with individuals who show viral symptoms and rash.

What are the current CDC quarantine recommendations?

People with monkeypox should follow these recommendations (posted on the CDC website) unless approved by state or local public health officials:

• Friends, family or other people should not go into the house without any urgent need.
• Avoid close contact with others.
• Avoid close contact with pets and other animals in the home.
• Do not engage in sexual activity that involves direct physical contact.
• Do not share potentially contaminated items, such as bed linens, clothing, towels, laundry, drinking glasses or eating utensils.
• Regularly clean and disinfect commonly touched surfaces and objects such as counters or light switches.
• Wear well-fitting source control (eg, medical masks) when in close contact with others at home.
• Avoid the use of contact lenses to prevent unintentional infection of the eye.
• Avoid shaving the rash-covered areas of the body as this can spread the virus.
• Bathroom use:
• If possible, use separate bathrooms for other people living in the same house.
• If the home does not have a separate bathroom, the patient should clean and disinfect surfaces such as counters, toilet seats, faucets using an EPA-registered disinfectant after using the shared space. This can include taking a bath, using the toilet, or during activities such as changing the bandages that cover the rash. If a rash is present on the hands, consider using disposable gloves when cleaning.

Limit exposure to others:

• Avoid contact with unaffected individuals until the rash has resolved, the scab has fallen off, and a new layer of intact skin has formed.
• Isolate in a separate room or area from other household members and pets whenever possible.
• Do not share utensils and other eating utensils. It is not necessary for an infected person to use a separate vessel if properly washed. Wash dirty dishes and eating utensils in the dishwasher or by hand with warm water and soap.

Ideas for separation with animals in the home:

• People with monkeypox should avoid contact with animals (especially mammals), including pets.
• If possible, friends or family members should care for healthy animals until the owner is fully recovered.
• Keep any potentially infectious bandages, clothing (such as clothing, bedding) and other items away from pets, other domestic animals, and wildlife.

Darren P. Marinis, MD, FACEP