*This article was originally published on May 31, 2022, and has been updated to reflect additional information on this virus in the U.S.
Monkeypox continues to spread in pockets across the U.S. and the world, with Iowa reporting its first case on July 1 and the first reported case in Johnson County on July 19.
Karen Brust, MD, hospital epidemiologist.
We know you’re likely getting questions from your patients, and you may even have questions yourself.
To learn more, we spoke to Hospital Epidemiologist Karen Brust, MD.
What is monkeypox?
Monkeypox is a rare disease that is caused by infection with the monkeypox virus. Monkeypox virus is related to variola virus (which causes smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus. Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, which give us the name ‘monkeypox.’
The first human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo during a period of intensified effort to eliminate smallpox. Since then, monkeypox infections have been rare, and mostly confined to central and west Africa. In 2003, there was an outbreak of cases in the U.S. linked to infected exotic pets. This outbreak was quickly contained, in part because sustained human-to-human transmission of monkeypox has been uncommon. Recently, however, there has been active spread of cases outside of Africa in areas not previously affected.
What are the symptoms of monkeypox?
Traditionally, monkeypox has started with a flu-like illness and includes symptoms of fever, headache, muscle aches, and exhaustion. Then the patient may develop swollen lymph nodes (lymphadenopathy). Within one to three days (sometimes longer) after the appearance of fever, the patient develops a rash. During this current outbreak, there may be a rash with or without flu-like illness. It may present as a genital or perianal skin eruption. The incubation period (time from infection to symptoms) for monkeypox is usually seven to 14 days but can range from five to 21 days. The illness typically lasts for two to four weeks.
How does monkeypox spread?
Monkeypox is spread when a person comes into contact with the virus from an animal, human, or materials contaminated with the virus. The virus enters the body through broken skin (even if not visible), respiratory tract, or the mucous membranes (eyes, nose, or mouth).
Human-to-human transmission does not occur readily but when it does, it is thought to occur primarily through large respiratory droplets from prolonged face-to-face contact. Other human-to-human methods of transmission include direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens.
People with monkeypox in the current outbreak generally report having close, sustained physical contact with other people who have monkeypox. While many of those affected in the current global outbreaks are gay, bisexual, or other men who have sex with men, anyone who has been in close contact with someone who has monkeypox can get the illness.
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.
Source: CDC/Cynthia S. Goldsmith
What should you do if you think you may have monkeypox?
People who have flu-like symptoms followed by swollen lymph nodes and/or unusual skin lesions should contact their health care provider.
What should health care providers do if they suspect a patient may have monkeypox?
Identify. Identify a rash consistent with monkeypox, irrespective of travel history and sexual orientation. Skin lesions may vary from umbilicated papules to pustules. Lesions may look similar to molluscum contagiosum, syphilis, herpes simplex virus, varicella zoster virus, chancroid, etc.
Isolate. Patients should be placed in an airborne isolation room if available, otherwise keep the door closed and have patients wear a surgical mask. Staff caring for the patient must wear an N95 respirator, (or CAPR), gown, gloves and eye protection. If possible, room the patient immediately.
Inform. To test for monkeypox, you can place an order in Epic by searching for “monkeypox” as a synonym. Be sure to follow the instructions in the order carefully. Once this order is placed, public health authorities will be informed and will provide guidance regarding specimen collection and handling. View more on The Point.
Is UI Health Care testing for monkeypox?
Yes, testing is available in Epic (search for “monkeypox” as a synonym). Please follow the instructions in the order carefully and be sure to read them every time as they are likely to change. Ordering instructions will be duplicated in the Pathology Handbook if you would like to read about the materials needed to collect samples, or the protocol for ordering testing.
Is there a vaccine to prevent monkeypox?
Because monkeypox and smallpox viruses are genetically similar, vaccines developed to protect against smallpox viruses may be used to prevent monkeypox infections.
Can I receive the monkeypox vaccine through UI Health Care?
At this time, UI Health Care has not received any vaccine for monkeypox. Because supplies are limited in the United States, the vaccine has been used only for people with a known exposure to someone who has tested positive for monkeypox. Please contact your local public health office for details about your eligibility for this vaccine.
For answers to other frequently asked questions, visit uihc.org.
Additional resources
- Infection Prevention on The Point
- U.S. Centers for Disease Control and Prevention (CDC)
- World Health Organization (WHO)
- Rounding@Iowa Podcast: Talking to your patients about monkeypox
Source: CDC