Trending Clinical Topic: Monkeypox

Ryan Syrek


June 24, 2022

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Although the World Health Organization has stated that it does not believe that monkeypox will become a pandemic on the scale of COVID-19, concerns about the recent global outbreak have resulted in the week's top trending clinical topic. Until recently, the disease has been limited primarily to Central and Western Africa. However, 2022 has seen a dramatic uptick in cases around the globe (see Infographic).

Monkeypox symptoms usually develop 5-21 days after infection and include fever, chills, and swollen lymph nodes. Within 1-3 days of fever onset, a rash typically develops and is followed by the formation of monkeypox lesions. These progress from macules to papules, vesicles, pustules, and scabs before falling off.

The monkeypox virus is known to spread through close contact. Infected individuals shed the virus via lesions or large respiratory droplets. Although some experts disagree, the Centers for Disease Control and Prevention (CDC) has pushed back against suggestions of airborne spread. Many of the confirmed cases thus far are among sexual partners. The CDC has also cited early data which suggest that gay, bisexual, and other men who have sex with men comprise a high number of cases. Recent findings out of Italy suggest that fragments of the monkeypox virus have been detected in semen.

Most cases spreading in the United Kingdom, Europe, and the United States are the same strain. However, investigators have also identified a monkeypox variant. Both strains appear to have evolved from those present in Nigeria since at least 2017, when the country had its first outbreak in over 40 years.

Although currently licensed in the United States specifically to prevent smallpox, ACAM200 and JYNNEOS are two vaccines with known efficacy against monkeypox. The CDC suggests that the vaccines may be at least 85% effective in preventing disease. In regard to nonvaccination prevention strategies, the European Centre for Disease Prevention and Control (ECDC) has provided guidance, including:

  • Close contacts for cases of monkeypox should monitor for symptom development until 21 days have passed from their most recent exposure.

  • Healthcare workers should wear appropriate personal protective equipment  during screening or when working with confirmed cases.

  • Close contacts should not donate blood, organs, or bone marrow for at least 21 days from the last day of exposure.

The CDC's prevention guidance has been fluid. After issuing a recommendation regarding mask wearing, the organization later rescinded the statement. This was out of fear that the suggestion "caused confusion," a CDC spokesperson said in a statement to Reuters. "The problem with that statement is that it can be interpreted as if masks are the solution to preventing monkeypox transmission, which is not at all the case," added Shira Doron, MD, an infectious disease physician and hospital epidemiologist at Tufts Medical Center in Boston. "Masks would have a negligible effect on monkeypox transmission," she said in an interview with Medscape.

As for treatment, tecovirimat is approved for treating smallpox in the United States but can be used in patients with monkeypox, under a CDC expanded-access drug protocol. ECDC guidance states that tecovirimat is the only antiviral drug with a European Medicines Agency –authorized indication for orthopoxvirus infection. Brincidofovir, another drug used to treat smallpox, is not authorized in the EU but has been authorized by the US Food and Drug Administration.

As case numbers continue to rise, so too does interest in information about why and how monkeypox is spreading, as well as steps to prevent and treat the condition. As more clarity emerges, the disease is likely to stay among the most watched clinical subjects, as it was this week. 

Review a slideshow of critical images related to monkeypox.


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