Monkeypox Outbreak: Answers for Patients

Monkeypox seen under a microscope (Adobe Stock)

Many patients are concerned about the recent worldwide monkeypox outbreak. Health care workers could struggle how to answer the questions. How should health care workers answers the questions that their patients ask? Recently, Infection Control Today^® (ICT^®) asked Acey Albert, MD, FACP, internist, pediatrician, and director of clinical content at epocrates, how health care workers should answer their questions.

ICT^®: How did monkeypox start? And how does it spread?

Acey Albert, MD, FACP: Monkeypox was first discovered in 1958 in colonies of monkeys kept for research purposes, it and was named because of these outbreaks, even though the true source of the infection remains unknown. It is thought that certain rodents and non-human primates may harbor the infection. The first human case occurred in 1970. Until this year’s outbreak, cases in humans occurred only in people who lived in or visited certain central and west African countries, or via contact with animals imported from those areas. Transmission to humans has typically occurred through being scratched or bitten by the animal or by preparing or eating meat or using products from an infected animal. Though, this recent outbreak has been a bit different. The initial cluster has been described in the United Kingdom in May of this year, and the first case had travel ties to Nigeria, where the disease is endemic. This has been typical of previous outbreaks outside of Africa. However, this outbreak then spread via human-to-human transmission, primarily among groups of men who have sex with men.

The disease is spread via close, personal, often skin-to-skin contact and contact with contaminated objects such as clothing, bedding, or towels, according to the Centers for Disease Control and Prevention (CDC). Unlike COVID-19, the risk of airborne transmission with monkeypox is low.

ICT^®: People think that monkeypox is a sexually transmitted disease. Is that accurate?

AA: Yes and no. This outbreak of monkeypox differs from previous outbreaks outside of the endemic African countries in that there has been significant human-to-human transmission. While much of this transmission has occurred through intimate and sexual contact, it is important to note that transmission occurs through any prolonged contact with the rash, scabs, or body fluids of an infected person, sexual or not. It can also be spread via fabrics or objects that have come in contact with those skin lesions or fluids, and potentially by close, prolonged, face-to-face contact.

ICT^® : Many people worry about getting infected by touching someone with monkeypox on public transportation or even from a handshake. Is there a risk of getting monkeypox that way or does it require closer contact? Also, when is a person infectious and most likely to spread the disease?

AA: Though this is theoretically possible, it hasn’t really happened in this outbreak. Most of the cases involve closer, more prolonged contact.

We know monkeypox is contagious from the time symptoms start until the last lesions have completely healed and a fresh layer of skin has formed. However, because the first lesions typically occur in the mouth or in parts of the body not readily visible (such as the area around the anus) and because the rash in this outbreak can occur without the typical preceding symptoms (eg, fever, muscle aches, swollen lymph nodes), people may not know their symptoms have started. Research is ongoing to determine whether people without symptoms can spread monkeypox virus.

ICT^®: What are some precautions people should take to avoid monkeypox?

AA: First and foremost, monkeypox can be prevented by the exact same hand hygiene measures (eg, handwashing, hand sanitizer) we reintroduced to people during the early stages of the COVID-19 pandemic. In the setting of this outbreak, it is also important to avoid close, skin-to-skin contact with anyone with the disease or who has skin lesions consistent with monkeypox. Contact with objects or materials used by people with monkeypox should also be avoided. For those at high risk of coming in contact with the illness, two vaccines, Jynneos and ACAM2000, are available, and immunization providers can be located via mpoxvaxmap.org.

ICT^®: What should health practices be doing to prevent monkeypox from spreading?

AA: The most important thing is to remember that the symptoms in this outbreak mimic other diseases clinicians are used to seeing, such as herpes, syphilis, and chickenpox. Hence, they need to ensure they are maintaining a high level of suspicion of any patient presenting those symptoms and properly screening those cases. They also need to pay extra attention to communications from their public health departments, either at a local or state level, because those are the entities that are key to testing, preventing, and treating monkeypox. We also must remind ourselves of all the lessons we learned for COVID-19, for example, ensuring that practices have adequate personal protective equipment on hand and keeping the same precaution used during the pandemic, like using gowns, gloves, goggles, and masks, and regularly reviewing the latest CDC guidelines.

ICT^®: Do you think the outbreak could evolve to an epidemic or even a pandemic?

AA: The case numbers and trends here in the US don’t seem to indicate that either will happen. At the moment, we seem to be on a sustained downward trend, with cases peaking in mid-August, just a couple of weeks after the peak in first-dose vaccination administration. Though this outbreak was significantly larger than previous outbreaks in humans, the case numbers just aren't large enough to declare an epidemic or pandemic. To date, there have been over 65,000 cases worldwide, and just shy of 25,000 here in the US. Compare that with COVID-19, which, as a pandemic, infected over 95 million here in the US alone.