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Published on July 29, 2022

What you should know about monkeypoxWhat you need to know about monkeypox

The latest health issue to receive widespread publicity might not be as deadly as COVID-19, but it’s still serious.

The current international spread of monkeypox has recently been designated a “public health emergency of international concern,” by the World Health Organization. As of July 28, there were about 21,000 cases reported worldwide, including at least 4,907 in the United States and 117 in Massachusetts. WHO has reported five deaths worldwide.

While the disease is rarely lethal, it can create health issues for some people and lead to complications. David J. Pombo, MD, medical director of infection prevention at Cape Cod Healthcare, recently answered some basic questions about the disease and how to treat and prevent it. His answers are below; they have been edited for length.

What is monkeypox?

Monkeypox is a DNA virus related to smallpox and varicella (the virus that causes chickenpox and shingles), but it is not as lethal as smallpox. However, it's worrisome because monkeypox really can lead to secondary complications, especially in immunocompromised people, children, and pregnant women. The virus can apparently cross the placenta and cause fetal death, so pregnant women have to be quite careful.

In immunocompromised people, it can cause a pretty [widespread] disease as well. Occasionally, people can get encephalitis or pneumonia, things that can cause serious complications. But most of the complications are related to either the pain or the secondary skin infections, such as severe streptococcal cellulitis. Hospitalizations are generally for control of pain from the lesions if they're in a sensitive area, such as the genitals, or in the throat. Some patients get ulcerative lesions on the tonsils, which can cause difficulty with oral intake, leading to dehydration.

Are we seeing monkeypox on Cape Cod?

Cape Cod is having some cases. In the Provincetown area there is a vaccination center that has been set up by the state.

How does monkeypox spread?

The current outbreak is being transmitted primarily through sexual networks and is passed by skin-to-skin contact. It can occur in the genital regions, and that can increase the risk for other sexually transmitted diseases like syphilis, gonorrhea, and chlamydia. Monkeypox infection has nothing to do with your sexual preferences; it can be spread by anybody who has close contacts with the skin lesions or respiratory droplets, just like chickenpox. People who have frequent sexual partners are more at risk, however. The WHO Director General Tedros Adhanom Ghebreyesus said on July 28 that, so far, 98 percent of monkeypox cases have been reported in men who have sex with men.

What are the symptoms of monkeypox?

For most people, it's just general flu-like symptoms, headache, muscle aches, fever, and swollen lymph nodes. Then, usually, patients develop a rash with a pustule. The pustule can be limited – as few as only one on the genitals, or a few scattered ones that develop over time. Most people get a rash with what we call a vesicle, which is like a fluid-filled blister, which then ruptures, like a chickenpox, but bigger. Usually on the face, or the trunk, or the arms, but anogenital is very common in the current outbreak, and/or genital.

What is the treatment for monkeypox?

In the United States, the CDC has approved two vaccines: Jynneos and ACAM2000. However, there’s a limited supply of Jynneos, and ACAM2000 cannot be given to people who have some health conditions, including a weakened immune system, skin conditions like atopic dermatitis/eczema, or pregnancy, according to the CDC. If you get Jynneos within the four days after exposure, it can actually prevent the disease and can ameliorate its intensity up to two weeks after exposure. Currently there's a Jynneos bottleneck that hopefully will be relieved soon by importation. There are some antivirals that are possibly useful, but they're not widely available.

In Massachusetts, vaccination appointments are available at 13 locations, including at Outer Cape Health Services in Provincetown. Appointments may be made by calling 508-487-9395, 8 a.m. to 5 p.m., Monday through Friday. To be eligible for the vaccine, patients must meet criteria established by the U.S. Centers for Disease Control, which include exposure to a known case or multiple sexual partners within the last 14 days.

How long would I be contagious with monkeypox?

You would no longer be contagious when the pustules are completely healed over, and the skin is normal. The virus has been found in semen, but it is not known if the semen is actually infectious. The WHO is recommending condom use for 12 weeks after recovery from monkeypox. The WHO has also recommended that men who have sex with men limit their number of partners to help stop the spread.

What else is important to understand about monkeypox?

The vaccine's going to be in limited supply for some period of time, and there's going to be a large demand. Estimates are that two million doses will be available in the United States in this current year, and for another two million doses next year. That's only four million doses for the entire country, and it's a two-dose series, so, you need another dose four weeks later. It's really incumbent on people to protect themselves by avoiding high-risk activities, because there are not widely available antivirals, and the vaccine, which is the only real approach to either preventing it or reducing the severity of disease, is in very short supply.

To avoid monkeypox, the CDC recommends:

  • Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox.
  • Do not touch the rash or scabs of a person with monkeypox.
  • Do not kiss, hug, cuddle or have sex with someone with monkeypox.
  • Do not share eating utensils or cups with a person with monkeypox.
  • Do not handle or touch the bedding, towels, or clothing of a person with monkeypox.
  • Wash your hands often with soap and water or use an alcohol-based hand sanitizer.