Monkeypox Virus Infections

Scientists at the Centers for Disease Control and Prevention (CDC) are tracking multiple cases of monkeypox that have been reported in several countries that don’t normally report monkeypox, including the United States.  As of August 10th, 2022, the US is reporting 20,733 cases of monkeypox. Texas has 1,859 confirmed cases of monkeypox.

The Centers for Disease Control and Prevention (CDC) and the Texas Department of State Health Services (DSHS), along with local and regional public health departments are investigating persons with suspicion of monkeypox to determine whether they meet case definitions and are monitoring anyone with reported contact with confirmed cases.

monkeypox

Recommendations for the Public

Based on the evolving situation, risk to the general public appears low. People who may have symptoms of monkeypox, such as the characteristic rash or lesions, should contact their healthcare provider for evaluation. This especially includes anyone who 1) has symptoms concerning for monkeypox who traveled to countries or states where monkeypox cases have been reported, 2) reports contact with a person who has a rash similar to monkeypox or who has received a diagnosis of confirmed or suspected monkeypox, or 3) has symptoms concerning for monkeypox who is a man who has had close or intimate in-person contact with other men in the past month.

Recommendations for Clinicians

If clinicians identify patients with a rash that could be consistent with monkeypox, especially those with a recent travel history to a country or state where monkeypox has been reported, monkeypox should be considered as a possible diagnosis. The rash associated with monkeypox can be confused with other diseases that are more commonly encountered in clinical practice (e.g., secondary syphilis, herpes, chancroid, and varicella zoster). Clinicians should be familiar with the typical presentation of monkeypox.

Clinicians should consult their local health department if they suspect monkeypox. If unable to make contact, please send an e-mail to ([email protected]).

All specimens for monkeypox testing must be approved by the Texas Department of State Health Services before being sent to a Laboratory Response Network (LRN) laboratory. Testing for other more likely etiologies should continue as normal and not be delayed on the basis of testing for monkeypox.

Symptoms

In humans, the symptoms of monkeypox are similar to but milder than the symptoms of smallpox. Monkeypox begins with fever, headache, muscle aches, and exhaustion. The main difference between symptoms of smallpox and monkeypox is that monkeypox causes lymph nodes to swell (lymphadenopathy) while smallpox does not. The incubation period (time from infection to symptoms) for monkeypox is usually 7−14 days but can range from 5−21 days.

The illness begins with:

  • Fever
  • Headache
  • Muscle aches
  • Backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion

Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body.

Lesions progress through the following stages before falling off:

  • Macules
  • Papules
  • Vesicles
  • Pustules
  • Scabs

The illness typically lasts for 2−4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease.

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Monkeypox Vaccines

Mass vaccination is not required nor recommended for monkeypox at this time.

For contact cases, post-exposure prophylaxis (PEP) is recommended with an appropriate second- or third-generation vaccine, ideally within four days of first exposure to prevent the onset of disease.

Pre-exposure prophylaxis (PrEP) is recommended for health workers at risk, laboratory personnel working with orthopoxviruses, clinical laboratory staff performing diagnostic testing for monkeypox, and others who may be at risk as per national policy.

Decisions on the use of smallpox or monkeypox vaccines should be based on a full assessment of risks and benefits on a case-by-case basis.

If you feel you are eligible for a monkeypox vaccine, please contact Tarrant County Public Health at (817) 321-4700.