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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

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Dr. Francisco R. Velázquez: During global monkeypox outbreak, important to understand the virus, risk level

Francisco R. Velázquez, M.D., S.M., FCAP

By Francisco R. Velázquez, M.D., S.M., FCAP

As summer progresses, so does the news about monkeypox. It is not difficult to imagine why there are so many questions and misconceptions about this disease. Let’s start at the beginning.

The virus we know today was identified in the 1950s in research monkeys, hence the name. In the 1970s, the first case of human infection was recorded. Throughout the years, this disease has been endemic, meaning found in specific locations in at least 12 nations in Africa. Transmission is usually the result of an interaction with an infected animal. However, about a quarter of the cases of monkeypox in endemic areas are person-to-person transmission. Most cases in the past were traced back to either an animal exposure or international travel involving either an infectious person or an infected animal.

Animal bites, scratches, uncooked meat, or prolonged skin contact with a person’s rash or soiled porous items such as linens and towels have been the main transmission sources. In general terms, this disease is not easily transmitted, and casual contact has not been identified as a transmission risk. This is why the disease remains rare and not a high risk for most people.

Symptoms that can include fatigue, muscle aches, chills, fever and swollen lymph nodes can appear after an incubation period that usually lasts for six to 13 days, but can be as long as 21 days. Shortly after, a rash can appear as raised spots, which turn to fluid-filled vesicles and pustules. These lesions can be identified in different parts of the body. The disease usually lasts two to four weeks, and a person is infectious until all skin lesions have completely resolved and the person is asymptomatic. Clinically, most patients do not require intensive treatment. A small percentage require hospitalization for pain management or secondary infections.

What do we know about the almost 30,000 cases in close to 90 countries identified in the 2022 outbreak? As opposed to prior outbreaks, we know that transmission is mostly person-to-person. It is not a sexually transmitted infection but rather a disease being transmitted through prolonged, close or intimate contact with the skin of someone infected and infectious. Over 98% of those affected are men who have sex with men, and according to recently published data, roughly 95% of them report sex with one or more partners in the previous 14 days. Close skin contact, such as cuddling, appears to be the transmission mode for household contacts such as children, of whom at least five have been infected in the United States. It has not been determined if there is enough replicating virus in body fluids to cause infection, though the high viral load in saliva and semen suggests it may be possible.

There are some other differences in clinical presentation that have been described. As an example, the flu-like symptoms have not been present in all patients. Many people were diagnosed when seeking medical care for lesions. Some have presented with rectal pain, sores in their mouth, or single lesions in their genitals. The atypical presentation may initially make it difficult to differentiate from other diseases. Assessment of travel, sexual history and other risk factors is crucial in the differential diagnosis. If monkeypox is suspected, testing is widely available throughout the country.

Prevention, testing, post-exposure prophylaxis and available antiviral treatment are all important in preventing severe disease and disease spread. If a person has an unexplained rash and a clinical history consistent with a higher risk, they should seek medical attention, isolate and avoid prolonged physical contact with others to decrease transmission risk. Limiting activities where prolonged skin contact is difficult to avoid can prevent a potential exposure. The Jynneos vaccine can be used in post-exposure prophylaxis. In addition, some public health agencies, including Spokane Regional Health District are deploying a single dose of vaccine for those at highest risk for infection to try to decrease potential cases. Symptomatic individuals may be treated with Tecovirimat (Tpoxx) if at risk for more severe disease due to pre-existing conditions, age (particularly children younger than 8 years of age), and pregnancy.

As with any other communicable disease, know your level of risk and the risk for those around you.

This is still considered a rare disease, not easily transmitted person-to-person, but it is important to know the facts and take the appropriate actions to safeguard yourself and others from transmission.

Francisco R. Velázquez, M.D., S.M., FCAP, is the health officer for Spokane Regional Health District.