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Emerging Infectious Diseases: Monkeypox


Monkeypox

General Information

The current number of identified monkeypox cases can be found on the Centers for Disease Control (CDC) webpage. Based on the information about monkeypox in Delaware available at this time, risk to the public appears low. Some people who may have symptoms of monkeypox, such as characteristic rashes or lesions, should contact their health care provider for a risk assessment. This includes anyone who 1) traveled to countries where monkeypox cases have been reported; 2) reports contact with a person who has a similar rash or received a diagnosis of confirmed or suspected monkeypox; or 3) is a man who has had close or intimate in-person contact with another man who has a similar rash within the past month, including through an online website, digital application (“app”), or at a bar or party.

 

 

CDC Announcements

Update for Clinicians on Testing and Treatment for Monkeypox 7.28.2022

 

DHSS Announcements  

DPH Announces Additional Cases of Monkeypox 8.04.22

Delaware Division Of Public Health Reports Two New Cases Of Monkeypox; Risk To Public Remains Low 7.21.22

Delaware Division of Public Health Reports First Case of Monkeypox in State  7.12.2022

 

What is Monkeypox? 

Monkeypox is a viral disease that can be spread between people and certain animals.The monkeypox virus is a part of the same family of viruses as the virus that causes smallpox.

 The first human case of monkeypox was recorded in 1970. Prior to the 2022 outbreak, monkeypox had been reported in people in several central and western African countries. Previously, almost all monkeypox cases in people outside of Africa were linked to international travel to countries where the disease commonly occurs or through imported animals. These cases occurred on multiple continents.

Signs and 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 seven to 14 days but can range from five to 21 days.

The illness begins with:

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

Within one to three 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

Monkeypox spreads in several ways

Monkeypox can spread to anyone through close, personal, often skin-to-skin contact, including:

  • Direct contact with monkeypox rash, scabs, or body fluids from a person with monkeypox.
    • This direct contact can happen during intimate contact, as well as through hugging, massage, and kissing.
  • Touching objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox.
  • Contact with respiratory secretions.
  • Touching fabrics and objects during sex that were used by a person with monkeypox and that have not been disinfected, such as bedding, towels, fetish gear, and sex toys.
  • A pregnant person can spread the virus to their fetus through the placenta.

A person with monkeypox can spread it to others from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks.

Prevention

There are number of measures that can be taken to prevent infection with monkeypox virus: 

  • 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.
  • Avoid contact with objects and materials that a person with monkeypox has used.
  • 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, especially before eating or touching your face and after you use the bathroom.
  • Avoid contact with animals that could harbor the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).

Vaccination

The CDC recommends vaccination for people exposed to monkeypox and for those at higher risk of exposure, including:

  •  People who have been identified as a contact of someone with monkeypox.
  •  People who are aware that one of their sexual partners in the past two weeks was diagnosed with monkeypox.
  •  People who had multiple sexual partners in the past two weeks in an area with known monkeypox.

It is important to understand that while there may be many persons in DE who want a monkeypox vaccine, not everyone in the population needs a monkeypox vaccine. This is very different from COVID. Spread is primarily through direct contact with an infected person and not airborne transmission. Vaccines are not recommended for children. There are things that people in the general public, as well as the LGTBQ+ community can do to protect themselves regardless of their ability to access vaccine such as limiting direct contact with anyone with a concerning rash, limiting the number of intimate partners, talking openly with intimate contacts about recent behaviors, and not sharing bedding, towels and eating or drinking utensils with anyone who does.

 

Treatment

There are no treatments specifically for monkeypox virus infections. Antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat monkeypox virus infections. Antivirals, such as tecovirimat (TPOXX), may be recommended for people who are more likely to get severely ill, like patients with weakened immune systems. Not everyone with Monkeypox will need antivirals. Many have symptoms that will resolve without additional treatment.

 

If you have symptoms of monkeypox, talk to your health care provider.

 

Testing

If you have symptoms of monkeypox, or are concerned you may have been exposed, contact your health care provider to discuss testing. Don't have a health care provider? Contact MPX hotline at xxx to discuss scheduling a testing appointment at a public health clinic

 

For Medical Providers

If a provider is unable to collect specimen or if a person is under/uninsured or does not have access to a health care provider, DPH/OIDE will coordinate specimen collection with one of the Delaware Public Health Clinics, Delaware Public Health Laboratory (DPHL), and the CDC, if a patient meets the criteria for a suspected case

 

Antivirals

Antivirals should be considered for patients who may be at high risk of severe disease (refer to Interim Clinical Guidance for the Treatment of Monkeypox

 

Vaccine

Refer to the CDC’s Considerations for Monkeypox Vaccination for the recommended use of vaccine in the U.S.  The current vaccine supply in Delaware will be prioritized for post-exposure prophylaxis only. As more doses are available, other strategies, such as Pre-exposure prophylaxis of high-risk groups will be considered.

All requests for vaccines and antivirals should be sent to DPH Office of Infectious Disease Epidemiology (OIDE) at 302-744-4990 (business hours) or 1-888-295-5156 (24/7). OIDE business hours are Monday through Friday from 8 a.m. to 4:30 p.m.

 

Reporting of Cases

  • Once OIDE is notified of a suspected/confirmed monkeypox case, they will help to facilitate obtaining vaccine and antiviral supply through the CDC and the Investigational New Drug (IND) application process. A SHOC Resource Request form must be completed by facility requesting vaccine/antivirals.
  • All suspected cases should be reported to OIDE.
  • To report after hours or on weekends or holidays, Fill out the Morbidity Card and send to reportdisease@delaware.gov  Please include details on where the specimen is located (i.e. specify hospital campus, building) and the estimated time when it will be ready for pickup by courier services.


Office of Infectious Disease Epidemiology
Normal Business Hours Contact Number: 302-744-4990

24/7 Emergency Contact Number: 1-888-295-5156

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