From the Guidelines
Monkeypox is a viral infection that requires prompt medical attention if suspected, and the most effective way to prevent it is by avoiding close contact with infected individuals or animals, practicing good hand hygiene, and using personal protective equipment if you're a healthcare worker, as recommended by the most recent guidelines 1.
Symptoms
The symptoms of monkeypox typically include fever, headache, muscle aches, and fatigue, followed by a distinctive rash that progresses from flat spots to raised bumps, then fluid-filled blisters that eventually scab over. The rash often starts on the face and spreads to other parts of the body, including hands, feet, and genitals.
Precautions
To prevent monkeypox, it is essential to avoid close contact with infected individuals or animals, practice good hand hygiene, and use personal protective equipment if you're a healthcare worker. If you've been exposed, consider getting vaccinated within 4 days of exposure, as it may prevent the disease or reduce its severity. A live replication-deficient modified vaccinia Ankara vaccine (Jynneos) to prevent monkeypox is safe for household contacts of immunocompromised patients 1.
Diagnosis
Diagnosis is typically made through clinical evaluation and confirmed by PCR testing of lesion samples. If you suspect monkeypox, isolate yourself and contact your healthcare provider immediately for guidance.
Treatment
Treatment is mainly supportive, focusing on symptom relief. This includes rest, staying hydrated, and managing fever with acetaminophen or ibuprofen. In severe cases or for high-risk individuals, antiviral medications like tecovirimat (TPOXX) may be prescribed. The typical course is 14 days, with 600 mg taken twice daily for adults.
Prevention and Isolation
Most people recover from monkeypox within 2-4 weeks without specific treatment. However, it's crucial to follow isolation protocols to prevent transmission to others. The virus spreads through close contact with lesions, body fluids, or respiratory droplets from an infected person or animal. Understanding these basics can help in early recognition and proper management of monkeypox. Personnel involved with direct patient care activities should observe strict contact and airborne precautions until postvaccination immunity has been demonstrated 1.
Some key points to consider:
- Vaccination is recommended for laboratory workers who directly handle cultures or animals contaminated or infected with orthopoxviruses, including monkeypox 1.
- Vaccinia vaccine should not be administered to immunocompromised persons, persons who have eczema or a history of eczema, or to pregnant women 1.
- A live replication-deficient modified vaccinia Ankara vaccine (Jynneos) to prevent monkeypox is safe for household contacts of immunocompromised patients 1.
From the FDA Drug Label
The primary efficacy endpoint for these studies was survival In non-human primate studies, cynomolgus macaques were lethally challenged intravenously with 5 x 107 plaque-forming units of monkeypox virus; Clinical signs of disease were evident in some animals at Day 2-3 post-challenge but were evident in all animals by Day 4 post-challenge Survival was monitored for 3-6 times the mean time to death for untreated animals in each model.
The symptoms of Monkeypox (Orthopoxvirus) in the animal studies included:
- Dermal pox lesions in cynomolgus macaques
- Fever in rabbits The diagnosis of Monkeypox (Orthopoxvirus) is not directly stated in the provided text. The treatment options for Monkeypox (Orthopoxvirus) included:
- Tecovirimat administered orally once daily at a dose level of 10 mg/kg for 14 days, starting at Day 4,5 or 6 post-challenge in cynomolgus macaques
- Tecovirimat administered orally once daily for 14 days at a dose level of 40 mg/kg, starting at Day 4 post-challenge in NZW rabbits Precautions to consider:
- The possibility of resistance to tecovirimat should be considered in patients who either fail to respond to therapy or who develop recrudescence of disease after an initial period of responsiveness 2
- Cross-resistance between tecovirimat and brincidofovir is not expected based on their distinct mechanisms of action 2
From the Research
Symptoms of Monkeypox
- Fever, fatigue, headache, and rash are common symptoms of monkeypox 3, 4, 5, 6
- Lymphadenopathy is a prominent and key symptom of monkeypox, which distinguishes this disease from other diseases and is useful for diagnosing the disease 3, 5, 6
- Other symptoms include chills, muscle aches, backache, and fatigue that may progress to exhaustion 4
- Severe complications such as encephalitis, pneumonia, and retropharyngeal abscess could appear in immunocompromised or critically ill patients 4
Precautions and Prevention
- Avoiding contact with people infected with the virus and using appropriate personal protective equipment are mandatory 3, 5, 6
- Vaccines such as JYNNEOS and ACAM2000 are available, but their effectiveness and safety need further investigation 3, 5, 6
- Pre- and postexposure prophylaxis to prevent monkeypox transmission are recommended in the US for those at high risk for disease transmission 4
- Reducing contact with individuals displaying symptoms, maintaining personal safety, and adhering to practices commonly used to prevent sexually transmitted infections can help prevent the disease 5
Diagnosis
- PCR testing of lesions and secretions is a preferred method for diagnosing monkeypox infection 3, 5, 6
- Early detection of new cases through PCR testing can enhance infection control measures 5
Treatment Options
- The disease therapy is based on medicines such as brincidofovir, cidofovir, and Vaccinia Immune Globulin Intravenous 3
- Tecovirimat is also used to treat monkeypox, and its injectable format was approved recently, in May 2022 3, 4, 5, 6
- Supportive care is the backbone of monkeypox clinical management 4
- There are currently no specific Food and Drug Administration (FDA)-approved therapies for monkeypox, but therapies effective for smallpox have previously been reported to be effective in the management of monkeypox 4