What is the treatment and prevention for monkeypox?

Monkeypox Treatment and Prevention

Tecovirimat is the recommended first-line antiviral treatment for severe monkeypox cases, while supportive care is appropriate for most mild to moderate cases, and vaccination with JYNNEOS is the preferred preventive measure for high-risk individuals. 1

Clinical Presentation

Monkeypox is a zoonotic viral infection characterized by:

• Initial symptoms: fever, severe headache, lymphadenopathy, myalgia, and fatigue
• Skin lesions: typically erupt within 1-3 days after fever onset
• Distribution: rash tends to be more concentrated on face and extremities than trunk
• Duration: symptoms typically last 2-4 weeks 2

Treatment Approach

Supportive Care (First-Line for Mild-Moderate Cases)

• Pain management with appropriate analgesics
• Adequate hydration
• Wound care for lesions
• Isolation until all lesions have crusted over 1

Antiviral Therapy (For Severe or High-Risk Cases)

Antiviral treatment is indicated for:

• Immunocompromised patients
• Severe disease (>100 lesions, high fever, significant constitutional symptoms)
• Complications (encephalitis, pneumonia, retropharyngeal abscess)
• Lesions near eyes, mouth, or genitals 1

First-Line Antiviral:

• Tecovirimat: 600 mg twice daily orally for 14 days 1
  • FDA-approved based on animal studies showing significant survival improvement in monkeypox-infected macaques (80-100% survival vs 0% in placebo) 3
  • Most effective when started within 4-5 days of symptom onset 3

Alternative Antivirals:

• Cidofovir: Consider when tecovirimat is ineffective
  • Limitations: nephrotoxicity, only available intravenously 1
• Brincidofovir: Another potential option 4

Prevention Strategies

Vaccination

Two FDA-approved vaccines are available:

• JYNNEOS (preferred): Live non-replicating vaccinia virus vaccine

  • Safer option, especially for immunocompromised individuals
  • Approved specifically for monkeypox prevention 1, 4

• ACAM2000: Live replicating vaccinia virus vaccine

  • Higher risk of adverse effects
  • Not recommended for immunocompromised individuals, pregnant women, or those with certain skin conditions 4

Post-Exposure Prophylaxis

• Vaccination ideally within 4 days of exposure can prevent disease onset
• Vaccination 4-14 days after exposure may reduce disease severity 1

Infection Control Measures

• Isolate infected individuals until all lesions have crusted over
• Frequent handwashing with soap and water or alcohol-based (>60%) hand sanitizers
• Avoid direct contact with lesions
• Place used bandages in sealed plastic bags before disposal 1, 5
• Cover rash sites and avoid skin-to-skin contact with others 5

Special Considerations

Immunocompromised Patients

• Higher risk for severe disease
• Should receive antiviral treatment promptly
• Consider Vaccinia Immune Globulin Intravenous (VIGIV) in severe cases 2

Household Contacts

• Household contacts of monkeypox patients should be vaccinated
• JYNNEOS is the preferred vaccine for household contacts as it's safer than ACAM2000
• ACAM2000 should not be used in household members of immunocompromised patients due to risk of transmission 5

Monitoring and Follow-up

• Monitor for disease progression and complications
• Continue isolation until all lesions have crusted over and fallen off
• Watch for secondary bacterial infections of lesions

Complications to Watch For

• Secondary bacterial infections
• Pneumonitis
• Encephalitis
• Keratitis and corneal ulceration if lesions affect the eyes
• Severe scarring in some cases

Monkeypox is typically self-limiting in immunocompetent individuals, but early intervention with appropriate treatment and preventive measures is crucial to reduce transmission and prevent severe outcomes.