Monkeypox

Monkeypox is a rare disease that occurs mostly in central and western countries of Africa that contain rain forests. It was discovered in laboratory monkeys in 1958, but has since been found in other African rodents such as squirrels, rats, mice and rabbits. This smallpox-like disease was first discovered in humans in Africa in 1970.

In June 2003, cases of human monkeypox infection were mostly found in the midwestern United States. These cases are the result of handling sick prairie dogs purchased as pets. The Centers for Disease Control and Prevention (CDC) believe that the source of infection probably came from a shipment of animals from Africa. The prairie dogs came in close contact with these animals while in the United States. A Gambian rat, dormice and rope squirrels in the African shipment have tested positive for the monkeypox virus.


Causes/associated factors
Monkeypox is caused by the monkeypox virus. This virus belongs to the orthopoxvirus group. Other viruses in this group known to cause infections in people include variola (smallpox), vaccinia (the virus in the smallpox vaccine) and cowpox viruses.

Transmission
Monkeypox is spread to humans from an animal bite or direct contact with an infected animal's lesions or body fluids. It may also be spread from person to person by respiratory droplets, direct contact with bodily fluids of an infected person, or by touching contaminated objects, such as clothing or soiled dressings. Monkeypox is much less infectious than smallpox, however.

Signs/symptoms
Symptoms begin about 12 days after exposure, and include fever of 100.5°F or higher, chills, sweats, headache, muscle aches, backache, swollen lymph glands, cough, general feeling of discomfort and fatigue. One to three days (sometimes longer) after the fever starts, a raised bumpy rash begins, often on the face, but can start on other parts of the body. The lesions progress from papules (bumps) to vesicles (blisters) to pustules (bumps filled with pus), and eventually crust and fall off. Monkeypox usually lasts for two to four weeks.

Diagnosis
Monkeypox is diagnosed based on medical history (including exposure to an infected rodent or contact with an infected person), physical examination and laboratory testing. Tests include culturing and isolating the virus from a specimen, checking levels of antibodies to the virus, and polymerase chain reaction testing.
If you suspect you have monkeypox, contact your doctor immediately. Before going to a medical facility, let medical personnel know ahead of time that you're coming so they have an opportunity to isolate you from others.


Treatment
There is no specific treatment for monkeypox, but antiviral drugs (cidofovir, for example) are being evaluated as a possible treatment. The smallpox vaccine has appeared to reduce the risk of monkeypox in vaccinated persons in Africa. The CDC is currently recommending the smallpox vaccine to prevent getting monkeypox in those at high risk (investigators of monkeypox cases and health care personnel caring for monkeypox patients, for example). The CDC also recommends the smallpox vaccine for certain people who have been exposed to the monkeypox virus. It may be given up to 14 days following exposure. But due to the risks associated with the smallpox vaccination, it's not recommended for those with weakened immune systems or life-threatening allergies to the vaccine or any of its ingredients, even if they have been exposed to monkeypox.
If you're treated in the hospital, you will be placed in isolation. If you're recovering at home, stay home while you're sick and until all lesions are crusted over. Skin lesions should be covered if possible with clothing to minimize exposure for others. If lesions are extensive, draining or weeping, or if respiratory symptoms are present, you should stay in a separate room from other family members. If respiratory symptoms are present, wear a surgical mask when outside of this area.

Other family members should wear a surgical mask when in the isolation room, and wear gloves if they will be in direct contact with the infected family member. All household members should frequently wash their hands with soap and water. See the "Prevention" section below for further tips.


Complications
Lesions from the monkeypox virus may become infected. Monkeypox has been fatal in 10 percent of the cases in Africa. There have been no deaths from monkeypox reported in the United States.

Pregnancy-specific information
Currently, there is no information about the effect of monkeypox on pregnancy.

Senior-specific information
Currently, there is no information about the effect of monkeypox on older adults.

Prevention
If you have monkeypox and your doctor determines that you can be treated at home, stay home while you're sick and until all lesions are crusted over. Wear a surgical mask when in close contact with anyone who is not infected. Do not go to work, school or other public areas during this time.
If you live with an infected person, wash your hands often with soap and water, or use alcohol-based hand rubs. Wear a surgical mask when in close contact with the infected person, and wear disposable gloves when contacting his or her respiratory secretions, skin lesions or bodily fluids. After contact, throw away the gloves, and wash your hands thoroughly with soap and water. Don't share eating utensils, towels or bedding with the infected person. Use common household cleaners often to disinfect surfaces touched by the infected person. Wash utensils and launder clothes, towels and bedding with soap and hot water.

If you have been exposed to a person or pet that has monkeypox, contact your doctor and monitor yourself for symptoms of illness, including taking your temperature twice a day for 21 days following exposure. The CDC will offer advice about whether someone who has had close contact with a monkeypox patient or an infected pet should receive a smallpox vaccine within the first 14 days of exposure. For assistance with this, contact your local health department.

If you are a pet owner and suspect your pet may have monkeypox, immediately isolate the pet from all people and pets, and contact your local health department for further instructions. Do not release your animal outdoors, and do not leave it at a shelter.