Submitted by Dr. Steve Miszkiewicz
LCO Health Chief Medical Director
For the week up to Thursday, May 26, LCO has had eleven positive cases and none of which have been severely ill. We continue to stress vaccines. Boosters for 5-11yr olds are now available as well as second boosters for age 50 and above if more than 4 months has passed since first booster.
Below you'll find some information regarding “Monkey pox." So far it is not a major concern in this area but, once again, a reminder that with social distancing one will not catch this illness.
Monkeypox, an orthopoxvirus, was first isolated in the late 1950s from a colony of sick monkeys. The virus is in the same genus as variola (causative agent of smallpox) and vaccinia viruses (the virus used in smallpox vaccine). ●Transmission – The virus is typically acquired through contact with an infected animal's bodily fluids or through a bite. Monkeys and humans are incidental hosts; the reservoir remains unknown but is likely to be certain rodents.
Human-to-human transmission can also occur. Transmission can occur through large respiratory droplets, and prolonged face-to-face contact may be required (eg, within a six-foot radius for ≥3 hours in the absence of personal protection equipment [PPE]). Transmission can also occur through close contact with infectious skin lesions. In May 2022, an outbreak in non-endemic countries appears to be associated with sexual activity, although the exact mechanism of transmission is not yet known.
●Geographic distribution – Since discontinuation of smallpox immunization, most cases have occurred in Central and West Africa. However, sporadic cases have been reported in several nonendemic countries, typically in returning travelers. In the United States, an outbreak of monkeypox due to infected prairie dogs exposed to imported animals from Africa occurred in 2003.
●Clinical features – In patients with monkeypox, the incubation period from time of exposure to clinical illness is usually from 6 to 13 days.
Predominant symptoms of monkeypox include fever, rash, lymphadenopathy, myalgias, and chills. Most patients with monkeypox have a mild illness; those with nausea, vomiting, or dysphagia may need hospitalization for intravenous hydration.
●Diagnosis – The clinical features are helpful in making the diagnosis of monkeypox; however, laboratory confirmation is necessary to differentiate this disease from those caused by other potential etiologies.
Diagnostic assays include virus isolation (in mammalian cell cultures), electron microscopy, real-time polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA), and immunofluorescent antibody assay. If the diagnosis of monkeypox is being considered, local and state public health officials, along with the Centers for Disease Control and Prevention (CDC), should be notified.
When evaluating a patient with suspected monkeypox, varicella, herpes simplex infection, smallpox, and other orthopoxvirus infections should be included in the differential diagnosis.
●Patient management – Most patients have mild disease and recover without medical intervention. For the seriously ill patient, supportive care is necessary until the patient recovers from the infection. The antiviral agents, tecovirimat and brincidofovir, which have been approved for treatment of smallpox in the United States, also have activity against monkeypox in animal models and are likely to be efficacious against this infection in humans as well.
●Prevention – Standard, contact, droplet, and airborne precautions should be initiated in any hospitalized patients with generalized vesicular rash of unknown etiology in which monkeypox and smallpox are included in the differential diagnosis. In addition, close contacts should be monitored. The use of smallpox vaccination for pre-exposure and post-exposure prophylaxis may also be reasonable in select settings, and should be considered in consultation with public health authorities.