- Cases of monkeypox have been climbing globally.
- The U.S. currently has the highest number of known cases compared to other countries.
- Treatments used for smallpox may work for monkeypox but are not easy to get.
Health experts globally are working to reduce the burden and lessen the outbreak of monkeypox as the World Health Organization has recently declared monkeypox to be a global health emergency.
Although this is a rare condition, numbers have been climbing steadily since May. Experts are not only trying to raise public awareness but are attempting to use vaccines and medications to prevent and treat this virus as well.
Monkeypox has been seen in the U.S. previously but this outbreak has led to a record number of cases. In 2003, 47 cases in the United States were linked to animals and last year there were two travelers from Nigeria who contracted monkeypox as well.
According to the Centers for Disease Control and Prevention, there have been over 3,400 confirmed cases in the United States. This number contributes to over 16,000 reported cases around the world according to University of Oxford data.
What are the symptoms of monkeypox?
Symptoms of monkeypox tend to be mild and are overall non-life-threatening to most however the pain and disability associated with it can be severe.
Symptoms include a rash and flu-like symptoms which can show up several weeks after being initially infected. Additionally, lymphadenopathy, or enlarged lymph nodes, also appear after the upper respiratory symptoms.
In some cases, people may only experience a rash and no flu symptoms.
Although classic symptoms of monkeypox include raised pox, or enlarged pimples, throughout the entire body, with this current outbreak the symptoms can be more discrete. Skin lesions can be in various areas of the body, in the current outbreak physicians have seen lesions on the face, the hands, feet, chest, genitalia, the buttocks, and sometimes within the mouth as this virus is mostly transmitted through close contact including sexual or intimate contact.
What treatment options are available?
There are no definitive treatments for monkeypox that have shown to be efficacious in people who acquire the virus, however, there are medications that have the potential to show promise in severe cases.
Most monkeypox cases resolve with only the use of over-the-counter medications for symptomatic care. However, more severe cases can be treated with an antiviral medication called Tecovirimat or TPOXX, which is available through the US stockpile.
Although this medication is available, it is not directly approved for monkeypox. Tecovirimat was approved in 2018 for the treatment of smallpox in adults and children but it has not been directly studied in monkeypox. Clinical trials of animals have shown that there is some efficacy in treating all diseases caused by orthopoxviruses, which includes monkeypox.
Several physicians have reported that getting this medication can be difficult as they had to go through a lengthy process to obtain it from the US Stockpile for their patients.
“The administrative and bureaucratic issues surrounding giving tecovirimat are substantial and many clinicians struggle with getting this medication,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Tennessee.
The CDC has given guidance to those who qualify for this medication including those with severe illnesses.
“Currently tecovirimat is only available from a CDC-sponsored expanded access program for patients at high risk for complications – those that are immunocompromised, pregnant, and children under eight – or those with severe disease such as lesions in the eye, mouth, or anogenital areas, disseminated lesions, or encephalitis,” said Dr. Roy Gulick, Chief of the Division of Infectious Diseases at the Weill Medical College of Cornell University.
Another medication called Brincidofovir, or CMX001, has similarly been approved for the treatment of smallpox, and the CDC is currently creating a protocol to use it for monkeypox but can be more toxic to individuals taking the medication.
Despite the potential promise of these medications, they are still not readily available to all physicians and pharmacies.
“The primary option for treatment is Tecovirimat which is not readily available in hospitals or pharmacies and must be obtained through a specialist working closely with the health department or CDC,” explained Dr. Jeremey Walker, assistant professor at the University of Alabama at Birmingham Division of Infectious Diseases.
Is vaccination still an option?
“There are currently two vaccines, however JYNNEOS, which is the less dangerous vaccine, is currently…being deployed in areas where there are the most cases such as New York,” Schaffner told Healthline.
Schaffner explains that not everyone who wants the vaccine can get it and “it is being targeted at people who are known to be exposed or have been in circumstances where there has been known or substantial transmissions.”
Hot spots like New York City have government officials asking for more doses to help keep up with the demand but it seems to be slow to roll out in comparison to the demand.
“With limited supplies of monkeypox vaccine, they are prioritizing close contacts of known cases within the last 14 days as well as those at greatest risk – currently considered to be men who have sex with men who have had ‘multiple or anonymous sex partners in the last 14 days’”, said Gulick.
While many may want the vaccination, those who are receiving it are getting it as a “postexposure prophylaxis,” says Walker.
“Providing the vaccine following exposure to monkeypox in order to prevent disease, and in order to do this the vaccine should be given within four days of exposure,” Walker continued.
How do we prevent the spread of monkeypox?
Health experts recommend that vulnerable populations monitor themselves for symptoms and examine intimate partners for symptoms. The disease spreads through close contact, as the lesions can contain virus, and exposure to the lesions can result in developing the disease.
“Spreading awareness of the condition and rapid diagnosis and quarantining remain important strategies to control this outbreak,” Walker tells Healthline.
While vaccines are still not as readily available as some experts would like, Walker also believes that having an “infrastructure to providing these vaccines to those with known exposure or at high risk for exposure in appropriate settings,” will make the greatest impact in gaining control – something he believes we can do.
As cases of monkeypox rise, Gulick advises the public should be educated on the virus and its symptoms as symptoms can be atypical – not having the usual classic symptoms – so being vigilant can be important to your health.
“If you have been exposed, think you have been exposed, or believe you have the symptoms of monkeypox, you should talk to your physician or the health department as the major lab companies across the country are now able to test to identify those who have the virus,” says Schaffner.
Rajiv Bahl, MD, MBA, MS, is a board-certified emergency medicine physician and health writer. You can find him at RajivBahlMD.com.