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Responding to the monkeypox outbreak
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Rosemary Pitrone
Vial indicating positive monkeypox test result

As of June 22, more than 3,308 cases of monkeypox have been confirmed in 42 countries where the disease is not endemic, including 155 cases in the U.S.

The growing international outbreak of monkeypox virus will require careful coordination among public health officials, clinicians and the community to control, say the authors of a new JAMA Viewpoint article. More than 40 countries around the world have reported new monkeypox cases since May 2022, including countries such as the U.S. where the disease is not endemic.  

Monkeypox is an infectious disease that can cause skin lesions, swollen lymph nodes, fever, chills, muscle aches, headache, sore throat and fatigue. The virus can be transmitted to humans when they encounter infected animals. Until now, monkeypox cases outside of Africa have been rare.  

“The current outbreak illustrates the easy human-to-human transmissibility by direct, intimate contact with lesions that contain the virus,” writes a team of infectious diseases experts from Emory University and the University of Michigan. Jeannette Guarner, MD, professor of pathology and laboratory medicine at Emory University School of Medicine, Carlos del Rio, MD, distinguished professor of medicine in the division of infectious diseases at Emory University School of Medicine, and Preeti N. Malani, MD, professor of medicine in the division of infectious diseases at the University of Michigan, co-authored the article. 

As of June 22, more than 3,308 cases of monkeypox have been confirmed in 42 non-endemic countries. Most cases were reported in Portugal, Spain, Germany and the U.K. among people with no travel-related link to an endemic country. As of June 22, 155 cases have been reported in the U.S. across 23 states and the District of Columbia. Many of these cases have been reported among men who have sex with men, suggesting possible transmission through sexual networks. 

“While monkeypox is not a sexually transmitted infection in the typical sense, it can be easily transmitted during sexual and intimate contact,” the authors write. Direct contact with skin lesions or materials such as clothing, bedding or towels used by an individual with monkeypox should be avoided to prevent transmission. 

Health care workers who care for patients with suspected or confirmed cases of monkeypox should wear personal protective equipment. Patients with monkeypox should be masked and placed in isolation, and skin lesions should be covered with a gown or sheet. 

Contact tracing and diagnostic testing are critical to prevent further transmission. The incubation period for monkeypox infection ranges from five days to three weeks, and infection typically lasts two to four weeks. Currently, monkeypox infections in the U.S. can only be confirmed by PCR testing conducted through state public health departments.  

The authors note that previous smallpox vaccination, which is no longer routine, may provide some protection against monkeypox. Smallpox vaccines are no longer widely accessible in the U.S., but they can prevent disease if administered within four days of exposure or reduce the severity of symptoms if administered within 14 days after exposure. 

While there are no specific drugs for the treatment of monkeypox, there are antivirals that can alleviate symptoms. Clinicians should consult with local public health departments to access antiviral drugs for monkeypox treatment. 

The risk of developing monkeypox infection remains low in the U.S., but health care providers should remain alert for patients who have skin lesions consistent with monkeypox. 

More information about the 2022 monkeypox outbreak can be found at the Centers for Disease Control and Prevention website

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