Well folks we seem to have another viral outbreak on our hands. So, for anyone who hasn’t been following the Monkeypox news coverage here is a bit of information on what it is and what it means for us at this point in time. The short version is that If you have any new and unidentified rash, lesion, or sore, you will need to get this diagnosed by a physician before returning to our clinic. For more information, keep reading!
What is Monkeypox?
It is a viral infection of the same family as smallpox and cowpox. (Not, however, related to chickenpox.) It has been endemic in the African continent, the first case was identified in humans in the 1970s. It has recently been spreading more globally, with a big jump in human to human transmission than what is typically seen in this disease. The US has about 6,000 cases identified and it is on the rise. In late July San Francisco saw its case numbers double in about 10 days. There are two primary strains of monkeypox. One that is mostly found in Central Africa and can cause fairly serious illness, and another found mostly in Western Africa that tends to be more mild. The primary strain detected in the recent global outbreak is related to the West African version (phew!). It was declared a global emergency by the WHO on July 24th, and San Francisco declared it a state of emergency July 28th. SF has identified about ⅓ of the cases in the state of California. California has some of the highest case rates in the country with New York having the highest.
What are the symptoms?
The most identifiable symptom is a rash that forms blisters/pustules that then start to itch as they scab over and start to heal. The rash can be widespread or localized to a small area, sometimes only resulting in a small number of blisters. The course of infection is typically an incubation period of 1-2 weeks, then a prodrome period consisting of flu-like symptoms: fever, aches, swollen lymph nodes, etc. After that, the rash forms and can take a few weeks until all the blisters are fully healed. “Fully healed” in this case means that the scabs have fallen off and new skin has covered the area. Some people may not have any flu-like symptoms and only develop a rash. Most people are able to recover at home within 2-4 weeks.
How is it spread?
At this point, the best information is that monkeypox is primarily spread through direct and prolonged contact with a symptomatic individual or with a surface such as bed sheets or clothing that an infected person has used, particularly surfaces that have been in contact with their lesions. At this point the most common mode of transmission seems to be through intimate contact such as prolonged kissing, cuddling, and sex, with a some cases being spread within family members that share a household. People who have not begun to show symptoms of infection do not seem to be contagious.
How is it treated?
For most people, monkeypox can be ridden out at home and in isolation. Some people may need medical care, such as the elderly and immunocompromised. But, ANYONE who has been exposed to monkeypox or has symptoms suggestive of it need to be seen by a doctor. This is important for two reasons: so those people can isolate themselves to prevent spreading it, and for surveillance of community transmission. There are no established medications to treat monkeypox, though some antivirals may be helpful once infection has set in. Vaccines for it exist and have been given in hospital settings to people diagnosed with the disease in early stages or with confirmed exposures. Supplies and distribution at this time are limited. Public health departments are using their doses to inoculate the most at risk populations, which brings us to a tricky part of this story:
Who is most at risk of contracting monkeypox?
At this moment the data show that the largest affected demographic infected has been CIS/trans/NB people with penises who have sex with other people with penises, especially CIS men. Because of this data point many public health departments are focusing their vaccine campaigns on people in these groups, San Francisco has also opened that up to anyone who does sex work. Many health departments seem to mostly be treating this outbreak as an STD(which it is NOT), but all of this can, and most likely will, change. It can be difficult to share demographic information while protecting marginalized communities from stigmatization, shaming and prejudice. I know that we all know that prejudicial thinking/behavior is shitty, so we won’t go down that rabbit hole here. Besides this NPR article addresses this issue much better than we can: