MONKEYPOX HAS ARRIVED AT THE SHORES of the United States. A gentleman has been hospitalized in Massachusetts following recent travel to Canada. Monkeypox is not confined to the USA: More than 100 suspected or confirmed cases of monkeypox have been reported in 12 nations, including the United States.

The World Health Organization (WHO) offers that confirmed cases have been identified in Australia, Belgium, Canada, France, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, the United Kingdom, and the United States — which had between one and five confirmed monkeypox cases mid-May 2022.

“Everybody should be concerned,” offers US President Biden. But how concerned should you and I be? While monkeypox is only occasionally fatal, are we on the verge of another pandemic? Today we explore what you should know about this uncommon illness.

What is monkeypox?

Monkeypox is a virus endemic in parts of West and Central Africa. The condition is a less virulent form of smallpox.

The name “monkeypox” comes from the first documented cases of the illness in animals in 1958, when two outbreaks occurred in monkeys kept for research. However, the virus did not jump from monkeys to humans, nor are monkeys significant carriers of the disease.

The monkeypox virus belongs to a family of viruses: cowpox, smallpox, and vaccinia.

Monkeypox virus causes the condition, with the virus a subset of the Poxviridae family of viruses called Orthopoxvirus. This subset includes smallpox, vaccinia, and cowpox viruses. Scientists suspect that African rodents play a role in transmission, but the natural reservoir of monkeypox is not clear.

Monkeypox transmission and symptoms

Contacting an infected individual or animal (or contaminated surfaces) can lead to virus transmission.

Most commonly, the monkeyvirus enters the body through broken skin, mucous membranes of the eyes, nose, or mouth, or through inhalation. Contaminated clothing can be a vector, too. How and where infections are happening remains under investigation.

Monkeypox creates a rash that starts with flat red marks that become raised and filled with pus. Infected people may also have a fever and body aches. Monkeypox can also cause lymph nodes to swell (in contradistinction, smallpox does not). Other initial symptoms may include:

• Fever or chills
• Headache
• Muscle aches or backache
• Exhaustion

Symptoms usually appear in six to 13 days but can take as long as three weeks after exposure to become noticeable and last for two to four weeks.

Often, the rash develops within one to three days of the fever, with the skin changes beginning on the face and then spreading to other body parts. The skin lesions can begin as flat (macules), become raised (papules), and then transition to vesicles (a thin-walled sac filled with a fluid, usually clear and small).

If progression continues, pustules may form and finally transition to scabs. The overall course is usually around two to four weeks. In Africa, monkeypox is fatal in as many as 10 percent of those who get the disease.

Monkeypox risk reduction and management

The United States Centers for Disease Control (CDC) volunteers these risk reduction strategies:

• Avoid contact with animals that may have the virus (including sick or dead animals in endemic areas).
• Avoid contact with any materials (such as bedding) that have been in contact with a sick animal.
• Isolate infected patients from others who could be at risk for infection.
• Practice good hand hygiene after contact with infected animals or humans. For example, wash your hands with soap and water or use an alcohol-based hand sanitizer.
• Use personal protective equipment (PPE) when caring for patients.

An attenuated live virus vaccine for monkeypox is JYNNEOSTM (Imvamune or Imvanex).

The CDC explains there is no proven, safe treatment for monkeypox virus infection. Smallpox vaccine, antivirals, and vaccinia immune globulin (VIG) are options to control a monkeypox outbreak in the United States. Learn more about treatment here:Monkeypox TreatmentClinician Treatment. Monkeypox is a viral disease that occurs mainly in central and western Africa. It is called…www.cdc.gov.

If you have a new skin rash or are concerned about monkeypox, the US Centers for Disease Control (CDC) urges people to contact their health care provider. The agency has asked doctors to be on the alert for signs of the telltale rash and says potential monkeypox cases should be isolated and flagged to them.

Am I worried? Not particularly, but I will be on guard until we get more clarity on the scope of the problem. It is challenging to estimate how big a problem monkeypox will become. For now, be aware but know that the risk posed by monkeypox is currently remarkably low.

The likelihood of transmission during sexual contact is high. Still, the risk of transmission from other forms of close contact is low, the European Center for Disease Prevention and Control explains.

Fortunately, symptoms are usually mild, but in Nigeria, 3.3 percent died (with the most vulnerable including children, young adults, and immunocompromised people. Thank you for joining me today.

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Researchers evaluated the stability of the SARS CoV-2 virus on human skin and compared it to influenza A, which is the same virus that causes pandemic flu like H1N1. They found that SARS CoV-2 lasts about 9 hours on human skin, as opposed to less than 2 hours for influenza A.

This stability is much less than on other surfaces such as glass, plastic, and stainless steel. Still, 9 hours is a pretty long time. They also found that 80% ethanol inactivates the virus within 15 seconds.

What does this mean?

First, while it is becoming increasingly evident that SARS CoV-2 is an airborne virus, given this data, it is conceivable that one can catch Covid-19 by touching your hand to your nose, eyes, and mouth. And so, it is imperative that we wash our hands — for at least 20 seconds with soap and water ideally — frequently…very frequently.

We should not go 9 hours without washing our hands, especially if we have been out to the grocery store, or gas station, or even an outdoor restaurant. If we can’t use soap and water, we should use alcohol-based sanitizer and rub until our hands are dry.

As far as I am concerned, we can’t wash our hands enough. When I’m working in the ICU, I don’t go 9 minutes without washing my hands. We can’t be too safe, and unlike the contention of some, you need to be afraid of Covid-19. This is a horrific disease, and you don’t want to get it. Trust me.

Reference:

1. Ryohei Hirose, Hiroshi Ikegaya, Yuji Naito, Naoto Watanabe, Takuma Yoshida, Risa Bandou, Tomo Daidoji, Yoshito Itoh, Takaaki Nakaya, Survival of SARS-CoV-2 and influenza virus on the human skin: Importance of hand hygiene in COVID-19, Clinical Infectious Diseases, , ciaa1517, https://doi.org/10.1093/cid/ciaa1517

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DATE OF ISSUE: Aug. 28, 2020

WASHINGTON /PRNewswire/ — New research suggests that children can shed SARS-CoV-2, the virus that causes COVID-19, even if they never develop symptoms or for long after symptoms have cleared. But many questions remain about the significance of the pediatric population as vectors for this sometimes deadly disease, according to an invited commentary by Children’s National Hospital doctors that accompanies this new study published online Aug. 28, 2020 in JAMA Pediatrics. The commissioned editorial, written by Roberta L. DeBiasi, M.D., M.S., chief of the Division of Infectious Diseases, and Meghan Delaney, D.O., M.P.H., chief of the Division of Pathology and Lab Medicine, provides important insight on the role children might play in the spread of COVID-19 as communities continue to develop public health strategies to reign in this disease.

The study that sparked this commentary focused on 91 pediatric patients followed at 22 hospitals throughout South Korea. “Unlike in the American health system, those who test positive for COVID-19 in South Korea stay at the hospital until they clear their infections even if they aren’t symptomatic,” explains Dr. DeBiasi.

The patients here were identified for testing through contact tracing or developing symptoms. About 22% never developed symptoms, 20% were initially asymptomatic but developed symptoms later, and 58% were symptomatic at their initial test. Over the course of the study, the hospitals where these children stayed continued to test them every three days on average, providing a picture of how long viral shedding continues over time.

The study’s findings show that the duration of symptoms varied widely, from three days to nearly three weeks. There was also a significant spread in how long children continued to shed virus and could be potentially infectious. While the virus was detectable for an average of about two-and-a-half weeks in the entire group, a significant portion of the children — about a fifth of the asymptomatic patients and about half of the symptomatic ones — were still shedding virus at the three week mark.

Drs. DeBiasi and Delaney write in their commentary that the study makes several important points that add to the knowledge base about COVID-19 in children. One of these is the large number of asymptomatic patients — about a fifth of the group followed in this study. Another is that children, a group widely thought to develop mostly mild disease that quickly passes, can retain symptoms for weeks. A third and important point, they say, is the duration of viral shedding. Even asymptomatic children continued to shed virus for a long time after initial testing, making them potential key vectors.

However, the commentary authors say, despite these important findings, the study raises several questions. One concerns the link between testing and transmission. A qualitative “positive” or “negative” on testing platforms may not necessarily reflect infectivity, with some positives reflecting bits of genetic material that may not be able to make someone sick or negatives reflecting low levels of virus that may still be infectious.

Testing reliability may be further limited by the testers themselves, with sampling along different portions of the respiratory tract or even by different staff members leading to different laboratory results. It’s also unknown whether asymptomatic individuals are shedding different quantities of virus than those with symptoms, a drawback of the qualitative testing performed by most labs. Further, testing only for active virus instead of antibodies ignores the vast number of individuals who may have had and cleared an asymptomatic or mild infection, an important factor for understanding herd immunity.

Lastly, Drs. DeBiasi and Delaney point out, the study only tested for viral shedding from the respiratory tract even though multiple studies have detected the virus in other bodily fluids, including stool. It’s unknown what role these other sources might play in the spread of this disease.

Drs. DeBiasi and Delaney note that each of these findings and additional questions could affect public health efforts continually being developed and refined to bring COVID-19 under control in the U.S. and around the world. Children’s National has added their own research to these efforts, with ongoing studies to assess how SARS-CoV-2 infections proceed in children, including how antibodies develop both at the individual and population level.

“Each of these pieces of information that we, our collaborators and other scientists around the world are working to gather,” says Dr. DeBiasi, “is critical for developing policies that will slow the rate of viral transmission in our community.”

About Children’s National Hospital
Children’s National Hospital, based in Washington, D.C., celebrates 150 years of pediatric care, research and commitment to community. Volunteers opened the hospital in 1870 with 12 beds for children displaced after the Civil War. Today, 150 years stronger, it is among the nation’s top 10 children’s hospitals. It is ranked No. 1 for newborn care for the fourth straight year and ranked in all specialties evaluated by U.S. News & World Report. Children’s National is transforming pediatric medicine for all children. In 2020, construction will be complete on the Children’s National Research & Innovation Campus, the first in the nation dedicated to pediatric research. Children’s National has been designated twice as a Magnet®  hospital, demonstrating the highest standards of nursing and patient care delivery.

This pediatric academic health system offers expert care through a convenient, community-based primary care network and specialty outpatient centers in the D.C., metropolitan area, including the Maryland and Northern Virginia suburbs. Children’s National is home to the Children’s National Research Institute and Sheikh Zayed Institute for Pediatric Surgical Innovation and is the nation’s seventh-highest NIH-funded children’s hospital. It is recognized for its expertise and innovation in pediatric care and as a strong voice for children through advocacy at the local, regional and national levels.

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SOURCE Children’s National Hospital

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