Mpox (monkeypox) is a viral illness that affects both humans and animals. It is caused by the monkeypox virus, a member of the Orthopoxvirus genus, which also includes the variola virus responsible for smallpox. Mpox has gained public health attention due to its ability to cause a painful rash, along with other symptoms like fever and swollen lymph nodes. While most individuals recover fully, mpox can lead to severe illness in some cases.
What is Monkeypox and How it Spreads
The monkeypox virus was first identified in 1958 during outbreaks in research monkeys in Denmark. The first human case was documented in 1970 in a nine-month-old boy in the Democratic Republic of the Congo. Historically, mpox has been more commonly found in central and western African nations, with the Democratic Republic of the Congo reporting a majority of cases. Following the global eradication of smallpox and the cessation of routine smallpox vaccinations in 1980, mpox cases have steadily increased in parts of Africa.
Mpox spreads through direct contact with an infected animal or person, or with contaminated materials. This includes direct skin-to-skin contact with the mpox rash, scabs, or body fluids, such as saliva or respiratory secretions from the nose or mouth. Prolonged face-to-face contact can also lead to spread through respiratory droplets. Contact with contaminated objects (fomites), like clothing, bedding, or towels used by an infected person, can also transmit the virus. Additionally, mpox can spread from animals to humans through bites, scratches, or when handling or consuming infected wild animals in regions where the disease is naturally present.
Identifying Symptoms
Mpox symptoms typically emerge between three and seventeen days after exposure and usually last for two to four weeks. Initial symptoms often include flu-like symptoms such as fever, headache, muscle aches, back pain, exhaustion, and swollen lymph nodes. Swollen lymph nodes distinguish mpox from smallpox.
Following these initial symptoms, or sometimes appearing as the first symptom, a characteristic rash develops. The rash progresses through stages: flat, red spots (macules) become raised bumps (papules), then fluid-filled (vesicles), and finally pus-filled lesions (pustules). These lesions crust over, form scabs, and eventually fall off, revealing new skin.
The rash can appear on various parts of the body, including the face, mouth, hands, feet, genitals, or anus. Some individuals may develop only a few lesions, while others may have hundreds.
Preventing Infection
Prevention involves reducing exposure to the mpox virus. Avoid close, skin-to-skin contact, including intimate or sexual contact, with individuals who have an mpox rash or sores. Also avoid contact with contaminated objects, such as bedding, clothing, or towels, used by an infected person.
Good hand hygiene, including frequent handwashing with soap and water, is also important. For individuals at higher risk of exposure, such as certain laboratory workers or emergency response teams, vaccination is a recommended prevention strategy. The JYNNEOS vaccine is approved for the prevention of smallpox and mpox in adults 18 years and older who are at high risk of infection. It is typically administered as a two-dose series, four weeks apart, and has shown significant effectiveness in preventing mpox and reducing symptom severity. Even after vaccination, it is still advisable to continue avoiding close contact with infected individuals.
Diagnosis and Treatment
Prompt medical attention is important if mpox is suspected. Healthcare providers diagnose mpox primarily through polymerase chain reaction (PCR) testing, which detects the viral DNA. The most accurate specimens for testing are typically collected directly from the rash, including skin lesions, fluid from blisters, or scabs, through vigorous swabbing. While less reliable, in the absence of skin lesions, samples from the throat or anus may also be tested. It is important to isolate at home immediately if symptoms appear and contact a healthcare provider for guidance.
Treatment for mpox is largely supportive, focusing on managing symptoms such as pain and fever, ensuring adequate hydration, and keeping lesions clean. Most people with mpox recover without specific antiviral treatment. For severe cases or individuals at high risk for complications, such as those with weakened immune systems, pregnant individuals, or young children, antiviral medications may be considered. Tecovirimat (TPOXX) is an antiviral drug that may be prescribed for severe cases or high-risk individuals. While initially approved for smallpox, its use for mpox is under an expanded access protocol. Other antivirals like brincidofovir or cidofovir, and Vaccinia Immune Globulin Intravenous (VIGIV), may also be considered for severe cases. Infected individuals should remain isolated until all lesions have scabbed over and new skin has formed, which typically takes two to four weeks.