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Gone Bananas – Experts Weigh in on Monkeypox

July 18, 2022

Written by Rebecca White

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As monkeypox cases continue to increase, experts warn of potential morbidity and mortality. However, we have the tools to keep things under control. Recommendations are offered for healthcare providers.

Why does this matter?
This year, cases of monkeypox have increased outside of Central and Western Africa and have occurred in patients with no travel to endemic areas, suggesting human-to-human transmission. In a post-COVID era, the public is understandably puzzled and concerned. But do we need to be worried?

Not Quite COVID 2.0
Monkeypox is a zoonotic virus of the Orthopoxvirus genus, typically transmitted via human-to-animal contact. It has become endemic to Central and Western Africa, with 8 cases carried abroad in the last 5 years in patients with travel to Nigeria. However, there has been a recent increase in cases in Europe and North America, even in patients with no travel history. Presentation in new cases has been atypical, with minimal prodrome and rash beginning in the genital region rather than on the head.

Despite the increase in cases and apparent human transmission, risk to the general public remains low. Human transmission appears to occur via direct contact with lesions or respiratory droplets. Mortality rate is 4-11%, compared to smallpox at 30%. At the time this article was published, no deaths were associated with the outbreaks (Note: there is now 1 reported death).

Currently, two vaccinations (ACAM2000 and JYNNEOS) exist for close contacts of infected individuals or those with known exposures. Healthcare providers should keep a high index of suspicion and contact their local health department about potential cases. These patients should be placed in negative pressure rooms under standard droplet precautions.

What to Know About Monkeypox. JAMA. 2022 Jun 21;327(23):2278-2279. doi: 10.1001/jama.2022.9499.

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