USET Tribal Epidemiology Center Monkeypox Alert
June 30, 2022

Dear USET/USET SPF Family,

Monkeypox is a zoonotic disease caused by the monkeypox virus and is rarely observed in the United States. In light of the recent monkeypox outbreak, USET TEC would like to share some valuable information regarding the current Monkeypox outbreak.

Current Outbreak Information

In May 2022, a resident of Massachusetts returning home from Canada was the first known monkeypox case in the United States during the current outbreak. Since then, there have been 4,357 cases identified in 48 countries as of June 27, 2022. There have been 243 cases reported in the United States, with a majority of cases in the United Kingdom (910 cases), followed by Germany (765 cases), and Spain (736 cases) as of June 27.  Monkeypox is rarely fatal, especially the West African strain in the current outbreak, and milder than smallpox. It can be extremely painful and may result in permanent scarring.  Clinicians providing services connected to primary care or sexually transmitted diseases, especially to populations with multiple sexual partners, need to remain vigilant. Groups at highest risk for serious illness or death are people with a weakened immune system, pregnant or breastfeeding, children under 8 years old, and those with a history of eczema.

Transmission

This monkeypox outbreak is different than previous outbreaks as it seems to be spread through close contact, sustained skin-to-skin contact (including sexual contact) with a person with monkeypox rash or lesions or contaminated fomites (surfaces), such as bedding. Many of the reported cases are among gay, bisexual, or other men who have sex with men. Any person, regardless of gender or sexual orientation, can get and transmit monkeypox. The current threat level in the United States currently is low.

Possible methods for person-to-person transmission include:

  • Direct contact with infectious rash, scabs, or body fluids
  • Respiratory secretions during prolonged face-to-face contact
  • Intimate physical contact (kissing, cuddling, sex, etc.)
  • Touching items that were in contact with infectious rash or body fluids
  • Pregnant people to fetus through placenta

Monkeypox can spread from the time symptoms begin until the rash is fully healed with a fresh layer of skin. People without symptoms cannot spread the virus. It is currently unknown if monkeypox can spread through semen or vaginal fluid.

For Healthcare Providers
Clinical Symptoms

Symptoms in this outbreak also seem to be slightly different than previous outbreaks. The incubation period is most commonly 7 to 14 days but can range from 5 to 21 days and people are not contagious during this time period. General symptoms include fever, headache, muscle and backache, swollen lymph nodes, chills, exhaustion, and rash. For detailed information and pictures for clinical recognition please consult the CDC website.

Monkeypox is most like a clinical course of discrete smallpox, but with the addition of swollen lymph nodes. Lesions go through four stages- macular, papular, vesicular, to pustular- over 2 to 3 weeks. These lesions are well circumscribed, deep seated, and likely develop umbilication. In this outbreak, lesions have been noted to be in different stages of development, which is new. For complete case definitions and detailed histories of clinical presentations of confirmed cases in the current outbreak, please visit the CDC website. There have been cases of co-infections of similarly presenting infections such as chickenpox, syphilis, and herpes.

Testing, Treatment, and Vaccines

Testing is vital in identifying cases. Information on tests available can be found on the CDC website. Providers should utilize appropriate precautions when collecting samples. Antivirals used for smallpox treatment, such as tecovirimat (TPOXX), may be recommended for those with a weakened immune system. A full guide on treatment options is available on the CDC website.

For clinicians, laboratory staff, or anyone whose job may expose them to orthopoxviruses, such as monkeypox, The Advisory Committee on Immunization Practices (ACIP), recommends getting vaccinated with ACAM2000 or JYNNEOS. This is essentially a pre-exposure prophylaxis. Not all clinicians need to receive this vaccine, only those with high risks for exposure. CDC also recommends a vaccine 4 days after exposure to monkeypox or if a smallpox vaccine is more than 3 years old. For additional guidance on vaccines, information is on the CDC website.

Monkeypox History

Monkeypox is caused by infection with the monkeypox virus, which is a Orthopoxvirus. The Orthopoxvirus genus also includes variola virus (smallpox), vaccinia virus (smallpox vaccine), and cowpox virus. The virus gets its name from the first two outbreaks in 1958, in which monkeys kept for research developed this pox-like disease. The source of the disease remains unknown.

Monkeypox is rare in the United States but is endemic in several countries in Central and West Africa. The first time monkeypox was reported outside of Africa was during the 2003 outbreak in the United States. The 2003 outbreak was traced back to a shipment of small rodents imported from Ghana. These rodents were then housed near prairie dogs. The prairie dogs were sold as pets before they developed clinical signs. People who contracted monkeypox in this outbreak had direct contact, a bite or scratch, or contact with bedding from these infected animals. Due to this, the importation of African rodents was restricted by the CDC and still is to this day. Up until the current outbreak, monkeypox has been linked to international travel to endemic countries or imported animals.

Please refer to the list of associated sources for more in-depth information and additional guidance. If you have any questions, please reach out to usetepi@usetinc.org.

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