The Dangers of Monkeypox

Monkeypox. The name is easy to remember, like chickenpox. Why do the CDC and WHO want to change the name of this virus? The virus's moniker Monkeypox seems perfect, reminding us to stay away from monkeys! But wait...is it the monkeys we should be concerned about?

The fact that most of us never come near monkeys is irrelevant, as you may have guessed. This Monkeypox virus, the cause of Monkeypox, is mostly spreading among men who have sex with men (MSM) who then develop genital vesicles or penile discharge. Despite being identified initially in MSM at STD clinics in Europe, Monkeypox is not considered a sexually transmitted disease, and the transmission is thought to be related to close physical contact, and shared bedding. Monkeypox is well known to be transmitted by contact with lesions on a person's skin, respiratory droplets from coughing or sneezing, and sharing the same environment. So it's not just monkeys, and this does not only concern MSM. It concerns all of us.


Here's what everyone wants to know about Monkeypox: Should I worry about Monkeypox? What happens if I get it? Can I die from it?


Studies of Monkeypox have been ongoing since the virus was identified in 1958 in captive primates (hence the name!) who became ill in a research facility in Copenhagen, Denmark. Since then, multiple research facilities have experienced fatal and nonfatal Monkeypox outbreaks, all contained within the lab, including in Philadelphia, PA, United States. The "first human case" was reported in 1970 in Zaire. Despite small sporadic outbreaks of Monkeypox, the virus has had a geographically contained animal reservoir located in Africa. As a result of this epidemic, however, this may soon change.


It's not just monkeys

Monkeypox, like smallpox and chickenpox, spreads quite easily. There was a report in 2007 of a Wisconsin man inadvertently acquiring monkeypox when a sick prairie dog he'd bought for a pet at a swap meet a few days prior bit him. The sick prairie dog (who soon died from the illness) had been imported from Ghana, and developed eye discharge, lymph node swelling, and a vesicular rash similar to smallpox. To squash the breakout, the Health Department swiftly investigated and killed all the prairie dogs that had not yet been sold, limiting the number of infected individuals to 47. As it turns out, other rodents including squirrels and mice, can also become infected, and transmit it to humans. To date, no domestic pets have been diagnosed in this outbreak, but over 3,000 humans worldwide have been diagnosed with Monkeypox this time, a gross underestimate of the real number. People infected with Monkeypox are urged to stay away from animals, including their own pets. According to virologists, what makes this outbreak really concerning is that Monkeypox can make its permanent residence in wildlife outside of Africa, a first for the virus that causes Monkeypox. If Monkeypox establishes itself in an animal species (such as squirrels or rats) in the Western Hemisphere, it would take us back to the Middle Ages when contact with rodents caused the Pestilence (bubonic plague, which was transmitted by the fleas in the rats). This may lead to frequent, recurrent Monkeypox outbreaks.


Do I have Monkeypox? Symptoms

In humans, the symptoms can include a whole body rash, of easily over 100 vesicles, called "pocks", which can be absent in many cases, especially if a person has been vaccinated. Other common symptoms are similar to influenza, and include headache, fever, chills, muscle aches, cough, sore throat, pharyngitis, tonsillitis.

Similar to chickenpox and smallpox, the Monkeypox fluid-filled vesicles contain infectious virus particles that are contagious when touched. Like chickenpox, you are contagious until all the pocks have crusted and dried. What's unique about this vesicular rash is its presence in the palms of the hands and soles of the feet. Hence the origin of the rule taught in medical school to never shake hands with a person who has a rash on their palms.


Can I die from Monkeypox?

In the United States, most people are not vaccinated against Monkeypox. In Africa, the vaccine for smallpox is quite good against monkeypox. Without the vaccine, the mortality rate among the unvaccinated is 11%, and 15% in children under 5 years of age. However, let's be clear that this high rate of death was observed specifically in a rural African area lacking access to modern medical care. In Nigeria where medical care is better, the mortality rate was observed to be 3%. In this present worldwide Monkeypox breakout, one death has been reported so far since January 2022. Though this figure may underestimate the real number, most people do not die from Monkeypox. Monkeypox is usually a self-limited disease that resolves in 2-4 weeks. But does smallpox vaccine protect? Good question.


In the United States, smallpox vaccination stopped in 1972 after the disease was eradicated worldwide. The smallpox vaccine is 85% effective at preventing Monkeypox. The vaccine for Monkeypox is available in the United States, but is recommended at this time only for laboratory personnel that conducts Monkeypox lab testing. Since chickenpox vaccination (against varicella, also the target of the adult shingles vaccine) is now routine administered to children in the United States, you might want to know if the chickenpox or shingles vaccine protects against monkeypox? Unfortunately, the answer is no.


Most of the currently reported cases of Monkeypox are in first world countries, including the United States, perhaps due to good surveillance and reporting mechanisms. We have no reason to believe the countries where there are "no reported cases" actually have no cases.


Diagnosing Monkeypox

Based on symptoms only, Monkeypox can be misdiagnosed, and confused with similar illnesses such as tularemia, (bubonic) plague, influenza, and other rashes such as herpes, molluscum, or syphilis. The diagnosis of Monkeypox has been complicated by the absence of a rash, or a rash that is not "whole body" in nature. Obtaining a diagnosis is also complicated by the lack of general testing, but there are efforts underway to address the lack of infrastructure for commercial laboratories to test for Monkeypox. Lastly, patients who do not have "all the symptoms" when they seek medical care may not be diagnosed correctly.


The best way to diagnose Monkeypox is to obtain a viral sample from the fluid inside the vesicles. If they have crusted over, it can make the test "false negative". Seek medical care if you develop a vesicular rash anywhere in your body. Due to unvaccinated laboratory personnel, most commercial labs such as Quest Diagnostics or Lab Corp do not offer Monkeypox testing, though that is expected to change in July through a partnership with the CDC to make commercial testing broadly available . Until then, if you live in Orange County, you may contact the local health department for testing and sample collection, and elsewhere in California, contact the local State Health Department


If you suspect you have Monkeypox, you need to isolate from others. Thanks to Covid, we are now a bit familiar with isolation (quarantine). In the case of Monkeypox, it's important to avoid contact with others and everything they touch. The current CDC guidelines recommend no touching (avoid all physical contact), and no coughing, sneezing or breathing on others (put on a face mask). You also need to understand this: the Monkeypox vesicles produce fluid containing virus that can survive outside the body for a long time (unlike Covid), facilitating the virus transfer from the skin of an infected person to surfaces, and subsequently transferred from that surface to the next person. For a park bench that was recently occupied by a person with Monkeypox, it is possible that the next person who immediately sits on the bench may become infected. This mode of transmission is the reason for the recommendation to stay home in your room or wear long sleeve clothing and gloves, if you believe you have Monkeypox.

Preventing Monkeypox

The New York Times article about Monkeypox in MSM who have frequent casual sexual encounters highlighted the MSM sitting outside a NYC clinic awaiting Monkeypox vaccination. This vaccination in this population is probably a good idea, especially during Pride Month when an increasing number of cases were traced to sex gatherings. If you are a man who has sex with men and have more than one sexual partner, or you have multiple frequent heterosexual casual sex encounters, you probably would benefit from a Monkeypox vaccination. It's important to say that condom protection or abstinence would help curtail this breakout. If you are recovering from Monkeypox, condom use is recommended for 12 weeks to prevent transmission.


What about the rest of us? If you are in the military, your smallpox vaccination will keep you safer from Monkeypox illness. If you work as a healthcare professional or allied health professional caring for patients with Monkeypox, live with someone at high risk, or simply want the protection, you may discuss your risk factors and situation with your physician. At this time there is no official recommendation for or against vaccination, and this may change within the next few days as new vaccine stockpile becomes available.


We know that chickenpox can cause shingles later in life, but what about Monkeypox? Are there any long term effects of Monkeypox? Monkeypox can cause severe permanent scarring including in the face, as well as eye damage (corneal abrasions) which can affect vision. Monkeypox can also inflame the brain (encephalitis) and lead to neurological symptoms such as seizures or behavior disturbances. Are there other long term effects? We'll be able to better answer that question as we gather more information. In the meantime, let's do all we can to curtail this breakout.


So should the name Monkeypox be changed? What do you think? Other potential names such as Mousepox, Squirrelpox, Chickenpox, and Cowpox are taken. We should do all we can to prevent this illness from establishing itself in domestic animals and rodents, lest its new name becomes Groundhogpox, or worse, Petpox.


If you believe you may have Monkeypox, schedule a consultation with Dr. Long. Disclaimer: The information here is educational. Nothing on this website represents medical advice, nor replaces it. All health related concerns should be discussed with your personal physician.


About Marta Long, MD

Marta Long, MD, a Board Certified Internist based in Irvine, California, specializes in complex medical cases and provides attentive, and exceptional internal medicine concierge house calls throughout Orange County, including Irvine, Tustin, Newport Beach, Santa Ana, Rancho Santa Margarita, Lake Forest, Mission Viejo, Aliso Viejo, Newport Coast, Costa Mesa, and the surroundings areas. She is Yale-educated and trained, has hospital privileges at Hoag Hospital and Mission Hospital, and has been in practice since 2006. Read more about Dr. Long's house call concierge practice at Www.MartaLongMD.com

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