Monkey Pox virus in the mix of our pandemic

The department of Health and the Center for Disease and Prevention (CDC) are investigating a possible case of Monkeypox. It seems that it is related to international travel in a patient residing in Broward County, Florida. The case was isolated and precautions are taking following the protocol.  No other case has been discovered.

Although others may have bees also exposed. A post exposure prophylaxis should be beneficial. Clusters of Monkeypox cases have been reported around the world and the CDC is monitoring the progress.

What should we do in face of a suspicious case?

1)    Contact the Local Health Department or call the HOT-Line in Florida at 859-245-4401 and you can be guided toward the local county health departments for specific testing (PCR: Monkeypox-virus-specific polymerase chain reaction testing.

2)    If there is suspicion for Human-Human transmission, a face-to-face contact, direct contact with contaminated material (from clothing or direct contact with secretions from the skin lesions)

3)    As healthcare providers, we should remain vigilant and be aware of the symptoms associated although the risk of exposure and catching the disease remain low.

Health care providers should know:

Monkeypox symptoms: Headache, Fever, Chills, Sore-throat, Fatigue, Malaise, Rashes, Lymphadenopathy. Exhaustion within 3 days of the contact especially if a travel history is reported. Symptoms similar to Smallpox but milder.

The transmission is generally Person-to-Person by close contacts with lesions or body fluids among individuals. It can be transmitted through clothing as well. 20 cases were discovered in the UK and since cases have been reported in more than a dozen of European countries like Italy, Spain, Portugal, Germany, Sweden, Germany, France and other countries like Australia, Canada and United States. Monkeypox is endemic in many African countries like Congo, Gabon, Cameroon, Ghana, Ivory Coast, Liberia, Nigeria, Sudan etc Since then, the World Health Organization (WHO) has reported more than 38 cases. The transmission can be done also via respiratory droplets or contaminated materials, bedding or other body fluids even by sex. A person is considered no longer contagious once the lesions haves disappeared and a new skin has re-grown.

The Incubation period is generally 6 to 13 days but can vary from 5 to 21 days.

Clinical recognition: through the symptoms described above: The characteristic rash associated with Monkeypox is a macular rash on the skin starting in the face and spreading to the arms and legs and starting one to three (1-3) days after the fever. Smallpox is more serious than Monkeypox and the rashes showed some difference. The pustules-macules-vesicles-papules are larger with the Monkeypox but the presence of a lymphadenopathy can also make the difference between the two diseases. The disease last generally 2 to 4 weeks.

Patients may present with generalized or local vesicular or pustular rashes, as well as perianal or genital, a deep seared rash with firm and well demarcated lesions with typically with generalized symptoms. This rash may mimic other disease like syphilis or herpes, or chancroid or varicella. A through sexual and travel history should be obtained upon presentation of those patients with rashes.

There is a high level oi suspicion in men having contact with men presenting the same lesions in the perianal or genital area. People with a significant travel history to the endemic areas mentioned above within the 4 weeks prior to the onset of the rashes. Any person who reports close contact with people with such described lesions or any people who report contact with someone diagnosed with Monkeypox.

600 cases of Monkeypox have been confirmed by the World Health Organization across more than 30 countries. A case was found also in the Valley of Artibonite, in Haiti and it is waiting for confirmation. It seems that the virus has been spreading for months outside of West and central Africa. So far most of the cases were encountered among men looking for sexual favor and no death has been reported. Vulnerable populations of pregnant women and children in the areas where cases were encountered, should be aware that they are at risk.