What are the best practices for cleaning monkey lesions? Do chickenpox and smallpox vaccines prevent monkeypox? CDC experts answered these and other questions during a call to clinicians for outreach and communication, while providing an update on the status of the current outbreak, guidelines for treatment options, and advice on prevention before and after exposure.
Monkeypox, a rare zoonotic infection endemic to West Central Africa, can be life-threatening. The first suspected case of an epidemic in 2022 was reported in the United States on May 17.
To take a sample to test for monkeypox, do you need to detect the lesion?
Bruce Furness, MD, MPH, a medical epidemiologist in the CDC’s Department of Sexually Transmitted Disease Prevention, said he had smeared more than 10 lesions on various patients and “none of them found a roof.”
“These are really small, rubbery, deep-seated lesions and unlike HSV [herpes simplex virus] lesions … you can’t really tell if you’ve got a good sample or not, based on whether there’s fluid or not, or if there’s any bleeding, he noted. “It simply came to our notice then. rub the swab on the surface of these connected rubber deep lesions as hard and aggressively as the patient can bear, because most of them are quite tender. “
Captain Brett Peterson, MD, MPH, deputy chief of the U.S. Public Health Service, a branch of poxviruses and rabies, of the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), said the lesions “contain an infectious virus”; therefore, it is important that the lesions and lesion materials are coated to prevent transmission.
Can samples be taken before they become pustular?
Captain Agam Rao, MD, a medical officer at the US Public Health Service at NCEZID, noted that tampons can also be taken during the vesicular phase.
In previous outbreaks, some patients had lesions in the mouth before skin lesions appeared, she explained. So, you can rub a swab on vesicles, pustules, [and] scabs can also be collected and tested, ”she said, noting that scabs are also a common source of transmission, such as through bedding.
Do prodromal symptoms always precede the appearance of monkeypox lesions?
The “classic presentation” of monkeypox includes prodromal symptoms – fever, malaise, headache and swollen lymph nodes – that precede the appearance of lesions, said Leandro A. Mena, PhD, MPH, director of the Department of Sexually Transmitted Diseases at the National CDC Center for the Prevention of HIV / AIDS, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis.
He pointed out that in the current outbreak, patients see lesions without any prodromal symptoms, and in some cases the symptoms develop after the development of the rash.
Does the smallpox vaccine or the chickenpox vaccine provide any protection against monkeypox?
The previous smallpox vaccination is expected to provide “some protection” against monkeypox, Petersen said, as the two viruses are linked.
In the monkeypox epidemic of 2003, six people who had been vaccinated as children became infected with monkeypox, but an analysis of the cases in that outbreak suggests that “among those who had been vaccinated before, there were effect, even after many decades of getting the smallpox vaccine, “he added.
It is not yet clear how long this protection lasts after vaccination, and CDC researchers are continuing to study the issue, he said.
Chickenpox is a herpes virus in a separate family of monkeypox and smallpox, “so chickenpox vaccination is not expected to provide any protection against monkeypox,” Petersen explained.
Can a person be infected with monkeypox more than once?
“We haven’t seen this happen, but that doesn’t mean it can’t happen,” Rao said. “In general, smallpox infection provides lifelong protection; however, it is unclear whether this will also apply to monkeypox infections.”
The CDC is aware of a report of a single case of possible re-infection with monkeypox, but the agency expects this to be a rare scenario, Petersen said.
“What we don’t know is with this new outbreak and the new epidemiology and the way it is transmitted, whether it can affect some of what was previously seen in monkeypox and other related viruses, such as smallpox. So I think there is more to learn there, “he added.
Can monkeypox spread easily from person to person, similar to COVID-19?
“Monkeypox is certainly not COVID-19,” Rao said. Based on previous outbreaks and the current outbreak, monkeypox appears to be spread through “direct close contact. So, intimate contact that can happen during sex, but also any other close contact that can occur – for example, if you live with someone who has monkeypox and sleep on the same bed and use the same the same towels. “
“It’s really not something you just pass on to someone walking down the street,” she said.
While researchers from the agency “have an open opinion” about the possibility of the virus being transmitted more easily, “there are currently no indications that it will spread the way COVID spreads to so many people, [and] at this point, the risk to the world’s population … is low, “she added.
In addition to answering clinicians’ questions, Mena presented a case study of a male patient and his developing symptoms, while Petersen reviewed medical countermeasures, including vaccines and organic products that are not commercially available but are stored by the US government.
In November 2021, the Advisory Committee on Immunization Practices voted to recommend pre-exposure prophylaxis with Jynneos, a live non-replicable smallpox and monkeypox vaccine, as an alternative to ACAM2000, a live smallpox vaccine, “for certain individuals at risk of orthopoxvirus exposures. “In June, the CDC updated these recommendations.
Petersen noted that ACAM2000 has risks of serious adverse events, including myopericarditis.
“Myopericarditis has not been reported in association with Jynneos in a limited number of subjects who received the vaccine in clinical trials, and therefore the risk is considered to be lower than for ACAM2000,” he said.
As of Wednesday afternoon, there were 351 confirmed cases of monkeypox / orthopoxvirus in the United States. One case in Florida is listed in the tracker, but is included in the number of cases for the United Kingdom since the patient was tested there.
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Shannon Firth has been reporting on health policy as a correspondent for MedPage Today in Washington since 2014. She is also a member of the Enterprise & Investigative Reporting team at the site. I follow
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