Ask a Nurse: What Is Monkeypox and Should We Be Concerned?
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Question: What is monkeypox, and should we be concerned?
On July 23, 2022, the World Health Organization (WHO) declared monkeypox a global emergency. WHO's director general Dr. Tedros Adhanom Ghebreyesus dubbed monkeypox a "public health emergency of international concern." Monkeypox is now the third disease to be described this way, along with COVID-19 and polio.
There have been more than 16,000 cases in 75 countries and nearly 3,000 cases recorded in the U.S. as of July 23, 2022. The virus spreads primarily through close contact, but research is assessing other ways monkeypox may be spreading.
Vaccine options for monkeypox remain limited but include JYNNEOS and ACAM2000. There is a limited supply of JYNNEOS, though more are expected in the coming weeks. There is a significant supply of ACAM2000, but this vaccine should not be used in people with weakened immune systems, skin conditions including eczema, or pregnancy. There is no data available on the effectiveness of these vaccines in the current outbreak.
The Centers for Disease Control and Prevention (CDC) is currently tracking cases of monkeypox in several countries, including the U.S. The movement of the viral illness outside Central and Western Africa has public health officials puzzled. The illness is rare but has recently been identified in 37 countries in Europe and North America.
Questions are being asked about whether this virus will be the start of a new global pandemic. However, it is important to note that as of July 12, 2022, the CDC has recorded just 928 cases of monkeypox in the U.S.
This page discusses what you need to know about monkeypox, its symptoms, treatment, and how contagious it is.
What Is Monkeypox?
Monkeypox is a zoonotic viral illness caused by the monkeypox virus. Zoonotic viruses can be transmitted between animals and humans after contact with material like bedding or clothes. It can also be transmitted between animals and humans after a scratch, bite, or contact with the rash on the animal.
Historically, there have been fewer cases of human-to-human transmission. The illness was discovered in1958 in two groups of monkeys kept for research. Scientists believe it is spread in the wild through rodents.
The first human case was recorded in 1970 when it was found in an infant in the Democratic Republic of the Congo. According to the World Health Organization (WHO), monkeypox is endemic in 12 countries including the Democratic Republic of the Congo, Nigeria, and the Central African Republic.
Monkeypox has been reported in the U.S. in the past after individuals have traveled to countries where the virus is endemic or after exposure to imported animals.
Symptoms of Monkeypox
Symptoms are similar to smallpox but are usually milder and last 2-4 weeks. Symptoms include:
- Swollen lymph nodes
- Muscle aches
Symptoms begin to develop 1-2 weeks after exposure to the virus. At the onset, people usually have flu-like symptoms. Then, a rash begins to appear after 1-3 days. The rash starts as flat red bumps that turn into pus-filled blisters. Several days later, the blisters crust and fall off. The rash usually starts on the face and spreads to the rest of the body.
However, currently, the virus has been presenting differently. In some cases, patients do not have early symptoms, or if they do, they may be mild. For some, the rash is the first symptom.
How Does the Illness Spread?
Researchers believe that person-to-person transmission occurs only with direct contact with material found in the pus-filled blisters. It may also be transmitted through respiratory droplets when a person who is infected coughs or sneezes.
This requires prolonged face-to-face contact. Other ways the virus can be transmitted is by coming into direct or indirect contact with material that has been contaminated with the virus from a sneeze or the pus-filled blisters.
For example, the infection can spread from an infected person's:
- Utensils (like a plate or fork)
In a recent news article, Dr. Tom Inglesby, director of The Johns Hopkins Center for Health Security, explained that while it can be spread through respiratory droplets, it is not spread across distances, like across a room. The way it spreads also makes it easier to control outbreaks.
Compared to smallpox, this viral illness has a low fatality rate. There are two forms of monkeypox, one from West Africa and the other from Central Africa. According to a paper published in the Journal of the American Medical Association on May 27, 2022, the current outbreak has involved a milder West African form with a case fatality rate of less than 4%.
By comparison, the Central African virus is more virulent, spreads more easily, and has a case fatality rate of roughly 11%. In comparison, smallpox has a case fatality rate of 30%. Given that monkeypox infections have appeared to increase in endemic countries in the past few years, experts have expected sporadic cases to show up globally.
Guidelines Issued to Control Transmission
The U.S. CDC recommends several measures to help prevent the spread of infection. These include:
- Avoid contact with animals that may harbor the virus, including those that are sick or found dead.
- Avoid contact with material that's been in contact with a sick animal or individual.
- Isolate infected individuals.
- Practice good hygiene after contact, such as washing with soap and water or using an alcohol-based hand sanitizer.
- Use personal protective equipment when caring for patients who have monkeypox.
United Kingdom (U.K.) public health agencies have also issued guidance to help control the transmission within the community. They have found no evidence that infected people can transmit the disease before presenting with a fever or rash.
They also recommend good handwashing and disinfection of any materials that have come into contact with an infected person or animal. This includes waste management and decontamination processes.
While there is no evidence that the virus is spread through genital excretions, they recommend condoms for eight weeks after an individual has been sick and abstaining from sex when the lesions are present.
Additionally, their guidelines include the statement that the disease in healthy adults is "self-limiting and with a relatively low mortality."
Treatment Options and Vaccinations Are Available
Monkeypox can appear like other rash illnesses such as chickenpox, smallpox, or measles. However, individuals with monkeypox will have swollen lymph nodes, which distinguishes it from other rash-related illnesses. Diagnosis may be made after taking a tissue or blood sample for the virus.
At this time, there is no proven treatment for the illness. However, according to the CDC, most people have a "mild self-limiting disease course in the absence of specific therapy."
Prognosis depends on many factors, including other concurrent illnesses or comorbidities, vaccinations status, and initial health status. History of the disease in endemic countries indicates that several populations may be at high risk of severe disease. This includes people who are immunocompromised and pregnant or chestfeeding individuals.
People with a history of atopic dermatitis or other skin conditions and those who develop complications from the condition are also at higher risk of severe disease. Antiviral medications that were developed for smallpox may prove beneficial. These include:
- Tecovirimat (also known as TPOXX)
- Cidofovir (also known as Vistide)
- Vaccinia Immune Globulin Intravenous
- Brincidofovir (also known as Tembexa)
Brincidofovir was approved by the Food and Drug Administration in 2021 for smallpox in adults, children, and neonates. The WHO also recommends optimizing treatment to help alleviate symptoms and manage complications. This includes fluids and food to maintain nutritional status and treating secondary bacterial infections when they occur.
According to the WHO, there is some cross-protective immunity in older adults who were immunized against smallpox. There are limited amounts of two different vaccines available in the U.S. These include:
- ACAM2000: This vaccine was approved in 2007 against smallpox. It contains live virus and can be used after a person was exposed to monkeypox. It has serious potential adverse effects, so wide distribution of this vaccine requires serious discussion, according to the CDC.
- JYNNEOS: This is a live, nonreplicating vaccine approved in 2019 for the prevention of monkeypox and smallpox.
Currently, there are 100 million doses of ACAM2000 and 1,000 doses of JYNNEOS.
Mitigating measures used by individuals are the best and most widespread approach. This includes good handwashing techniques and paying attention to genital lesions on sexual partners.
How COVID-19 Has Changed Public Perception of Disease
According to information from the U.K. Health Security Agency, the U.K. is not on the brink of a national outbreak. They do offer advice to limit your contact with people who have been in contact with a confirmed case. What has been learned since 2020 is that COVID-19 has changed the perception of viral disease.
One study in 2021 found that 64% of people who responded to the survey experience stress related to COVID-19. They identified headaches, insomnia, anxiety, and weight gain as health concerns that resulted from this stress.
The public experience from the COVID-19 pandemic has colored the perception of new viral illnesses as they emerge. Some have found it easier to use mainstream media as a major source of information. Yet, it is better and mentally healthier to read studies and papers from independent researchers for information that guides your actions and decision-making.
You can protect your mental and physical health by seeking accurate information on which you can take action while leaving fear-generating news behind.
- Monkeypox is a rare zoonotic viral illness that spreads through contact with an infected person's respiratory secretions or pus-filled blisters.
- Symptoms of monkeypox may start 1-2 weeks after exposure. It usually starts with flu-like symptoms before developing a flat, raised rash that progresses to pus-filled blisters.
- Treatment includes supportive care, nutrition, and hydration. The CDC has four antiviral medications that may help shorten the illness and two vaccines. One vaccine has significant side effects.
- Preventive measures include good handwashing and not handling a sick animal. Also avoid bedding and clothing from individuals or animals with monkeypox.
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