Clinicians should prepare for monkeypox

The current monkeypox outbreak is more widespread than previous outbreaks outside of Africa and should prompt all clinicians to be attuned to the possibility that patients presenting with febrile illness and rash may be infected, according to the authors of a new commentary from the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.

The authors also note that a significant number of these new cases have occurred among men who have sex with men (MSM), though the cause is unclear. These and other important facts about the current monkeypox outbreak are explained in a new commentary published in Annals of Internal Medicine.

Currently, several dozen monkeypox cases have been reported in Europe, the UK and North America, concerning epidemiologists and public health experts around the world. What distinguishes these cases — all occurring outside of the endemic region of the virus — is that person-to-person transmission is occurring, with the majority of the cases seemingly unlinked to travel from an endemic country, with the appearance of multiple, so far unlinked clusters.  In addition, a significant proportion, though not all, of the cases are occurring in MSM, and many of these cases are being diagnosed at sexually transmitted infection (STI) clinics. The authors emphasize that this does not necessarily mean that monkeypox is sexually transmitted.

As a member of the orthopox viral family, of which smallpox is also a member, it is possible that the rise in monkeypox outbreaks in recent years is related to diminished population immunity to smallpox over time. Smallpox vaccination could prevent cases and smallpox antivirals may treat monkeypox cases, as well.

Monkeypox typically presents with fever and rash that starts in the mouth, then moves to the face, followed by the extremities, including palms and soles in a tell-tale centrifugal pattern. Primary care physicians, urgent care physicians, emergency medicine physicians, dermatologists, and those working in STI clinics may be the most likely to identify new monkeypox patients should they continue to appear. Clinicians who suspect monkeypox should alert state health officials to initiate testing, as commercially available test for monkeypox.

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