Your Monkeypox Questions Answered | MedPage today

What are the best practices for swabbing monkeypox lesions? Do Chickenpox and Smallpox Vaccines Prevent Monkeypox? CDC experts answered these and other questions during a clinician call for outreach and communication, while also providing a status update on the current outbreak, guidelines for treatment options, and advice for pre- and post-exposure prophylaxis.

Monkeypox, a rare zoonotic infection endemic to West-Central Africa, can be life-threatening. The first suspected case in the 2022 outbreak was reported in the US on May 17.

Do you need to remove the lesion to take a sample for monkey pox testing?

Bruce Furness, MD, MPH, a medical epidemiologist in the division of STD prevention at the CDC, said he wiped out more than 10 lesions on several patients, and “none of them opened the roof.”

“These are really small, rubbery, deep-seated lesions, and unlike HSV [herpes simplex virus] lesions… you can’t really tell if you got a good one or not based on whether or not fluid is present, or whether or not some is bleeding,” he noted. “You just have to scrub the swab as hard and aggressive as the patient can tolerate, as most of these are quite soft.’

Capt. Brett Petersen, MD, MPH, the deputy chief of the U.S. Public Health Service, Poxvirus and Rabies Branch, of CDC’s National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), said the lesions “do contain infectious virus”; therefore, it is important to keep the lesions and lesion materials covered to prevent transmission.

Can samples be taken before they become pustular?

Capt. Agam Rao, MD, a medical officer with the US Public Health Service at NCEZID, noted that swabs can also be taken during the vesicular phase.

In previous outbreaks, some patients had lesions in the mouth before lesions were presented on the skin, she explained. “So you can have blisters, 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 lesion formation, said Leandro A. Mena, MD, MPH, director of the division of STD prevention at the CDCs National Center for HIV/AIDS, Viral Hepatitis, STI and TB Prevention.

He pointed out that in the current outbreak, patients see lesions without any prodromal symptoms, and in some cases, symptoms develop after the rash develops.

Does the smallpox vaccine or the chickenpox vaccine provide any protection against monkeypox?

Previous smallpox vaccination is expected to provide “some protection” against monkeypox, Petersen said, as the two viruses are related.

In the 2003 monkeypox outbreak, six individuals vaccinated as children contracted monkeypox, but an analysis of cases in that outbreak suggested that “among those who had been previously vaccinated, there was a protective effect even after many decades of receiving monkeypox.” the smallpox vaccine,” he added.

It’s not yet clear how long after vaccination that protection lasts, and CDC researchers are continuing to study this question, he noted.

Chickenpox is a herpes virus in a separate family of monkeypox and smallpox, “so vaccination against chickenpox would not be expected to protect against monkeypox,” explained Petersen.

Can a person be infected with monkey pox more than once?

“We didn’t see that happen, but that doesn’t mean it couldn’t happen,” Rao said. “In general, smallpox infection provided lifelong protection, but it is not clear whether the same is true for monkeypox virus infections.”

The CDC is aware of a single case report of a possible monkeypox reinfection, but the agency expects this to be a rare scenario, Petersen noted.

“What we don’t know is with this new outbreak, and the new epidemiology and transmission route, whether that could affect some of what was seen before in monkeypox and other related viruses, like smallpox. So I think there’s more to it than that.” hand. learn there,” he added.

Can monkeypox be easily spread from person to person, similar to COVID-19?

“Monkeypox is definitely not COVID-19,” Rao emphasized. Based on past outbreaks and the current outbreak, monkeypox appears to spread through “direct close contact”. So intimate contact that can take place during sex, but also any other close contact that can occur – for example if you live with someone who has Monkeypox and you. sleeps on the same bedding and uses the same towels.”

“It’s really not something you just pass on to someone walking down the street,” she said.

While the agency’s researchers are “open” about the possibility that the virus could be more easily transmitted, “there is currently no evidence that it would spread the way COVID spread and spread to as many people as possible. [and] right now, the risk to the world’s population is … low,” she added.

In addition to answering questions from clinicians, Mena presented a case study of a male patient and his evolving symptoms, while Petersen provided an overview of medical countermeasures, including vaccines and biologics that are not commercially available but are stockpiled by the US government.

In November 2021, the Advisory Committee on Immunization Practices voted to recommend pre-exposure prophylaxis with Jynneos, a live non-replicating smallpox and monkeypox vaccine, as an alternative to ACAM2000, a live smallpox vaccine, “for certain individuals at risk of exposure to orthopox viruses.” .” In June, the CDC updated those recommendations.

Petersen noted that ACAM2000 carries risks of serious side effects, including myopericarditis.

“Myopericarditis has not been reported in association with Jynneos in the limited number of individuals who have received the vaccine in clinical trials, and therefore the risk is believed to be lower than that for ACAM2000,” he said.

As of Wednesday afternoon, there are 351 confirmed cases of monkeypox/orthopoxviruses in the US. One case in Florida is listed on the tracker but is included in the case count for the UK as the patient was tested there.

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    Shannon Firth has been reporting on health policy since 2014 as a Washington MedPage Today correspondent. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

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