Monkeypox

As the United States declares Monkeypox outbreak a public health emergency, NYC declares a local state of emergency due to the outbreak.  The American Academy of Dermatology & The World Health Organization have put together a Task Force to address the growing outbreak of Monkeypox (orthopoxvirus) in the US.  Monkeypox is a contagious disease caused by the Monkeypox virus. US Map and case count on the 2020 outbreak here ... 

Transmission:

Anyone can get Monkeypox.  It is primarily spread through close, physical contact between people.  In the current outbreak, the Monkeypox virus is spreading mainly during oral, anal and vaginal sex and other intimate contact, such as rimming, hugging, kissing, biting, cuddling and massage.

Previous outbreak experience elsewhere suggests that the elderly, those with weakened immune systems, pregnant people, and children under 8 years of age may be at heightened risk for severe outcomes. Smallpox vaccine may help protect you against Monkeypox. Although, immunity may wain with age, it is estimated that the smallpox vaccine can be over 80% effective in preventing Monkeypox. Howevver, the vaccine for smallpox was discontinued in 1972 when it was eradicated in the United States. So therefore, anyone who is 49 years of age or younger most likely did not receive a smallpox vaccine.

Prevention:

The best way to protect yourself from Monkeypox is to avoid sex and other intimate contact with multiple or anonymous partners. 

If you choose to have sex or other intimate contact, the following can help reduce your risk:

• Reduce your number of partners, especially those you do not know or whose recent sexual history you do not know.
• Ask your partners if they have Monkeypox symptoms or feel sick. If you or your partners are sick, especially if you or they have a new or unexpected rash or sore, do not have sex or close physical contact.
• Avoid sex parties, circuit parties and other spaces where people are having sex and other intimate contact with multiple people.
• If you choose to have sex or other intimate contact while sick, cover all rashes and sores with clothing or sealed bandages. This may reduce spread from contact with the rash or sores, but other methods of transmission may still be possible.
• Since it may be possible the virus can be transmitted through semen, use latex condoms during sex.
• Do not share towels, clothing, fetish gear, sex toys or toothbrushes.
• Wash your hands, fetish gear and bedding. Sex toys should be washed after each use or sex act.

How to Protect Yourself and Others from Monkeypox (PDF)

Symptoms:

Most cases are mild. Symptoms usually start within two weeks of exposure, but in some cases they may not appear for up to 21 days. If you have a new, unexplained skin rash or lesion(s)/bump(s) on your skin and you don’t know what caused it and think you may have Monkeypox, it is important to see your dermatologist quickly to prevent exposing more people. Eligible New Yorkers who may have been exposed to Monkeypox can now get vaccinated to stay safe and slow the spread.

Some symptoms include:

• Lesions on the face, hands, feet and body as well as inside the mouth, genitals or anus. They can be extremely itchy and painful and may interfere with daily activities. 
•  Some people also have flu-like symptoms. These symptoms can occur before or at the same time as the rash or bumps. Flu-like symptoms include: 
•  Swelling of the lymph nodes
•  Fever
•  Chills
•  Muscle aches
• Headache
• Back pain
• Weakness/Fatigue

If  You Have Symptoms:

A person is contagious until all sores have healed and a new layer of skin has formed, which can take two to four weeks.

If you start experiencing symptoms, isolate at home immediately, ideally stay in a separate area away from other family members and pets and talk to your dermatologist. 

The following may increase your risk for severe disease if you are infected: HIV; other conditions that weaken your immune system; and a history of atopic dermatitis or eczema. If you have one of these conditions, it is especially important to see a provider right away, if you have symptoms.

To protect others while you are sick:

• Avoid sex, being intimate or having skin to skin contact with anyone until you have been checked by your dermatologist.
• Stay home and separate from other people in your household. 
• If you cannot fully separate from others in your household and avoid physical contact. Wear clothing that covers your lesions when in shared spaces.
• If you must leave home for essential needs or medical care, cover your lesions with clothing.
• Do not share or let others touch your clothing, towels, bedding or utensils. Do not share a bed. 
• Do not share dishes, food, drink or utensils. Wash dishes with warm water and soap or in a dishwasher.
• Wash your hands frequently with soap and water and clean shared surfaces, such as countertops and doorknobs, often. Household members should also wash their hands often, especially if they touch materials or surfaces that may have come in contact with lesions.

Diagnosis -- Where To Get Tested:

Not every rash is Monkeypox. Dr. Robinson can make a diagnosis of Monkeypox by looking at the pattern on the skin and where the rash appears. Please let the office know ahead of your visit that you have a "new unexplained rash or lesions" and think you may have monkeypox. If Dr. Robinson suspects Monkeypox may be the cause of the rash, he will swab the rash and send it to a lab, where a polymerase chain reaction test will be performed.

Treatment:

There is treatment approved for Monkeypox. Most people get better on their own without treatment. However, antiviral medication(s) (TPOXX) may help. Your provider will help you find out if you are eligible for antiviral treatment. They may be able to prescribe medicine and provide information about symptom relief.

Vaccine Information:

Vaccination after possible exposure ... Eligible New Yorkers who may have been recently exposed to Monkeypox can get the JYNNEOS TM vaccine. Vaccine is free and available regardless of immigration status.  Information about eligibility for the vaccine and appointments can be found here.

Getting vaccinated after a recent exposure may reduce the chance of you getting Monkeypox and it can reduce the symptoms if you do get it. 

People should get two doses, at least four weeks apart. 

Information about eligibility for the vaccine clinic and appointments can be found here.

JYNNEOS Vaccine for Monkeypox: Frequently Asked Questions (PDF)

Additionally, here is a link to a letter published in the Journal of the American Academy of Dermatology (JAAD) that explains the symptoms and features of monkeypox. For more information about monkeypox, visit the AAD website.