Monkeypox: Is it something to be concerned about?

Helmut Albrecht, MD

Internal Medicine

A rare viral infection called monkeypox has shown up in the U.S., prompting concern. Infectious disease expert Helmut Albrecht, MD, explained what you need to know.

Monkeypox isn’t a new disease

Monkeypox is a viral infection transmitted to humans from animals that is endemic to several Central and West African countries. The U.S. saw an outbreak of monkeypox in 2003 with 47 cases in the Midwest. It was significantly less infectious than other viruses, and there were no deaths.

“The cases we’re seeing now are slightly different than previous outbreaks of monkeypox because there’s a potential sexual transmission,” Dr. Albrecht said. “We’re preparing our emergency and primary care providers so they’re ready to recognize it, but this will not be the next pandemic. It’s a virus we know very well and have vaccines and medications licensed in the U.S. to treat it.”

How does a person catch monkeypox?

Usually, monkeypox spreads through contact with an infected animal. It can be spread from person to person through contact with pox lesions, which are blisters or scabs.

“The virus can be shed through the air, but it is not an effective way of transmitting the virus” Dr. Albrecht said.

It is very different from COVID-19 in that it requires prolonged face-to-face contact to spread through the air. It also is not spread by asymptomatic people.

What symptoms should people look out for?

Monkeypox is an illness with fever and a blistering rash. There’s an incubation period which averages seven to 14 days but can range from five to 21 days. During this period, a person is not contagious and may not have symptoms.

A fever typically starts a day or so before the blisters appear. Other symptoms can include:

• Headache
• Sore throat
• Cough
• Swollen lymph nodes

The rash typically affects the mouth, face, palms of the hands, soles of the feet, and genitalia. Lesions will develop, starting flat, then raised with clear then yellowish fluid. Eventually, the lesions will open, dry up, scab over and fall off.

A person is contagious from the onset of lesions until all scabs that have formed have fallen off.

The concern for us is that the rash looks like smallpox,” Dr. Albrecht said, “so we want people to know that there is a monkeypox outbreak, which is similar looking but a much more benign disease.”

How is monkeypox distinguished from smallpox?

Patients with smallpox are generally much sicker and have more lesions.

“They have a slightly different distribution of the lesions and monkeypox is associated with more pronounced swelling of lymph nodes,” Dr. Albrecht explained, “but in the end, it will require PCR testing of the virus to distinguish it.”

Is there a cure for monkeypox?

Most patients recover on their own, but monkeypox can be dangerous for young children, pregnant women and those who are immunocompromised.

Two antiviral medications have been approved for treatment and can reduce the illness: brincidofovir and tecovirimat.

A smallpox vaccine also is approved to reduce the spread of monkeypox, if needed.