MONKEYPOX

VIRUS
Stages of Monkeypox
Incubation period: 5 to 21 days (median 7 days)
 The Monkeypox Rash: Classic

●Fever before rash by 2 days

●Swollen lymph nodes – key

differentiating feature of monkeypox

from smallpox and bulutong
●Same stage, appearance of lesions
 The Monkeypox Rash: Classic
Face and extremities greatly affected

Size range from 0.5 - 1 cm Umbilication may be present

 The Monkeypox Rash: Classic

Over the following 2 to 4 weeks, the lesions evolve in 1 to 2-day increments through
macular, papular, vesicular, and pustular phases
 Rapid progression

More dense over the

trunk; palms and
soles spared
More dense over the
face; present on palms
and soles

Lesions often in
multiple stages of
Slow progression development
 Diagnosis

Clinical diagnosis relies on the characteristic features of the rash

Prominent lymph nodes during prodromal stage

Same stage of lesion

Concentrated on face and and extremities rather than trunk (centrifugal)

Lesion development: macule, vesicle, umbilicated pustule, crust

Monkeypox: Newer and Atypical Presentations

•528 cases in 16 countries outside Africa

• Male: 527 Trans or Non-binary: 1
• Median age: 38 years

• Presentation:
• 95% had rash (but 64% had <10 lesions)
• 73% had anogenital lesions
• 41% had mucosal lesions (with 54 having a single genital lesion)
• Common systemic features preceding the rash included:
• Fever (62%)
• Lethargy (41%)
• Muscle pain (31%)
• Headache (27%)
• Swollen lymph nodes (56%)
Monkeypox: Newer and Atypical Presentations

•Concomitant STI were reported in 109 of 377

persons (29%) who were tested.
•Monkeypox virus DNA was detected in 29 of the 32
persons in whom seminal fluid was analyzed
•Reasons for hospitalization:
• Pain management, mostly for severe anorectal pain (21 persons)
• Soft-tissue superinfection (18)
• Pharyngitis limiting oral intake (5)
• Eye lesions (2)
• Acute kidney injury (2)
• Myocarditis (2); and
• Infection-control purposes
 Who are affected?
According to recent published report, 96-98% of
cases were gays, bisexuals, or men who
have sex with men
Where are the cases
detected?
● Most cases presented through sexual
health or other health services in primary
or secondary health care facilities.
● History of travel primarily to countries in
Europe, and North America or other
countries
 Diagnosis:
What specimens to send?

• Vesicular or pustular fluid aspirate

• Crust or roof of skin lesion
• Skin or tissue
 Treatment

•Supportive care – antipyretics, hydration if with losses

•Keep skin clean and dry, avoid scratching or manipulation
•Cover lesions with sterile wound dressing.
•Change bed linens at regular intervals.
•Antibacterial treatment – only if with superimposed bacterial
infection
• Cloxacillin or clindamycin
 Vaccination
•Live vaccinia virus
•Licensed for immunization in people who are at least 18 years old and
at high risk for smallpox infection
•Monkeypox Vaccine
•JYNNEOS™ (Imvamune or Imvanex)
• Licensed in the US to prevent monkeypox and smallpox
• At least 85% effective in preventing monkeypox
MONKEYPOX
INFECTION
PREVENTION
 How is Monkeypox transmitted

•Unprotected contact with:

• Bodily fluids
Direct contact with • Skin lesions
monkeypox skin • Respiratory droplets
Large respiratory droplet lesions or scabs • Animal bites
• Indirectly via contaminated items
•Human-to-human transmission – limited
• Requires prolonged close contact with an
individual with a monkeypox rash

Contact with clothing or items used

for or by an infected person
 Transmission of Monkeypox

•Close physical contact (skin-to-skin, mouth-to-

skin), such as those involved in sexual activities
(with or without genital penetration) and non-
sexual activities with prolonged contact time,
especially in areas with reported cases of
Monkeypox
•Exposure to respiratory secretions
 Prevention of Transmission
•Standard, contact, and droplet precautions
•Recommended PPE:
•Disposable gown
•Disposable gloves
•Fit-tested N95 (or comparable) filtering disposable respirator
•Eye protection (e.g., face shields or goggles)
 Infectiousness and Duration of Isolation

•Risk of transmission is low during the prodromal period

until the rash (and/or oral lesions) appears.

•Isolation for at least 21 days or until resolution of all

symptoms, including any rash, crusting or scabs (until scabs
have separated, fallen off and underlying skin healed).
Screening for patients entering
healthcare facilities
 Sample Pathway for Monkeypox
• Transfer to isolation/ designated area
Rash PLUS significant exposure or • Wear PPE (for the person who will
travel history (i.e. Patients
identified though the Screening further evaluate the patient)
checklist) • Institute Respiratory and contact
precautions

Monkeypox suspect or
probable?

Consider and treat for • Admit to isolation area or refer to referral

other differentials
accordingly
Transmission-based
precaution depending on
working diagnosis.
center/ hospital if necessary
• Advise patient and prepare for specimen
collection
• Contact IPCU, local epidemiology and
surveillance unit
Specimen collection

• Coordinate transport of specimen

• Provide home advise
Insert important contact numbers here: IPCU: • Coordinate transport home
CESU/RESU:
• Provide contact details for telemedicine/ follow-up
IDS/Derma on call:
• Environmental cleaning and sanitation
Laboratory:
 Recommendations for MSM

For the moment

•Reducing number of sexual partners

•Reconsidering sex with new partners
•Exchanging contact details with any new
partners to enable follow up if needed
 How can a person lower their
risk during sex?

• Talk to your partner about any recent illness and be aware of new or unexplained rashes on your
body or your partner’s body, including the genitals and anus.

• If you or your partner have recently been sick, currently feel sick, or have a new or an unexplained
rash, do not have sex and see a healthcare provider.
 How can a person lower their
risk during sex?

•If you or a partner has monkeypox, the best way to protect

yourself and others is to avoid sex of any kind (oral, anal, vaginal)
and do not kiss or touch each other’s bodies while you are sick,
especially any rash.
•Do not share things like towels, fetish gear, sex toys, and
toothbrushes.
 What should a person do if they
have a new or unexplained rash or other symptoms?

•Avoid sex or being intimate with anyone until

you have been checked out by a healthcare
provider.
•If you don’t have a provider or health
insurance, visit a public health clinic near you
.
 What should a person do if they
have a new or unexplained rash or other symptoms?

•When you see a healthcare provider, wear a mask, and

remind them that this virus is circulating in the area.
•Avoid gatherings, especially if they involve close,
personal, skin-to-skin contact.
What is the preferred test to diagnose
monkeypox infection?
If you or your partner have (or think
you might have) monkeypox and you
decide to have sex, consider the
following to reduce the chance of
spreading the virus:

•Have virtual sex with no in-person

contact.
•Masturbate together at a distance of at
least 6 feet, without touching each other
and without touching any rash.
 If you or your partner have (or think you might have)
monkeypox and you decide to have sex,
consider the following to reduce
the chance of spreading the virus:
•Consider having sex with your clothes on or covering areas where
rash is present, reducing as much skin-to-skin contact as possible. If
the rash is confined to the genitals or anus, condoms may help;
however, condoms alone are likely not enough to prevent
monkeypox.
•Avoid kissing.
 If you or your partner have (or think you might have)
monkeypox and you decide to have sex,
consider the following to reduce the chance of
spreading the virus:
• Having multiple or anonymous sex partners may increase your chances of
• exposure to monkeypox. Limiting your
number of sex partners may reduce the possibility of exposure.
• Avoid touching the rash. Touching the rash can spread it to other parts of the body
and may delay healing.
Remember to wash
your hands, fetish
gear, sex toys and
any fabrics
(bedding, towels,
clothing) after
having sex.
Assess your risk of infection for
monkeypox in your activities.

Relatively safer

Some risk

Higher likelihood
 How can a person lower the chance of
getting monkeypox at places like raves,
parties, clubs, and festivals?

•Festivals, events, and concerts where attendees are

fully clothed and unlikely to share skin-to-skin contact
are safer.
•However, attendees should be mindful of activities (like
kissing) that might spread monkeypox
How can a person lower the chance of
getting monkeypox at places like raves,
parties, clubs, and festivals?

• A rave, party, or club where there is minimal

clothing and where there is

direct, personal, often skin-to-skin contact has some

risk.
• Avoid any rash you see on others and
consider minimizing skin-to-skin contact.
 How can a person lower the chance of
getting monkeypox at places like raves,
parties, clubs, and festivals?

• Enclosed spaces, such as back rooms,

saunas, sex

clubs, or private and public sex parties

where intimate,

often anonymous sexual contact with

multiple partners

occurs, may have a higher likelihood of

spreading

monkeypox.
 “Monkeypox response should be
centered on equity.”

“Efforts should be targeted to the population and in all cases

minimize stigma and discrimination.” 1
We should reach out and involve the gays, bisexuals and MSMs to
increase awareness and at the same time ask for assistance how to
reach out and develop friendly strategies to curb the Monkeypox
epidemic.
THANK YOU!