Elsevier created the Monkeypox Healthcare Hub to help healthcare professionals navigate the current outbreak. Here you will find evidence-based clinical resources, including clinical overviews, patient education, and drug monographs.
Monkeypox is a zoonotic viral disease caused by the monkeypox virus (1). Though originally endemic to Africa, in 2022 a significant multi-country outbreak arose in many countries throughout the world, driven by travel and person-to-person transmission. WHO and the United States have both declared the ongoing outbreak to be a public health emergency. Though monkeypox was first detected in monkeys, the natural host for the virus is unknown, and international discussions are underway for renaming the monkeypox disease and virus in accordance with current best practices for naming infectious diseases (2).
Monkeypox is closely related to smallpox and classically presents with a similar but milder clinical course (3). Initial symptoms can include fever, chills, headache, fatigue, joint and muscle pain, and swollen lymph nodes. A characteristic rash typically appears within several days, progressing through several different stages until lesions scab over and fall off. In the current outbreak, anogenital lesions have been very common, and symptoms other than rash are often very mild or absent altogether (4).
Male to male sexual contact is believed to be the primary mode of disease transmission in the current outbreak. Over 95% of cases worldwide have been in gay and bisexual men and other men who have sex with men (5). Transmission can occur through direct or indirect contact with monkeypox lesions, lesion material, respiratory secretions, other bodily fluids, and contaminated materials such as clothing and bedding (6).
Monkeypox should be suspected in patients with compatible clinical features (especially rash) and risk factors for exposure. Diagnosis is made via laboratory detection of monkeypox virus DNA from lesion material (7). Most patients with monkeypox have mild, self-limited disease, and can be managed supportively. Several antiviral agents originally developed for treatment of other viral infections appear effective against monkeypox and can be considered for certain patients (8). Additionally, in the United States, two vaccines are available for monkeypox pre- and post-exposure prophylaxis (9).
There have been relatively few deaths associated with the 2022 outbreak. Although the outbreak situation worldwide has been cautiously improving in recent months, intensive research and infection prevention efforts are ongoing (10).
WHO: Monkeypox Fact Sheet. WHO website. Published May 19, 2022. Accessed October 6, 2022. https://www.who.int/news-room/fact-sheets/detail/monkeypox
WHO: Monkeypox: Experts Give Virus Variants New Names. WHO website. Published August 12, 2022. Accessed October 6, 2022. https://www.who.int/news/item/12-08-2022-monkeypox--experts-give-virus-variants-new-names
Huhn GD et al: Clinical characteristics of human monkeypox, and risk factors for severe disease. Clin Infect Dis. 41(12):1742-51, 2005
CDC: Monkeypox: Healthcare Professionals: Clinical Guidance: Clinical Recognition. CDC website. Updated August 23, 2022. Accessed October 6, 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html
WHO: Multi-country Outbreak of Monkeypox, External Situation Report 4--24 August 2022. WHO website. Published August 24, 2022. Accessed October 6, 2022. https://www.who.int/publications/m/item/multi-country-outbreak-of-monkeypox--external-situation-report--4---24-august-2022
CDC: Monkeypox: How It Spreads. CDC website. Updated July 29, 2022. Accessed October 6, 2022. https://www.cdc.gov/poxvirus/monkeypox/transmission.html
CDC: Monkeypox: Healthcare Professionals: Case Definitions for Use in the 2022 Monkeypox Response. CDC website. Updated July 22, 2022. Accessed October 6, 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/case-definition.html
CDC: Monkeypox: Healthcare Professionals: Clinical Guidance: Clinical Treatment. CDC website. Updated September 15, 2022. Accessed October 6, 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/treatment.html
CDC: Monkeypox: Healthcare Professionals: Monkeypox and Smallpox Vaccine Guidance. CDC website. Reviewed June 2, 2022. Accessed October 6, 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html
WHO: Multi-country Outbreak of Monkeypox, External Situation Report #7 – 5 October 2022. WHO website. Published October 5, 2022. Accessed October 6, 2022. https://www.who.int/publications/m/item/multi-country-outbreak-of-monkeypox--external-situation-report--7---5-october-2022
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