What is Monkeypox?

Monkeypox is a virus that is similar to smallpox because they are part of the same genus – the orthopoxvirus genus. It is a zoonotic disease, which means its natural hosts are animals – in this case primates and rodents. This virus causes a syndrome of fevers, body aches, malaise, and a pustular rash that is similar to smallpox, although less deadly and less contagious.

This is not a new virus, and normally tends to occur primarily in the tropical forests of West and central Africa. However, this does occasionally cause small outbreaks outside of these areas.

In 2003 there was a brief outbreak in the US, which included only 71 confirmed cases. Out of these, there was no spread to any healthcare staff or other patients within the hospital, and no associated deaths. 

Since May 2022, there is another outbreak in the US that is current and continues to spread, this time much more prevalent with over 21,000 cases confirmed in Septemeber, and over 50,000 cases globally.

Check out CDC for updated statistics.

Transmission of Monkeypox

There are multiple ways in which viruses can be transmitted to other people.

Monkeypox has a few different routes of transmission, some more common than others. These routes of transmission include:

The CDC recommends that if a patient is exposed to monkeypox in the community, they should:

• Monitor for symptoms for up to 21 days
• If any symptoms develop, should isolate for at least 5 days to watch for the development of a rash
• If the rash develops, isolate until evaluated by a healthcare professional (likely isolate until lesions resolve)

How dangerous is Monkeypox?

It’s difficult to predict how dangerous monkeypox is for those in the US, as most of our data comes from Africa. In Africa, they have less access to quality healthcare, and the predominant strain (called a “clade”) is more deadly there. 

From the data regarding Monkeypox in Africa, up to  3-6% of cases die.

So far. in the US, there have been one confirmed death from Monkeypox in LA. 

Remember that most of the current monkeypox infections are circulating among younger, generally healthy men.

We have not yet seen monkeypox in large amounts in older patients with significant comorbidities and immunocompromised patients, and they’re expected to have higher rates of complications and death.

Even if monkeypox does not cause death, it can last for weeks and lead to very painful and sometimes scarring lesions.

Prevention

Prevention is the most important aspect of infection control. If we can prevent spreading the virus, we can’t control the virus. This leads to better patient outcomes overall.

With monkeypox, there are ways to prevent the spread within and outside of the hospital. Monkeypox prevention includes:

Assessment

Prodromal Symptoms

Patience with monkeypox will often present with a Prodromal period of symptoms, followed by the characteristic rash. During the prodrome, these symptoms will usually last up to 5 days and include:

The Monkeypox Rash

The characteristic rash of monkeypox will typically develop 1-4 days after the prodromal symptoms start.

Physical Assessment

The physical inspection will primarily involve inspecting the skin for the monkeypox lesions, noting their quality, amount, number, and locations.

• Generalized: May be febrile, sweaty, pale
• HEENT: May have enlarged and tender anterior cervical lymph nodes, throat may be erythematous
• Cardio: May have tachycardia, especially if fever present
• Respiratory: may have increased respiratory rate, sometimes could have cough
• Skin: Monkeypox lesions as described in detail below
• Extremities: Lymphadenopathy may be present in axillae or groin

Vitals:

• Temp: Often have fever >100.4
• BP: Often normal
• HR: May have mild tachycardia d/t fever, dehydration, etc
• RR: May by mildly tachypneic
• SPO2%: Often normal

Nursing interventions

There are some nursing inventions that you can do right off the bat with these patients he suspected to have a monkeypox:

Diagnosis of Monkeypox

Diagnosis of monkeypox is largely clinical – so based on their history and the rash. However, it is recommended to confirm this in a lab due to the current outbreak.

There are a few ways monkeypox can be confirmed in the lab:

There are other lab abnormalities that can present in patients with monkeypox, although these are NOT specific to monkeypox. these include:

• Leukocytosis (increased WBC)
• Transaminitis (Elevated liver enzymes)
• Thrombocytopenia (Low platelets)
• Hypoalbuminemia (low albumin levels)

Prognosis & Treatment

With the current US outbreak, patients who get Monkeypox generally have a good recovery, and most can fully recover at home without hospitalization. So far only one death has been specifically attributed to monkeypox in the US during this current outbreak.

However, patients can present with more severe symptoms and complications, which can lead to worse outcomes and even death. These patients are kept in the hospital and given more extensive treatment.

For most people who get Monkeypox, treatment is going to be symptomatic, just like with most viruses. Symptomatic or supportive care includes:

Complications & Monitoring

As discussed, most patients recover well at home, but there are certain complications and monitoring that you should watch for.

Patients at increased risk of developing more severe complications include:

• Immunocompromised: People with HIV/AIDS, leukemia, chronic steroid use or other immunosuppressants
• Age < 8
• Pregnant or breastfeeding women
• People with active skin diseases like severe eczema, impetigo, burns, etc

Secondary bacterial infections can occur with viral infections, and this is no different than with monkeypox. Bacteria like to strike while the immune system is busy fighting the virus. This can lead to infections like pneumonia or sepsis.

Common secondary infections include:

And hopefully that gave you a pretty good understanding of Monkeypox and how to care for your patients who may have it!