DVIDS – News – Army experts address monkeypox concerns

By V. Hauschild, MPH, US Army Medical Center

ABERDEEN PROVING GROUND, Md. — After more than two years of grappling with the COVID pandemic, concerns are now mounting about a possible new disease threat: monkeypox.

The US Army Public Health Center has compiled key facts to educate soldiers and guide doctors about this disease.

Best known for its characteristic rash of hard pustules that form scabs, monkeypox belongs to the same virus family as smallpox. Although monkeypox is painful and can be transmitted between people, it is much less serious than smallpox and is generally treatable. Most people with monkeypox make a full recovery within two to four weeks, even without treatment.

Although monkeypox can lead to serious consequences such as blindness and is occasionally fatal in those with underlying health problems or a weak immune system, it is a different type of virus that is much less contagious and life-threatening than COVID.

Unlike COVID, monkeypox is not a new disease; It is a rare infectious disease that has been known for decades. The Centers for Disease Control and Prevention state that it occurs naturally or is “endemic” in countries in Africa.

When monkeypox is reported in countries where it is not naturally occurring, such as the US and many other developed countries, the situation is called an “outbreak.” Numerous contained outbreaks with small numbers of cases have been reported over the years. In the US, the CDC reported outbreak cases in 2021 that were attributed to foreign travel; In 2003, cases of contact with infected imported mammals were reported.

Most recently, the CDC issued a health alert after a case of monkeypox was confirmed in Massachusetts. The CDC is now tracking new cases of monkeypox outbreaks in several countries in Europe and Australia, as well as the United States. As of September 19, over 59,000 cases of monkeypox have been reported worldwide; over 22,000 of these were in the US. There has been one confirmed death from monkeypox in the United States

It’s not clear how people were exposed to monkeypox in this recent outbreak, but according to the CDC, early data suggests that men who reported having intimate physical contact with other men account for a high number of cases. Travel to a country where monkeypox is endemic, such as Nigeria, has also been identified as a risk factor.

“The greatest risk appears to be direct contact with a source of the monkeypox virus,” says Dr. Chip McCannon, a physician with the APHC’s Directorate of Clinical Public Health and Epidemiology. “That’s why it’s important to avoid intimate contact with an infected person.”

Visible pustules, lesions, or crusts, which may appear on the palms and soles or be generalized in other areas, including the perianal or genital areas, are one way to identify potentially infected individuals. McCannon explains that a person could be contagious before showing these signs because the incubation period (the time from contracting monkeypox to showing symptoms) averages seven to 14 days.

“People have been infected through contact with surfaces and fabrics (clothing, bedding, or towels) used by someone with monkeypox,” says McCannon. “In healthcare settings where transmission of monkeypox has been rarely reported, standard precautions are taken to prevent direct contact with lesion material, respiratory droplets, or oral fluids.”

Recently, The Lancet Medical Journal reported on a case of a dog that contracted monkeypox through close contact with its infected owners. Not only can pets develop the disease, they can also be a source of transmission between people if one is infected.

Importantly, however, the CDC still rates the threat of monkeypox to the general US population as LOW, noting that the virus does not spread easily between people without close contact.

“We don’t foresee a monkeypox pandemic because its transmissibility is much more limited than COVID or influenza,” says Dr. John Ambrose, chief of the APHC’s Department of Preventive Medicine, which is responsible for tracking diseases in the Army population. “However, the current outbreak of monkeypox remains a cause for concern. To date, there are 26 confirmed cases of the disease in the Department of Defense population and dozens of other probable cases.”

The nature of monkeypox and how it spreads has more in common with sexually transmitted infections. STIs remain a major public health concern, including among military personnel.

The rash or pustules associated with monkeypox can even be confused with rashes associated with STIs, such as the still very common herpes and syphilis infections. However, it is also possible to contract both monkeypox and an STI.

Soldiers can reduce their risk of monkeypox and sexually transmitted diseases by practicing safe monogamous sex with partners they know and can trust.

Individuals with monkeypox can spread the disease to others for weeks, even after treatment, when lesions are no longer visible. If infected, patients are instructed to isolate themselves from others and avoid unprotected sex for at least 8 weeks.

Although monkeypox vaccines are already approved, they are typically used after exposure to prevent infection. Currently, the CDC does not promote monkeypox vaccination for the general public or anyone who is sexually active. The CDC notes that while supplies of monkeypox vaccine are limited, getting a vaccine when you don’t need it may mean people who need it can’t get it.

At the time of this writing, some locations in the US are offering pre-exposure vaccinations for those who self-identify as high-risk patients. However, supply is very limited and vaccination is not always medically recommended for some people. In addition, the CDC says it still doesn’t know how effective the vaccines are in the current outbreak. For this reason, prevention of monkeypox disease is best achieved through risk avoidance. Even those who are vaccinated are encouraged to protect themselves by avoiding close skin contact with someone who has monkeypox.

Until more vaccine supplies are available, military treatment facilities are using their limited supplies for those with known exposures and selected occupationally vulnerable personnel.

“In general, with the exception of certain research workers, clinical workers, and gay/bisexual men who are at high risk of exposure, monkeypox vaccines are used to prevent infection after a known exposure, rather than as a means of public health prevention prior.” of exposure. ‘ says McCann. “And physicians have to consider a variety of factors when determining whether a vaccine is beneficial when evaluating each individual.”

As anyone can be infected and the evidence is still evolving, Ambrose is reminding everyone to be aware of and protect against the known risks of exposure.

The U.S. Army Public Health Center focuses on promoting healthy people, communities, animals, and workplaces through the prevention of disease, injury, and disability in soldiers, retirees, family members, veterans, Army civilian employees, and animals through population-based surveillance. Studies and technical advice.

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