SEPTEMBER 15, 2022 – After more than two years spent dealing with the COVID pandemic, concerns are now rising about a possible new disease threat: monkeypox.
The U.S. Army Public Health Center has summarized key facts to educate soldiers and provide guidance to clinicians about this disease.
Known primarily for its characteristic rash of hard pustules that scab over, monkeypox is in the same family of viruses as smallpox. Though monkeypox is painful and can be transmitted between people, it is much less severe than smallpox and is generally treatable. Most people with monkeypox recover fully within two to four weeks even without treatment.
Though monkeypox can result in severe effects, such as blindness, and is occasionally fatal in persons with underlying health problems or weak immune systems, 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 indicates it is naturally found, or “endemic,” in countries of Africa.
When monkeypox is reported in countries where it does not naturally occur, such as the U.S. and many other developed countries, the situation is referred to as an “outbreak.” Over the years, numerous contained outbreaks with small numbers of cases have been reported. In the U.S., the CDC reported outbreak cases in 2021 that were attributed to travel abroad; in 2003, it reported cases from exposures to infected imported mammals.
Most recently, the CDC issued a Health Advisory after a monkeypox case was confirmed in Massachusetts. The CDC is now tracking new monkeypox outbreak cases in several countries in Europe and Australia, as well as the U.S. As of September 19, over 59,000 monkeypox cases have been reported worldwide; over 22,000 of those were in the U.S. There has been one confirmed death from monkeypox in the U.S.
It is not clear how people in this most recent outbreak have been exposed to monkeypox, but according to the CDC, early data suggest that men who reported having had intimate physical contact with other men make up a high number of cases. Traveling to a country where monkeypox is endemic, such as Nigeria, has also been identified as a risk factor.
“The greatest risk appears to be the direct contact with a source of the monkeypox virus,” says Dr. Chip McCannon, a medical doctor with the APHC’s Clinical Public Health and Epidemiology Directorate. “So it is critical to avoid intimate contact with an infected person.”
Visible pustules, lesions, or scabs, which can appear on the palms and soles or be generalized in other areas, including perianal or genital areas, are one way to identify potentially infections persons. McCannon explains that because the incubation period (the time from infection with monkeypox to the time symptoms appear) averages seven to 14 days, a person could be infectious before these signs are noticeable.
“Persons have been infected from contact with surfaces and fabrics (clothing, bedding, or towels) that have been used by someone with monkeypox,” says McCannon. “In health care settings where monkeypox transmission has rarely been described, standard precautions are followed to prevent direct contact with lesion material, respiratory droplets, or oral fluids.”
Recently, The Lancet medical journal reported a case of a pet dog that contracted monkeypox from close contact with its infected owners. Not only can pets develop the disease, they may also be a source of transmittal between humans if one is infected.
Importantly though, the CDC still considers the threat of monkeypox to the general U.S. population as LOW and states that the virus does not spread easily between people without close contact.
“We don’t foresee a monkeypox pandemic since its transmissibility is much more limited than COVID or influenza,” says Dr. John Ambrose, chief of the APHC’s Preventive Medicine Division, which is responsible for tracking diseases in the Army population. “However, the current monkeypox outbreak is still a concern. There are 26 confirmed cases of the disease in the Department of Defense population to date, and dozens of other probable cases.”
The nature of monkeypox and its spread has more in common with sexually transmitted infections. STIs remain a huge public health problem, including among soldiers.
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 be infected with both monkeypox and an STI.
Soldiers can reduce risks to monkeypox as well as STIs by practicing safe monogamous sex with partners they know and can trust.
Persons with monkeypox may transmit the disease to others for weeks, including after treatment when lesions are no longer visible. If infected, patients will be directed to isolate from others and avoid unprotected sex for at least 8 weeks.
While there are existing approved monkeypox vaccines, these are typically used after exposure to help prevent the infection. Currently the CDC is not encouraging vaccination against monkeypox for the broader public or everyone who is sexually active. The CDC notes that while monkeypox vaccine supplies are limited, getting a vaccine when you don’t need it can mean that people who need can’t get it.
At the time of this publication, a few locations in the U.S. are offering pre-exposure vaccines to those who self-identify as being high risk. The supply is very limited, however, and the vaccine is not always medically advised for some persons. In addition, the CDC states it is still not known how effective the vaccines are in the current outbreak. Because of this, prevention of monkeypox disease is best achieved through risk avoidance. Even those who are vaccinated are encouraged to protect themselves by avoid close skin-to skin contact with someone who has monkeypox.
Until vaccine supplies are more available, military treatment facilities are using their limited supplies for individuals with known exposures and select occupational at–risk personnel.
“Generally, with the exception of certain research workers, clinical workers, and gay/bisexual males who are at high risk of exposure, monkeypox vaccines are used to prevent infection after a known exposure and not as a pre-exposure public health prevention tool,” says McCannon. “And doctors need to consider a variety of factors when determining if a vaccine will be beneficial when assessing each individual.”
Since anyone can be infected, and evidence is still evolving, Ambrose reminds everyone to be aware of – and protect themselves from – the known exposure risks.
The U.S. Army Public Health Center focuses on promoting healthy people, communities, animals, and workplaces through the prevention of disease, injury, and disability of Soldiers, retirees, family members, veterans, Army civilian employees, and animals through population-based monitoring, investigations, and technical consultations.
By V. Hauschild, MPH, U.S. Army Public Health Center