Monkeypox

 
 
 
 
 
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    onkeypox is spread through close contact with someone who has a characteristic rash. ​DHHS strongly recommends anyone experiencing unexplained rash on their face, palms, arms, legs, genitals, or perianal region along with flu-like symptoms contact their healthcare provider.

    ​Anyone with prolonged physical contact with someone who has monkeypox is at risk of developing the infection.

    It is important to be aware of the current outbreak and follow the preventative measures described below.​​

    ​Symptoms

    • A rash that can look like pimples or blisters that appear on the genitals, anus, face, inside the mouth, and on other parts of the body, like the hands, feet, or chest.
      Examples of Monkeypox Rashes
      ​Examples of Monkeypox Rashes

      Photo Credit:
      NHS England High Consequence Infectious Diseases Network


    • Fever
    • Headache
    • Muscle aches or backache
    • Swollen lymph nodes
    • Chills
    • Exhaustion
    • Rectal pain
    • Conjunctivitis
    • Nausea/Vomiting
    • Abdominal pain
    • Tenesmus/urgency to defecate
    • Proctitis
    • Pus or blood on stools
    • Rectal bleeding

    Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash.

    Testing

    The Nebraska Public Health Laboratory (NPHL) is conducting monkeypox testing in Nebraska. The laboratory is NOT experiencing any shortfalls in test capacity and results are frequently reported within 24 hours. Physicians should have a low threshold to test a patient presenting with a characteristic rash.

    Commercial laboratories including Aegis Science, Labcorp, Mayo Clinic Laboratories, Quest Diagnostics, and Sonic Healthcare are now beginning to test for monkeypox. This list will be updated as more laboratories come online.​​

    Prevention​

    • Use personal protective equipment such as gloves to avoid contact when handling items such as bedding.
    • Avoid contact with animals that could harbor the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs).
    • Avoid contact with any materials, such as bedding, that has been in contact with a sick animal.
    • Isolate infected patients from others who could be at risk for infection.
    • Practice good hand hygiene after contact with infected animals or humans. For example, washing your hands with soap and water or using an alcohol-based hand sanitizer.
    • Use personal protective equipment (PPE) when caring for a patient.

    Treatment

    Currently, there is no treatment approved specifically for monkeypox virus infections. However, antivirals developed for use in patients with smallpox may be used to prevent and treat monkeypox virus infections.

    Tecovirimat (TPOXX) is an antiviral medication that is approved by the United States Food and Drug Administration (FDA) for the treatment of smallpox and may be considered following consultation with CDC for people who are likely to get severely ill with monkeypox (e.g., immunocompromised, pregnant or breastfeeding, comorbid conditions). This drug is currently available from the Strategic National Stockpile (SNS) as an option for the treatment of monkeypox.

    Vaccine Information​

    • JYNNEOS and ACAM2000 are the two vaccines licensed by the U.S. Food and Drug Administration (FDA) that are available for preventing monkeypox infection.
    • Nebraska has received the JYNNEOS vaccine from the CDC and will work with local health departments to ensure availability for individuals who fall under these three specific scenarios.
      • Outbreak Response Monkeypox Vaccine Post-Exposure Prophylaxis (PEP)++: For those with risk factors that increase the potential of exposure to monkeypox, even in absence of documented exposure to someone with confirmed monkeypox. This might include, but is not limited to men who have sex with men (MSM) who also have had multiple partners, group sex, and/or sex or skin-to-skin contact at certain venues​.
      • Monkeypox Vaccine Post-Exposure Prophylaxis (PEP): For those who had close contact with a confirmed or probable monkeypox patient. The CDC recommends that the vaccine be given within 4 days from the date of exposure for the best chance to prevent the onset of the disease. If given between 4 and 14 days after the date of exposure, vaccination may reduce the symptoms of the disease, but may not prevent the disease.
      • ​Monkeypox Vaccine Pre-Exposure Prophylaxis (PrEP): For people who have a high risk of occupational exposure to monkeypox virus such as laboratory technicians who are more likely to handle specimens that might contain monkeypox virus and clinicians who are more likely to see patients with monkeypox.​

    Frequently Asked Questions

    If an individual tests positive, how long should they isolate?

    Patients with monkeypox should isolate and follow prevention practices until cleared by public health officials after all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed.

    The illness typically lasts 2-4 weeks. Decisions regarding the discontinuation of isolation precautions at a healthcare facility should be made in consultation with the Local Health Department and DHHS. Please refer to CDC's Isolation and Prevention Practices for People with Monkeypox.

    When isolating, what should a patient do? 

    Patients should isolate until all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed.

    People with monkeypox should adhere to these recommendations until cleared by public health:

    • Do not leave the home except as required for emergencies or follow-up medical care.
    • Persons without an essential need to be in the home should not visit.
    • Avoid close contact with others.
    • Avoid close contact with pets in the home.
    • Abstain from all sexual activity.
    • Do not share items that could be contaminated by the lesions (e.g., bed linens, clothing, towels, washcloths). Do not share drinking glasses or eating utensils.
    • Routinely clean and disinfect commonly touched surfaces and items (e.g., counters, light switches) using an EPA-registered disinfectant (e.g., List Q) in accordance with the manufacturer's instructions.
    • Wear a well-fitting mask or respirator for source control when in close contact with others at home.
    • Avoid the use of contact lenses to prevent inadvertent infection of the eye.
    • Avoid shaving areas of the body with lesions as this can lead to the spread of the virus.

    Bathroom usage:

    • If possible, use a separate bathroom if there are others who live in the same household.
    • If there is not a separate bathroom in the home, the patient should clean and disinfect surfaces (e.g., counters, toilet seats, faucets) using an EPA-registered household cleaning product (List Q) after using a shared space if the lesions are exposed (e.g., showering, toileting, changing bandages covering the lesions). Consider disposable glove use while cleaning if lesions are present on the hands.


    Additional Resources