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Monkeypox

*Monkeypox information is sourced from the Centers for Disease Control and Prevention, Connecticut Department of Public Health and the U.S. Food and Drug Administration (FDA).

Monkeypox is a rare disease caused by an infection with the monkeypox virus. The virus is part of the same family of viruses as smallpox with similar symptoms, but milder, and is not likely to be deadly. In humans, the main difference between symptoms of smallpox and monkeypox is that monkeypox causes lymph nodes to swell while smallpox does not.

Symptoms

Symptoms of monkeypox can include:

  • Fever and fatigue—this doesn’t always happen
  • Headache
  • Muscle aches and backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion
  • Respiratory symptoms (e.g. sore throat, nasal congestion, or cough)
  • A new raised rash that looks like pimples, blisters or boils. Click here to view monkeypox rash photos from the CDC website. The rash:
    • Can appear one to three days (or longer) after flu-like symptoms (if it occurs)
    • Could be seen anywhere on the body, including on or near genitals, anus, hands, feet, chest, face, and mouth

Rashes that are flat, resemble eczema or look like large patches of red skin are not a cause for concern when it comes to monkeypox.

Monkeypox symptoms usually start within three weeks of exposure to the virus and can be spread from the time symptoms start until the rash has healed, all scabs have fallen off, and a fresh layer of skin has formed. The illness typically lasts two to four weeks.

Spread of monkeypox virus

The virus can spread from person to person through:

  • Unprotected direct contact with the infectious rash, scabs, or body fluids (e.g., sexual contact, accidental splashes to eyes or mucous membranes)
  • Respiratory droplets during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex
  • Touching items (such as clothing or linens) that previously touched the infectious rash or body fluids
  • Pregnancy—an expectant mother can spread the virus to her unborn baby through the placenta

Monkeypox screening for patients and families 

To help keep our patients and families safe, Connecticut Children’s is now screening for monkeypox-related symptoms in addition to COVID-19. Before appointments and procedures, we will ask about:

  • Any new, raised rashes (often a tell-tale symptom of monkeypox)
  • Known close contact with monkeypox
  • A confirmed positive monkeypox test

This will allow our clinical team to safely increase their personal protective equipment and reduce any spread of monkeypox to others. If we suspect a patient to have monkeypox, and they have a non-urgent scheduled appointment, we may reschedule and request clearance from their doctor. We will review any suspected case of monkeypox on an individual basis in consultation with our infection prevention, infectious diseases, and primary care teams.

Treatment

There is an antiviral treatment called tecovirimate (TPOXX) that is FDA approved for smallpox only, but can be used for monkeypox.

Most people don’t need treatment because of the high recovery rate of monkeypox. There are some exceptions:

  • Those who have severe disease that requires hospitalization
  • Those who are immunocompromised, or with certain underlying skin conditions that might put them at higher risk of severe illness
  • Children who are younger than 8 years of age
  • Pregnant or breastfeeding women

Hospitals and offices can apply for a compassionate use agreement under the CDC. Connecticut Children’s Infectious Diseases providers are registered to provide timely care to our patients if necessary. There are very specific requirements, including informed consent, evaluations before, during and after treatment and monitoring after treatment. TPOXX is usually a 14-day treatment.

Vaccine

The CDC does not recommend widespread vaccination at this time. The two existing monkeypox vaccines are available only for those who qualify and are at a higher risk of exposure or infection. For more information about eligibility, visit the Connecticut Department of Health’s list of eligible patients.

The FDA has given Emergency Use Authorization (EUA) for patients under 18 years of age who are at highest risk of illness. This fact Sheet from the FDA may also help answer some questions.

For Referring Clinicians

Caring for a patient with suspected or confirmed monkeypox

If you strongly suspect a patient has monkeypox, or have further questions about how to manage your patient, you may call the One Call Hotline to obtain a consultation from the on-call infectious diseases team member.

Per the CDC, those caring for patients with active symptoms of monkeypox should wear: gown, gloves, N95 mask, and eye protection until all lesions have crusted, crusts have separated and a fresh layer of healthy skin has formed underneath.

Healthcare professionals: what to do if you have symptoms

Anyone  who has cared for a monkeypox patient without adequate PPE should:

  • Notify the Connecticut Department of Public Health for guidance, including a possible medical evaluation.
  • Watch for developing symptoms that could suggest monkeypox infection, especially within the 21-day period after the last date of contact with the infected patient.

Anyone who has not cared for a monkeypox patient but is experiencing symptoms of monkeypox should not come to work and should contact their doctor for further instruction.

Cleaning

Per the CDC: Infection Control: Healthcare Settings | Monkeypox | Poxvirus | CDC

  • Standard cleaning and disinfection procedures can be used with an EPA-registered, hospital-grace disinfectant with an emerging viral pathogen claim.
  • Soiled laundry and linens can be cleaned per standard practices, but avoid direct contact with lesion material present. It should be gently and promptly contained in a regular laundry bad and never shaken or unnecessarily handled.
  • Avoid dry dusting, sweeping or vacuuming; use wet cleaning methods if possible.

Additional resources for healthcare professionals and families

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