Trenton Ducati's Message about Monkeypox
What is Monkeypox?
Monkeypox is a rare disease that is caused by infection with monkeypox virus.
DAP Health provides vaccination and testing for monkeypox by invitation only and based upon eligibility criteria defined by Riverside County Department of Public Health, CDC and California Department of Public Health.
Monkeypox can cause painful and potentially scarring blisters, rash, and swelling. Swelling from MPV in the mouth, throat, urethra, or anus can be extremely painful and possibly dangerous.
Monkeypox usually begins with the below symptoms:
- Muscle aches
- Swollen lymph nodes
Within one to three days after the appearance of fever, a rash develops. It may begin anywhere such as the genitals, genital area, butt, back, chest, hands, or face. The rash may also appear where it is hard to see such in anus/rectum, mouth, throat, and/or urethra. Afterwards, sores can begin to develop over a period of 14-21 days. The severity of illness depends upon a person’s health, how they were exposed, and the strain of the virus. Typically, monkeypox symptoms last for 14-28 days. For examples of what monkeypox rash looks like, visit the CDC.gov.
Monkeypox spreads from:
- Prolonged Skin-to-skin contact with person having monkeypox, shared bedding, sexual contact, towels, and clothing.
- Prolonged exposure to droplets (from coughing or sneezing) of someone infected with MPV.
Due to a national shortage of monkeypox vaccines, it is important to take steps to prevent the spread of monkeypox.
- Your skin for bumps, blisters, or rash that may look like pimples.
- Genital areas, around the anus, trunk, face, hands and back.
- Yourself and your partners.
- Rash may be in the mouth, urethra, and/or rectum. Some or all symptoms may be present during monkeypox infection. Isolate if you experience fever, swollen lymph nodes, and/or rash, which may or may not be painful.
- Do not share bedding/towels and avoid skin-to-skin contact.
- Wear a mask around others.
- Whenever possible, limit the number of sex partners. A tight or closed network of partners may help reduce your risk of infection.
- Avoid sex with partners whose monkeypox status is unknown.
Vaccination for Monkeypox
There is a vaccine called the Jynneos vaccine. This vaccine is a weakened live virus vaccine that is FDA approved for protection against smallpox and monkeypox. The Jynneos vaccine is recommended for those at risk of monkeypox. The vaccine is effective at protecting individuals against the monkeypox illness.
At the present time, DAP Health has a very limited supply of vaccinations for monkeypox. DAP Health will be following CDC and Riverside Department of Public Health guidelines, and we will be contacting approved patients directly to invite them to schedule a vaccine appointment.
Testing for monkeypox at DAP Health, can only be done if there are active sores, blisters or pox present. It requires a swab of the sore or blister that will be sent to LabCorp, results take up 3-4 days. Currently, there is no blood test available for monkeypox.
Anyone who has a known exposure to monkeypox, should contact the Riverside Department of Public health for vaccination. You can reach them by calling 1-951-358-5107. You can click here to access their monkeypox vaccine interest form.
The vaccine requires two injections four weeks apart and you are not considered fully vaccinated until two weeks after the second shot
Treatment for Monkeypox
Tecovirimat (TPOXX) is an available treatment for qualifying people with severe monkeypox. Because TPOXX is available through the CDC’s Expanded Access Investigational New Drug (EA-IND) protocol, we are required to obtain written informed consent prior to starting the medication. Only a small percentage of people with monkeypox will be eligible for treatment with TPOXX.
Eligibility for TPOXX includes:
Experiencing severe disease such as hemorrhagic disease, lesions that are extensive, sepsis, encephalitis, or other conditions requiring hospitalization.
Being at high risk of severe disease including people with immunocompromising conditions, such as recent organ transplant or on cancer-suppressing drugs; people who are pregnant or breastfeeding; people with gastroenteritis with severe nausea/vomiting, diarrhea, or dehydration; and people with infections involving accidental implantation in eyes, mouth, or other anatomic areas where monkeypox virus infection might constitute a special hazard (e.g., the genitals or anus).
Talk to your health care clinician to determine if you are eligible for monkeypox treatment with TPOXX.
Tips for Recovery
- If you have screened positive for monkeypox or are experiencing monkeypox symptoms, it is important to do what you can to minimize the chance of exposure to others.
- Self-isolate as much as possible until you are no longer experiencing symptoms.
- If you have lesions or a rash, cover them with clothing or a soft cloth when interacting with others or leaving your home.
- Do not share your bedding, towels, clothes, or other fabrics with others. Wash and dry your used bedding, towels, and clothing after use.
- Avoid skin-to-skin contact with others and use a face mask around others to minimize their risk of infection from large droplets from coughing or sneezing.
- Supportive care for any rash or lesions includes drinking plenty of fluids, pain management, and prevention or treatment of bacterial infections.
Proctitis is painful inflammation of the rectum lining and has been seen in cases of monkeypox.
Supportive care for anal/rectal inflammation includes drinking plenty of fluids, pain management, and prevention or treatment of bacterial infections. With early precautions and care, proctitis can be manageable at home.
For painful anal/rectal lesions, a warm sitz bath (soaking the butt in a tub of warm water) lasting at least 10 minutes several times per day can help. Topical benzocaine/lidocaine gels or creams may also provide temporary relief. If going to the bathroom is painful, stool softeners may also help. Pain from monkeypox proctitis may require prescription medications, in which case stool softeners may also be helpful to counteract constipation.
Proctitis can occur with internal lesions or bleeding. It is often manageable with appropriate supportive care, but it can become severe. If you have rectal bleeding with monkeypox or difficulty managing your pain, talk to your health care clinician to work on a care plan that works for you. If you are experiencing severe bleeding, please call 911.
DAP Health has launched a monkeypox hotline, which can be reached at 760-656-8432 or MPox@daphealth.org, for community members who have questions or concerns regarding the virus. The hotline is not for people to be put on a vaccine wait list.
Watch our video below with Chief Medical Officer, Dr. David Morris and Director of Infectious Disease, Dr. Shubha Kerkar answering questions and concerns regarding Monkeypox.
In humans, the symptoms of monkeypox are similar to but milder than the symptoms of smallpox. Monkeypox begins with fever, headache, muscle aches, and exhaustion. The main difference between symptoms of smallpox and monkeypox is that monkeypox causes lymph nodes to swell (lymphadenopathy) while smallpox does not. The incubation period (time from infection to symptoms) for monkeypox is usually 7−14 days but can range from 5−21 days.
The illness begins with:
- Muscle aches
- Swollen lymph nodes
Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body.
Lesions progress through the following stages before falling off:
The illness typically lasts for 2−4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease.
Monkeypox virus can spread when a person comes into contact with the virus from an infected animal, infected person, or materials contaminated with the virus. The virus can also cross the placenta from the mother to her fetus. Monkeypox virus may spread from animals to people through the bite or scratch of an infected animal, by handling wild game, or through the use of products made from infected animals. The virus may also spread through direct contact with body fluids or sores on an infected person or with materials that have touched body fluids or sores, such as clothing or linens.
Monkeypox spreads between people primarily through direct contact with infectious sores, scabs, or body fluids. It also can be spread by respiratory secretions during prolonged, face-to-face contact. Monkeypox can spread during intimate contact between people, including during sex, as well as activities like kissing, cuddling, or touching parts of the body with monkeypox sores. At this time, it is not known if monkeypox can spread through semen or vaginal fluids.
It is not yet known what animal maintains the virus in nature, although African rodents are suspected to play a part in monkeypox transmission to people.
There are number of measures that can be taken to prevent infection with monkeypox virus:
- 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 patients.
Many individuals infected with monkeypox virus have a mild, self-limiting disease course in the absence of specific therapy. However, the prognosis for monkeypox depends on multiple factors such as previous vaccination status, initial health status, concurrent illnesses, and comorbidities among others. People who should be considered for treatment following consultation with CDC might include:
- People with severe disease (e.g., hemorrhagic disease, confluent lesions, sepsis, encephalitis, or other conditions requiring hospitalization)
- People who may be at high risk of severe disease:
- People with immunocompromise (e.g., human immunodeficiency virus/acquired immune deficiency syndrome infection, leukemia, lymphoma, generalized malignancy, solid organ transplantation, therapy with alkylating agents, antimetabolites, radiation, tumor necrosis factor inhibitors, high-dose corticosteroids, being a recipient with hematopoietic stem cell transplant <24 months post-transplant or ≥24 months but with graft-versus-host disease or disease relapse, or having autoimmune disease with immunodeficiency as a clinical component)1
- Pediatric populations, particularly patients younger than 8 years of age2
- Pregnant or breastfeeding women3
- People with a history or presence of atopic dermatitis, people with other active exfoliative skin conditions (e.g., eczema, burns, impetigo, varicella zoster virus infection, herpes simplex virus infection, severe acne, severe diaper dermatitis with extensive areas of denuded skin, psoriasis, or Darier disease [keratosis follicularis])
- People with one or more complications (e.g., secondary bacterial skin infection; gastroenteritis with severe nausea/vomiting, diarrhea, or dehydration; bronchopneumonia; concurrent disease or other comorbidities)4
- People with monkeypox virus aberrant infections that include its accidental implantation in eyes, mouth, or other anatomical areas where monkeypox virus infection might constitute a special hazard (e.g., the genitals or anus)
Medical Countermeasures Available for the Treatment of Monkeypox
Currently there is no specific treatment approved for monkeypox virus infections. However, antivirals developed for use in patients with smallpox may prove beneficial.
Monkeypox is a rare disease caused by the monkeypox virus
- Monkeypox can make you sick including a rash or sores (pox), often with an earlier flu-like illness
- Monkeypox can spread to anyone through close, personal, often skin-to-skin contact including:
- Direct contact with monkeypox rash, sores, or scabs
- Contact with objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox
- Through respiratory droplets or oral fluids from a person with monkeypox
This contact can happen during intimate sexual contact including:
- Oral, anal, and vaginal sex or touching the genitals or anus of a person with monkeypox
- Hugging, massage, kissing, or talking closely
- Touching fabrics and objects during sex that were used by a person with monkeypox, such as bedding, towels and sex toys
We know the virus can be spread in fluid or pus from monkeypox sores, and are trying to better understand if virus could be present in semen, vaginal fluids or other body fluids
Monkeypox is a disease that can make you sick, including a rash, which may look like pimples or blisters, often with an earlier flu-like illness. Monkeypox can spread to anyone through close, personal, often skin-to-skin contact including:
- Direct contact with monkeypox rash, sores, or scabs from a person with monkeypox. We believe this is currently the most common way that monkeypox is spreading in the U.S.
- Contact with objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox.
- Contact with respiratory secretions, through kissing and other face-to-face contact.
This contact can happen when you have sex including:
- Oral, anal, and vaginal sex or touching the genitals (penis, testicles, labia, and vagina) or anus (butt) of a person with monkeypox.
- Hugging, massage, and kissing
- Touching fabrics and objects during sex that were used by a person with monkeypox and that have not been disinfected, such as bedding, towels, fetish gear, and sex toys.
- Enclosed spaces, such as back rooms, saunas, or sex clubs, where there is minimal or no clothing and where intimate sexual contact occurs have a higher likelihood of spreading monkeypox.
Talk to your partner about any recent illness and be aware of new or unexplained sores or rashes on your body or your partner’s body, including the genitals and anus. If you or your partner have recently been sick, currently feel sick, or have a new or an unexplained rash or sores, do not have sex and see a healthcare provider. This is always a good plan, even if monkeypox isn’t in your area.
If you or a partner has monkeypox, the best way to protect yourself and others is to not have sex of any kind (oral, anal, vaginal) and not kiss or touch each other’s bodies while you are sick, especially any rash or sores. Do not share things like towels, fetish gear, sex toys, and toothbrushes.
If you or your partner have (or think you might have) monkeypox and you decide to have sex, consider the following to reduce the chance of spreading the virus:
- Have virtual sex with no in-person contact.
- Masturbate together at a distance of at least 6 feet, without touching each other and without touching any rash or sores.
- Consider having sex with your clothes on or covering areas where rash or sores are present, reducing as much skin-to-skin contact as possible.
- Avoid kissing.
- Remember to wash your hands, fetish gear, sex toys and any fabrics (bedding, towels, clothing) after having sex
- Limit your number of partners to avoid opportunities for monkeypox to spread.