By Dorothy Brooks
As of late June, the CDC had confirmed more than 300 cases of monkeypox in 27 states and Washington, DC.1 Although cases are uncommon and the risk remains low, health authorities expect to see more cases in the coming weeks. They urge frontline providers to familiarize themselves with the signs and symptoms of monkeypox so any suspected cases are quickly identified and steps are taken to prevent further transmission. Sam Torbati, MD, co-chair of the department of emergency medicine at Cedars-Sinai Medical Center in Los Angeles, says triage processes should be amended to include questions pertaining to monkeypox. “Patients with fever, headache, body pain, weakness, or enlarged lymph nodes or new rash are asked about their travel history in the preceding month,” he says. “They are placed in isolated rooms and assessed by a physician.”
Torbati adds emergency clinicians should include the possibility of monkeypox in any patient presenting with early symptoms suggestive of the illness and certainly in patients with a new rash and epidemiological risk factors. This includes coming in close contact with someone reporting symptoms or a rash suggestive of monkeypox and close contact in a social network that is experiencing monkeypox activity. This also includes men who have sex with men, those who have traveled to a country with confirmed monkeypox cases, or those who have come in contact with a dead or live animal that is an African endemic species.2
“We can ensure the safety of staff and other patients by following the guidelines and evaluating suspected patients in separate or isolated areas in the ED,” Torbati says.
“With COVID-19, we learned a lot about managing patients with infectious diseases. Fortunately, monkeypox is far, far less contagious and harder to transmit from one person to another.”
Most individuals infected with monkeypox experience a mild, self-limiting disease course without specific therapy. However, Torbati notes some people are at higher risk for developing severe disease. “These include those who have weakened immune systems, children under age 8, pregnant or breastfeeding women, people with certain underlying skin conditions, and people who develop additional complications,” Torbati explains.
Although there are no specific treatments approved for monkeypox, therapies used to treat smallpox may provide some benefit.
“These therapies include antiviral medications such as tecovirimat, cidofovir, and brincidofovir. Vaccinia immune globulin may also be useful in treating complications of monkeypox virus infection,” he says.3
Torbati anticipates clinicians will continue to see more confirmed cases in the coming months, but he believes the U.S. health system can keep the outbreak under control.
“Unlike COVID, [monkeypox] is not easily transmitted, and close contact for a prolonged period of time appears to be needed for the infection to spread from one person to another,” he says. “The priority for EDs is to be on the lookout and identify potential cases, and pull in the health department.”
REFERENCES
1. Centers for Disease Control & Prevention. Monkeypox. 2022 U.S. map & case counts. As of June 28, 2022.
2. Centers for Disease Control & Prevention. Monkeypox. How it spreads. Page last reviewed June 24, 2022.
3. Centers for Disease Control & Prevention. Interim clinical guidance for the treatment of monkeypox. Page last reviewed June 17, 2022.
Emergency clinicians should include the possibility of monkeypox in any patient presenting with early symptoms suggestive of the illness and certainly for those with a new rash and epidemiological risk factors.
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