What to know about the outbreak of monkeypox infection

Medical providers and public health experts are increasingly sounding the alarm on monkeypox, an infectious disease that is spreading quickly across the world and in the Delaware Valley region.

The virus isn’t as contagious as the coronavirus behind COVID-19, nor is it nearly as fatal — most people fully recover. But an infection can still be painful, and dangerous for immunocompromised people.

Pennsylvania has documented about 125 cases so far, according to the U.S. Centers for Disease Control and Prevention, with more than half of those in Philadelphia.

Recent monkeypox outbreaks have disproportionately affected men who have sex with men, but anyone can contract the virus.

“It is important to be aware that this outbreak is happening,” said Dr. Amy Althoff, medical director of the Partnership Comprehensive Care Practice at Drexel Medicine. “And it’s also really important to stick with the facts.”

Existing tests, vaccines, and treatments have been proven effective against monkeypox. However, access to those tools has been limited for many Philadelphians at risk of contracting the virus. And the city health department has offered little guidance about preventive measures residents can take to protect themselves.

What does monkeypox look like?

Monkeypox predominantly spreads through close, intimate contact. This can be common during cuddling, kissing, sexual activity and other interactions. It’s also more likely to occur among people who live together.

“There is higher risk for household contacts just because that time together is long and continuous,” Althoff said.

Someone can also get monkeypox if they come into contact with material items, like bedsheet linens or clothing, that have touched the virus’ trademark symptom of lesions or rash.

Althoff said this type of transmission is less common.

“In terms of day-to-day life, like riding on the bus or going to a store, there’s not much concern there unless you are having prolonged skin-to-skin contact or prolonged face-to-face contact,” she said.

Symptoms can include a fever or chills, flu-like symptoms, before or after developing a rash or lesion, Althoff said.

Dr. Mark Watkins, a physician at the Mazzoni Center in Philadelphia, added that the rash or lesion can look different from case to case.

“We have had patients who’ve only had one or two lesions, which some people might not even notice,” he said. “But to patients who are having painful lesions, painful swollen lymph nodes, the proctalgia — the sore anus that’s associated with monkeypox — that pain is bringing them in for medical attention.”
Who is considered “high risk” for contracting monkeypox?

Anyone who has been in close contact with someone infected with monkeypox is at high risk of becoming infected themselves.

Because many new cases have been concentrated among men who have sex with men, the Philadelphia Department of Public Health has criteria for who is considered high risk for exposure to the virus.

That criteria includes adults 18 years and older who are gay, bisexual, transgender, non-binary, and other men who have sex with men, transgender, or non-binary persons.

The criteria further specifies people who’ve had multiple or anonymous sex partners in the last 14 days, or believe they may have been exposed to a sexually transmitted infection or monkeypox in the last 14 days.

What treatments are available for someone who gets monkeypox?

People who think they have symptoms of monkeypox should contact their health care provider or the city’s health department to get tested.

Watkins said medical staff will swab the lesion or rash and then send out the specimen to a laboratory. A majority of specimens so far have been sent to the state laboratory, but commercial labs like Quest Diagnostics and Labcorp are now able to run monkeypox tests.

Patients who test positive may be eligible to get the antiviral medication tecovirimat, brand name TPOXX. It’s a two-week course of pills that was initially developed to treat smallpox, another member of the orthopoxvirus family.

Infected residents have been advised to isolate during their illness, which can last between two to four weeks.
What prevention options are there to prevent a monkeypox infection?

The U.S. has a limited supply of vaccine that was initially developed to prevent smallpox. Those vaccines have been effective at also preventing monkeypox.

“If a patient receives the vaccine within the first four days of exposure, the likelihood of them actually developing symptoms of monkeypox is reduced,” Althoff said.

Routine vaccination of the American public against smallpox stopped in 1972. But for those who received a smallpox vaccine prior to that date, it may still offer protection against monkeypox, the CDC says.

Philadelphia has received more than 2,000 doses so far, with about 6,000 more on the way. Health officials say they are prioritizing its supply of vaccines for people considered high risk – mainly those who have come into close contact with someone who has tested positive for the virus.

The city has distributed some of its vaccine supply to partnering medical organizations, including Philadelphia FIGHT, the Mazzoni Center, Penn Medicine, and Drexel’s Partnership clinic.

Those medical clinics are only vaccinating existing patients at this time. Patients who’ve had a sexually transmitted infection in the last three months may also be eligible for vaccines at these sites.

“I’ve been getting messages all day from patients [saying], ‘Hey, I want a vaccine, sign me up, how do I get a vaccine?’” Watkins said. “So, the interest is really strong.”

People who are considered high risk, but who are not existing patients at these clinics, are encouraged to call the city health department’s hotline number to ask about testing and vaccine availability.

However, residents have so far reported difficulties in getting appointments this way. The city last week clarified its vaccine prioritization, and said it will first consider people who’ve been exposed to a confirmed case of monkeypox.

“If we had enough vaccine, that would make it a lot easier,” Watkins said. “‘You want a vaccine? Sure, we have it for you.’ We’re not quite there yet.”

The vaccine is administered subcutaneously, meaning just under the top layers of skin. Watkins said it can be less painful than an intramuscular injection, which is how COVID-19 vaccines are given.

A second dose of a monkeypox vaccine is required for full immunization. But the CDC and other federal agencies said those can be delayed during the public health emergency.

Watkins said one dose has been proven to provide a good level of protection in the short-term.

“If we get enough of a supply, then it might be reasonable to give people a second dose,” Watkins said. “But right now, we need as many shots into arms and at least some protection to try to stop this from becoming a longer term issue for us.”

Althoff said anyone who thinks they are in infected with, or exposed to monkeypox should contact their health care provider.

“I would say, have a low threshold for calling,” she said. “We’re happy to triage that over the phone and to determine eligibility for the vaccine.”

Information about the city’s monkeypox risk criteria, testing and vaccination can be found here. The Philadelphia Department of Public Health hotline number is 215-685-5488.