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Cases of monkeypox have greatly diminished in the U.S., but that doesn’t mean it’s gone for good or won’t come back in another form.

Daily Nurse spoke with Jennifer Meyer, Assistant Professor at the University of Alaska Anchorage, Division of Population Health Services, about monkeypox and what nurses should be aware of treating patients. (The interview has been edited for length and clarity).

Q: I know that monkeypox is a virus, but is it similar to COVID?

Although both are viruses, and we have vaccines and antivirals that can significantly prevent infection and reduce serious outcomes like prolonged hospitalization/death, several critical differences exist. Since May, about 20,000 Monkeypox cases have been reported.

First, monkeypox is not a novel virus like SARS-CoV-2, the virus that causes COVID-19. Monkeypox was identified in the 1950s, while SARS-CoV-2 was identified in 2019. Follow current U.S. case data here and Global data here.

The second key difference relates to transmission. Early versions of SARS-CoV-2 appeared to predominantly be transmitted by droplets in the air from one person to another.  Current versions appear to be far more efficiently transmitted in aerosols. How does this happen? Consider the three D’s.

If a virus is changing and finding ways to infect more people, it usually means you need less of a dose or exposure to the virus to cause an infection or less duration of exposure to the virus to cause an infection and/or changes in the distance the virus travels or survives while moving from one host to another.

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These days current SARS-CoV-2 variants (like Omicron) can easily transmit through the air in tiny aerosolized particles that can travel greater distances. This has been one of the lessons learned regarding our primitive descriptive terminology for infectious disease transmission.

Traditional terminology would indicate that monkeypox is predominantly transmitted via direct close contact with an infected person with symptoms (rash, sores, feeling ill) or soiled/contaminated surface/linens, etc. However, there is some evidence that Monkeypox can be transmitted via respiratory secretions. Scientists are still investigating how often that occurs along with how infectious someone might be just before the onset of symptoms.

Q: What are the symptoms? How do healthcare professionals know to test for monkeypox?

Symptoms include any combination of the following: rash that can go through several stages, from blisters to scabs, and may include fever, chills, swollen lymph nodes, aches, exhaustion, headaches, muscle aches, congestion, sore throat, etc.

The incubation period for monkeypox is quite long, up to three weeks. Once symptomatic, the person usually gets a rash 1-4 days later. The person is most contagious from when symptoms start to when blisters and scabs have healed, which takes 2-4 weeks. Review clinical guidance here.

Clinicians should be on the lookout for any unexplained rash and, of course, if a patient has been exposed or is suspected to be exposed to someone who has tested positive. Get more guidance here.

In general, viruses don’t live very long when outside the body. Monkeypox, however, can survive a long time–up to 15 days. For comparison, SARS-CoV-2 can survive a maximum of 5 days and HIV a few hours. These experiments are done in controlled lab settings, but you can see a clear difference.

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Safety First

Q: What precautions should nurses take to protect their patients?

Correctly don and doff PPE, wash hands, and disinfect equipment.

Q: What are the myths about monkeypox?

That the infections only occur among gay and bisexual men. While this population is disproportionately affected by monkeypox at this time, anyone can contract it.

Q: Is there a potential for it to have variants?

Certainly, however, pox viruses are not known for changing quickly, while coronaviruses are known for rapid changes.

Q: Is there anything important for our readers to know?

Nurses play a critical role in educating their patients and community. I encourage nurses to stay up-to-date on monkeypox information from high-quality resources. Help patients and community members understand how to protect themselves and each other, especially from health misinformation. Reach out to underserved and historically oppressed members of our community to ensure they have the information and resources they need to stay healthy. Consider inclusive communication strategies, read more here.

Learn more about the new Vaccine Equity Project and if your employer can apply to participate here.

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