Patient information from BMJ


Monkeypox

Last published:Aug 05, 2022

Monkeypox is a rare disease caused by a virus called the monkeypox virus. It is not usually seen outside of West and Central Africa.

But travellers to these areas sometimes become infected. Cases of monkeypox have been found in a number of countries outside Africa in 2022.

In July 2022 the World Health Organization (WHO) declared the monkeypox outbreak to be a Public Health Emergency of International Concern.

Monkeypox usually goes away by itself after a few weeks, but it can be dangerous in some people, especially children. If you think you have symptoms of monkeypox, avoid contact with others, and talk to a doctor urgently.

What is monkeypox?

The monkeypox virus is mainly found in West and Central Africa. Humans can catch it from animals that carry the virus, and it can then pass from person to person.

There are two variants of monkeypox: the Central African and the West African variants. The Central African variant causes a more severe illness than the West African variant.

Monkeypox is rarely found outside Africa. But in the Spring of 2022 a number of people were found to have the infection in North and South America, Australia, parts of Asia, and many countries in Europe, including the UK.

Monkeypox is usually what doctors call self-limiting. This means that after a while it goes away by itself, just like a cold or flu. After you have had monkeypox you are immune and you can’t get it again.

But monkeypox can sometimes cause serious illness, especially in children and those with weakened immune systems.

Monkeypox can cause death, but this is rare, especially from the West African variant, and in areas with good health care. So far, the latest outbreak seems to involve only the less dangerous West African variant.

  • With the Central African variant, between 3 and 6 in every 100 people will die from it.

  • With the less dangerous West African variant, less than 1 in 100 people will die.

There is a vaccine (called vaccinia) that offers a great deal of protection against monkeypox. It was developed mainly to protect people against smallpox, which has now been wiped out. But the two viruses are similar, so the vaccinia vaccine works against both.

The vaccine is usually given to people who are thought to have a strong chance of becoming infected. This includes:

  • health workers in certain countries, and

  • close contacts of people who are infected.

How does it spread?

Monkeypox usually spreads through skin-to-skin contact. This means that you can become infected by touching the rash, scabs, skin blisters, or bodily fluids of someone who has the infection.

But you usually need to have close contact with an infected person for some time. A brief, passing contact is not likely to cause infection.

Monkeypox can also spread by: 

  • contact with objects that have come into contact with the virus, such as clothes, bedding, towels, and surfaces, and

  • droplets breathed out through the mouth and nose of an infected person (for example, from coughing or sneezing).

The virus can also be passed from pregnant mothers to their babies in the womb.

So far, most of the people infected in the 2022 outbreak are men who identify as gay, bisexual, or men who have sex with men. We’re not sure why this is. But these groups are being advised to be alert for any unusual rashes, especially on their genitals.

Monkeypox is not usually thought of as a sexually transmitted infection (STI), and it's still not clear what role, if any, sexual bodily fluids play in infection.

But infection can be caused by the close physical contact that happens during sexual activity.

Monkeypox has an incubation period of about one to two weeks. This means that you can have the virus for up to two weeks before you have symptoms, and without knowing that you have it.

What are the symptoms?

The most common symptoms of monkeypox include:

  • a rash of blisters on the body and face

  • fever

  • headache

  • backache

  • general aches and pains

  • sore throat

  • vomiting

  • general weakness, and

  • swollen glands.

Less common symptoms include:

  • diarrhoea

  • delirium (confusion and feeling unsteady), and

  • seizures.

The monkeypox rash starts with flat areas on the skin that then become bumps filled with liquid, which then turns to pus after a few days. After about two weeks the bumps become scabs and start to drop off.

The rash can be itchy and painful, but it’s important not to scratch or burst the bumps, as this can spread the virus and lead to scarring.

In the 2022 outbreak, the monkeypox rash seems to be slightly different from previous outbreaks. The features of the rash in this outbreak include:

  • fewer blisters (doctors often call them lesions) than usual. Some people only have one or two

  • blisters/lesions appearing at different times during the illness. Monkeypox blisters usually appear at about the same time

  • blisters/lesions in the genital area and around the anus, which do not spread any further

  • severe pain in the rectal and anal areas, and

  • blisters appearing earlier than usual in the course of the illness.

Blisters can sometimes happen in the mouth. This can be painful, and it can make it hard to eat and drink normally. If this happens to you, talk to your doctor about how they can help. It's important to get enough nurtition and to stay hydrated when recovering from monkeypox.

If you see a doctor with symptoms of monkeypox they will take a sample of liquid from one of the lumps on your rash and test it for the virus.

If it’s possible that you caught the infection while travelling or staying in an area where malaria is common, you should also be tested for malaria.

What treatments are available?

Monkeypox usually clears up by itself after a few weeks. This means that many people with monkeypox don’t need any special treatment, and don’t need to be treated in hospital.

But people with monkeypox need to be isolated while they have symptoms, so that the virus doesn’t spread. This means that you should stay away from people and from pets until you no longer have symptoms. This will probably take three or four weeks. 

If you have been in contact with someone who has been infected, you should also isolate for 21 days.

Treatment in hospital

Most people with monkeypox recover at home in a few weeks. But about 10 in every 100 people need to be treated in hospital. This often happens when people become dehydrated from fever or vomiting and need to have fluids given into a vein.

Some people also need treatment for sepsis. Sepsis happens when the body’s immune system overreacts to an infection and attacks the body’s tissues instead of protecting them. If you have sepsis you will be given antibiotics into a vein.

Sepsis is a medical emergency and can cause death if not treated in time. The signs of sepsis to look out for are:

  • confusion

  • shortness of breath

  • fast heart rate

  • fever, or feeling very cold, and

  • clammy or sweaty skin.

Medicines

In most people the body’s immune system fights off the virus by itself, and medicines aren’t needed.

Antiviral medicines are sometimes given to people with severe symptoms. But if your symptoms are not severe these drugs won’t make much difference to how soon you get better.

Medicines for specific symptoms

If you have a headache or other painful symptoms, you can take paracetamol If you are being treated in hospital, you might be given stronger pain relief drugs, such as opioids.

If you have painful blisters in your mouth, your doctor might recommend an antiseptic mouthwash or local anaesthetic cream. Your doctor might also recommend local anaesthetic cream for painful blisters in the genital area or around the anus.

Antihistamines, which are usually used to treat allergies, are sometimes used to help with itching.

If you have severe nausea or vomiting, you might be given drugs called anti-emetics, which can help settle your stomach.

If needed, you might also be given medicines to help with heartburn, stomach ache, and seizures.

What to expect in the future

Monkeypox is unpleasant but it’s usually not serious, and most people recover within a few weeks. But the effects can affect some people for a long time.

For example, the rash can cause scarring and discoloured skin in some people. This can sometimes be permanent. This can be upsetting, and some people need counselling and support. Your doctor might be able to help arrange this.

Some people with severe dehydration can have kidney damage after recovering from monkeypox. If this happens, you might need to have treatment.

In people who are severely affected, monkeypox can sometimes affect the eyes and cause blindness. If you are being treated in hospital and show signs of monkeypox affecting your eyes, you should be given antiviral eye drops to help prevent this.

The vaccinia vaccine can also cause problems in some people. This is called progressive vaccinia. If this happens to you, you will need treatment with antiviral medicines.

Monkeypox can sometimes cause death. But this is rare, especially in countries with good healthcare facilities.

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