Monkeypox: What you need to know about vaccines, testing and treatment

The monkeypox outbreak continues to swell around the world, prompting the World Health Organization on Saturday to declare it a public health emergency of international concern. The designation means a coordinated international response is needed to prevent the virus from spreading further and may urge member countries to invest more in vaccines, treatments and other resources to contain the disease.

Many of these critical tools are still not widely available, even in the United States. The public health messages regarding individual risks and access to healthcare have not always been clear; the clinics that conduct tests and the health ministry officials that track patients often lack coordination; vaccine distribution is delayed; and treatment options remain unclear.

To complicate matters further, monkeypox symptoms can look different in some cases. People who get sick don’t always have the usual fever, pain, and rashes all over their body. Many patients have developed only a few pustules, especially in the genital area. And according to health officials, the disease mainly spreads through networks Men who have sex with men.

While prevention is still crucial, we asked experts to explain what steps you need to take to get vaccinated, tested and treated if you suspect an infection or have recently been exposed to monkeypox.

Two vaccines originally developed for smallpox and held in the United States national stockpile may help prevent monkeypox infection. The one most commonly used for monkeypox is called jynneos. It consists of two doses given four weeks apart. However, because its supply is limited and controlled by the federal government, it is not widely available to the public. Instead, the vaccine was offered primarily to two groups of people: healthcare workers or laboratories who might handle infected samples, and people who had confirmed or suspected exposure to monkeypox.

The vaccine can also work when given after exposure, and the Centers for Disease Control and Prevention recommends that people get vaccinated within four days of the day of exposure for the best chance of preventing monkeypox. You can make an appointment for the vaccination through your local or state health department.

You can also get a vaccine up to two weeks after exposure to relieve symptoms, although vaccination more than four days after exposure may not prevent onset of the disease.

“You still need to take all preventive measures for a few weeks after vaccination,” said Dr. Sharone Green, an infectious disease expert at the University of Massachusetts Chan Medical School in Worcester. Whether before or after exposure, people are generally considered fully protected two weeks after receiving their second dose, she said. However, some researchers have suggested that even a single dose of Jynneos can help slow the spread of monkeypox.

Some states where monkeypox case numbers are high have expanded their vaccine eligibility criteria to include people at high risk of getting it. For example, in New York and New Jersey, you can also get the vaccine if you attended an event where there was a known exposure to monkeypox, or if you identify as gay, bisexual, a man who has sex with other men , transgender, gender non-conforming or non-binary identifying and have had multiple sex partners or anonymous partners in the past 14 days. However, getting an appointment for the vaccine can be difficult as distribution has encountered several obstacles and delays.

Experts agree that vaccination and prevention should be a priority to slow the pace of the current outbreak. However, if you begin to notice red lesions, pimples, or pustules, you should contact your GP and let them know that you suspect monkeypox infection. Your doctor will swab a lesion and order a monkeypox test for you. You can also get tested at emergency centers or sexual health clinics and other healthcare providers.

The test is a polymerase chain reaction, or PCR, similar to that used in Covid-19, which detects a piece of the virus’s genetic material. However, the test capacity is still limited. Samples can only be sent to a public health laboratory or one of five commercial laboratories for analysis. And while turnaround time has improved, results can take anywhere from 24 hours to three days or more.

There is no home test for monkeypox. And even in a clinic, health care workers need to swab a lesion to do a monkeypox test, said Dr. William Morice, Chair of the Department of Laboratory Medicine and Pathology at Mayo Clinic and President of Mayo Clinic Laboratories, which developed one of the commercial monkeypox diagnostic tests. If you have no symptoms or only have a fever and flu-like symptoms, there’s no way to test for monkeypox yet, Dr. Morice.

Another problem is that some healthcare workers may be unaware of, or unable to recognize, monkeypox when patients come in for diagnosis. Monkeypox lesions, particularly in the genital area, can look very similar to the symptoms of more common diseases like herpes or syphilis.

“If a lesion looks like it could be monkeypox, people should just test it,” said Dr. Bernard Camins, medical director for infection prevention at Mount Sinai Health System.

Finally, some healthcare workers may not be sure how contagious the lesions are. “I hear anecdotal reports from patients who have been turned away,” said Dr. camins. “People have never seen this disease before, you know, and there’s just fear of the unknown. However, transmission of monkeypox in healthcare is so rare that healthcare workers should not worry about contracting monkeypox on the job as long as they wear the appropriate personal protective equipment.”

After you get a diagnosis, treating monkeypox mostly involves treating the symptoms, said Dr. camins. Patients with anal or rectal lesions may experience severe pain, especially with a bowel movement, and in these cases a doctor may prescribe pain relievers or recommend stool softeners and loose stools sitz baths, used to relieve pain or itching in the genital area, he said. Patients with mouth sores may have trouble swallowing and may be given medications to help. Some can develop secondary bacterial infections and require antibiotic treatment, especially if they have large, open lesions.

Antivirals such as Tecovirimat or TPOXX are usually only recommended for people who are more likely to have systemic symptoms or a body-wide rash and are at high risk for complications from monkeypox. Doctors must request the drug from the government stockpile, fill out extensive paperwork and obtain informed consent from patients to receive the treatment.

“It’s not a drug that sits on the shelf in the pharmacy or in the clinic,” said Dr. Sandro Cinti, an infectious disease physician at the University of Michigan at Ann Arbor.

Regardless of whether they are able to receive antiviral treatment, patients should do so isolate at home once they develop monkeypox symptoms. As with Covid-19, they should avoid close contact with friends, family and pets, cover any rashes as much as possible and wear good quality masks if they need to come into contact with others for medical care. The CDC recommends limiting your exposure to others and staying isolated until all lesions have completely healed. They don’t come out of the woods until the lesions have crusted over, the scab falls off, and a fresh layer of intact skin has formed. And that can take a long time – between two and four weeks.

“This puts us in a real dilemma,” said Dr. camins. While health professionals may hope that people will be able to take necessary sick days or work from home, it is unrealistic to expect that anyone who becomes infected will be able to strictly follow these guidelines. “It is all the more important that people are aware and careful about the spread of the virus.”

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