My first tweetorial – on #monkeypox. (Disclaimers: my views only, evolving situation)
Let’s talk the what, who, when, and why. Slides are mine.
#monkeypox is a dsDNA virus w/ famous relatives. esp. smallpox, a poxvirus w/ whopping 30% mortality rate. Smallpox eliminated) led ppl to learn variolation (ancient technique) + vaccination (w/ cowpox, then vaccinia virus = weak poxviruses). #monkeypox = less deadly smallpox.
Where’d it come from? Animal to human transmission, probably from reservoir host of rodents. annoyingly, has nothing to do with monkeys – the name is because it was discovered in monkeys.
This outbreak is big - >1400 at time of writing worldwide, 12 in CA. Different from other outbreaks in numbers, transmission person-to-person + possibly in rash appearance. Why now? Maybe because most ppl not vaccinated for smallpox (USA stopped in 1972)
What are the sx? Rash that starts macular (flat) -> papular (raised) -> vesicular (bubbly lesions) -> big indurated pustules. Pts contagious until scabs flake off. 2022 monkeypox may not be classic – lesions have been seen on genitals/anal area primarily instead of whole body
What about transmission? Probably by contact w/ very infectious lesions, maybe droplet. Sexual activity = skin-to-skin + faces close, good for spread. But this is NOT a sexually transmitted infection in usual sense. unclear if airborne transmission can occur
Healthcare workers should wear N95/eye protection/gown/gloves (same as covid). Put patient in neg pressure room if avail. Close contacts should avoid contact w/ pt and avoid handling clothing/bedding that can have scab material
Post-exposure prophylaxis? Same as for smallpox - we use a weak #poxvirus! Currently using jynneos (new replication-incompetent vaccinia vaccine). PEP is for exposed contacts +/- healthcare workers.
Treatment? Recommended for some pts but not all (most pts will have mild, self-limited disease, antivirals w/ potential side effects). Think of it for immunocompromised, pregnant, or w/ lesions near mouth/eyes/genitals. Cidofovir vs tecovirimat vs ?vaccinia immune globulin.
last thoughts, outbreaks (zoonotics in particular) often spark stigma and fear against affected pts/groups. my hope is to fight that w/ information. goal is to help people demystify this outbreak + keep selves and patients safe.
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