Monkeypox

Monkeypox

Monkeypox is a viral infection that causes a rash and infectious lesions. It is spread through close skin-to-skin physical contact with someone who has symptoms. There is currently a global outbreak of Monkeypox which peaked in August. So far there have been a handful of confirmed cases in New Zealand, with the majority acquired overseas.
Local transmission has been reported on 7th October 2022. Two separate individuals tested positive for monkey pox with no recent international travel or a known source of infection. This implies there are unknown cases in the community and more transmission is likely. It is important for people to be mindful of this increased risk and monitor for symptoms (lesions around the genitals, anus or mouth) and to keep contact details of sex partners for contact tracing.

What are the symptoms?

The mean incubation time is 7 days with initial symptoms of a flu-like illness with fever, malaise, headache, and fatigue often accompanied by swelling of lymph nodes.

Shortly after a rash can appear with lesions before scabbing. The lesions are the infectious component and usually occur at the site of contact eg throat/mouth for receptive oral sex. Most persons have fewer than 10 lesions and almost 10% present with only a single genital lesion. Hospitalisation is uncommon and the major reason for admission is usually for pain control, typically for anorectal or oral pain. Complications can occur if there is a secondary infection of the lesion. The symptoms usually resolve by themselves within a few weeks, but you are considered infectious while you have symptoms.
If you think you may have symptoms, you should isolate and seek medical advice from your primary care physician, sexual health clinic or contact Healthline on 0800-611-116. You may be asked to isolate until test results are returned.

Probable and confirmed cases will need to isolate for a minimum of 7 days from the first presence of lesions, and then take other precautions to prevent onward transmission once released from isolation. They must continue taking precautions until they are no longer infectious which is until their lesions have crusted, the scab has fallen off and a fresh layer of skin has formed underneath (symptoms normally last 14–28 days). There is no specific financial support available at this time.
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How is it transmitted?

Monkeypox is transmitted through intimate skin-to-skin contact with the skin lesions. Contaminated objects such as bedding, clothing, or sex toys can also carry the virus but have much lower risk.

It is not classified as a sexually transmitted infection, but sex can make its transmission easy and is considered to be a common driver of transmission in the current outbreaks.

A recent study (The Lancet), found that monkeypox transmits most efficiently when lesions come into contact with mucus membranes in the anus, rectum, genitals, mouth and throat. Monkeypox is more likely to transmit through oral or anal sex than through contact with external skin, which would need some sort of defect, such as a wound, to allow entry of the virus.

Monkeypox & HIV

People with advanced HIV infection or who are not taking antiretroviral drugs might be at increased risk for severe disease if they get monkeypox.

However there does not appear to be more severe monkeypox illness in people who have HIV, are on antiretroviral medication and are virally suppressed.

What treatment is available?

For most patients, treatment for Monkeypox is mainly supportive, such as pain medication. Most people with monkeypox recover fully within 2 to 4 weeks without the need for medical treatment.

There are no treatments specifically for monkeypox virus infections. However, monkeypox and smallpox viruses are genetically similar, which means that antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat monkeypox virus infections. New Zealand has secured 504 doses of Tecovirimat, also called Tpoxx which is reserved for severe cases who need to be hospitalised.

Tecovirimat is an antiviral medication approved by the FDA for treatment of smallpox in adults and children but not for monkeypox because data are not available on the effectiveness of Tecovirimat in treating monkeypox in humans.
Studies using a variety of animal species have shown that Tecovirimat is effective in treating orthopoxvirus-induced disease. Human clinical trials indicated the drug was safe and tolerable with only minor side effects. A case report from the UK suggested that Tecovirimat may shorten the duration of illness and viral shedding.

Is there a vaccine for Monkeypox?

Many countries around the world have begun a vaccine rollout to combat the Monkeypox outbreak. The Jynneos vaccine is a 2 dose vaccine that is being used for monkeypox. This requires two shots 4 weeks apart with maximum effectiveness attained 2 weeks after the second shot. Jynneos has been specifically evaluated in people with HIV and shown to be safe.
If you have been vaccinated for smallpox in the past this shows limited protection as the efficacy wanes over time and cases have still occurred. Research from the Spanish outbreak showed 18% of cases were amongst people that had previously been vaccinated as children.

At this stage, New Zealand’s response is still testing, isolating and contact tracing. The Ministry of Health has indicated that it will be December at the earliest before a supply of vaccine is available in New Zealand
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