What You need to Know About Monkeypox as a Nurse

• The current monkeypox outbreak has triggered our heightened sensitivity. Monkeypox is contagious but lacks the features for worldwide dissemination. 
• Presentation of monkeypox is similar to that of chickenpox. Swollen lymph nodes and maculae are defining characteristics.  
• Previous smallpox vaccination can offer protection from the re-emerged monkeypox. 

Consider this; a virus backstopped by a fetish fashion festival in Antwerp, Belgium. A name involving an exotic animal. A suggested tie to homosexuality.  

These components dictate that the media takes notice. This article has key information that can help your nursing practice.  

In the wake of pandemic exhaustion and societal unrest, the global population has limited capacity to be taunted by another virus. Monkeypox is not that virus. Our first exposure occurred two decades ago in the US and ensued without fatality.  

Most troublesome viruses are a flight away in our global world. The current monkeypox outbreak has triggered our heightened sensitivity. Which I believe is a good thing, granting us the humility to bolster public health and infectious disease surveillance.  

Monkeypox is contagious but lacks the features for worldwide dissemination.  

Two factors reinforce this hypothesis. Transmission requires close personal contact, and the virus does not have a high secondary case rate. 

Ignore the Headlines About Monkeypox

We have a duty as nurses and healthcare professionals, not to become distracted by the provocative headlines. Paraphrasing Mark Twain, never let the truth impede a good story.  

This current epidemiological story begins with a viral introduction to Europe. The media hints to a disease transmission among homosexual men.  

And the media focus on that population is misguided. Considering that sexual behavior requires close contact, you could say monkeypox is as much of a sexually transmitted pathogen as chickenpox. Stigmatizing rhetoric around homosexuality is not required or relevant when discussing monkeypox. 

The Lowdown on Monkeypox

What information do we need to inform ourselves as healthcare professionals, our patients, and the public? First, we need to allay our fears.  

Monkeypox is a frightening disease in which we have the tools to treat. Unlike Covid-19, which altered many aspects of our lives.  

The overall risk to healthcare professionals and the general population is low.  

In short, the sky is not falling.  

You cannot deny the recent low yield European outbreak has raised concerns and heightened awareness, and that’s a good thing.  

As with any viral outbreak, surveillance and education matters. 

Does Monkeypox Come From Monkeys?

Monkeypox is a double stranded DNA zoonosis virus. Yes, the same double stranded DNA found in humans.  

Despite the name, monkeys are not the vector. Experts believe rodents are the culprits as identified through sequenced DNA and phylogenetic tree data that hints to its origin.  

The pox infection, discovered in Denmark 1950s, likely arrived from West Africa in the 1970s, which has had hundreds of cases to date. 

The virus is familiar to infectious disease professionals. It belongs in the Poxviridae family of viruses which four have the potential to infect humans: Orthopoxvirus, Parapoxvirus, Yata Poxviridae, and Molluscipoxvirus.  

There are two clades that produce different disease outcomes. The more virulent Congo basin strain with a 10% case mortality, and the West African strain with a lower mortality of 1% to 5%. To date, no fatalities have occurred outside the Congo. Airborne transmission is possible, but less likely.  

Symptoms and Presentation of Monkeypox

Monkeypox is a viral illness. A pox disease with a prolonged incubation period of up to 21 days. As with other pox diseases, characteristics of monkeypox include fever and a unique rash with pox progression.  

A fulminant case should be recognizable through its pustules. 

Where do we direct our vigilance? To presentations that report the onset of fever and developing rash with small red macules over several days. The maculae develop into translucent thin-walled vesicles, progressing to purulence. If you have experienced or seen chickenpox, the presentation is similar, but with distinguishing characteristics.  

Swollen lymph nodes and vesicles in the same stage of expression on a single body location. In contrast to chickenpox, where the vesicles progress in various stages across the trunk, arms, and face.  

With monkeypox, you are infectious after the incubation period ends and through scarification. Vesicles and papules contain viral replication and are transmittable to other mammals, including your pets. The danger here lies in the virus leaving your household and ending up amongst the wild population of other mammals.  

Monkeypox Treatment

Monkeypox is a diagnostic challenge in parts of the world. Molecular DNA sequencing of the virus is required.  

Every lab does not have this capacity. The ideal diagnostic testing requires the un-roofing of a papule and the gathering of particulates on a non-cotton swab. 

On a fundamental global health level, proper nutrition, good baseline health and access to high quality medical care thwarts much of the dangerous sequelae from monkeypox.  

Outside the US and Europe, treatment of monkeypox involves supportive care: keeping the developing rash clean, dry and without infection.  

Professionals should continue hand washing and wear gowns, gloves and eye protection until clarification and identification.  

This considered, we have tools to treat the higher risk individuals. These include vaccination via attenuated non-replicating modified vaccinia orthopox virus (JYNNEOS™), antivirals that interfere with the protein synthesis and immune globulins.  

Smallpox Vaccination and Monkeypox

Older individuals who have had the smallpox vaccine can expect an 85% level of protection, though these individuals should continue to monitor symptoms if a fever and a rash develop.  

One should consider the last smallpox vaccine administration occurred in the 1970s.  

Vaccine administration that occurred over 40 years ago may not confer a high enough level of protection and induced immunity may wane. 

The Bottom Line

Monkeypox is not the next pandemic nor the next HIV, yet our surveillance, education and basic infectious disease practices should stay in place. 

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