Monkeypox: what you need to know about vaccines, tests and treatment

As a monkeypox epidemic continues to spread across the United States, health experts have said expanded testing, vaccination and treatment will be important to curb the disease. But these essential tools are still not widely available, and it can be difficult trying to get a diagnosis and access medications that can ease your symptoms.

In the United States, public health messages about individual risk and access to care have not always been clear; the clinics performing the tests and the health service managers following up on the patients are often uncoordinated; the distribution of vaccines has been delayed; and treatment options remain unclear.

To complicate matters, monkeypox symptoms may look different in some cases. People who get sick don’t always have the traditional fever, body aches, and rashes. Many patients have only developed a few pustules, mainly in the genital area. And according to health officials, the disease is mainly spreading through networks of men who have sex with men.

While prevention is always crucial, we asked experts to explain what steps you should 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 US National Stockpile may help prevent monkeypox infections. The one most commonly used for monkeypox is called Jynneos. It consists of two doses given four weeks apart. But because its supply is limited and controlled by the federal government, it is not widely available to the public. Instead, the vaccine has been widely offered to two groups of people: healthcare or lab workers who might handle infected samples, and people who have had confirmed or suspected exposure to monkeypox.

The vaccine can work even if given after a person has been exposed, and the Centers for Disease Control and Prevention recommends that people get vaccinated within four days of the date of exposure to have the best chance of prevent monkeypox. You can make an appointment for the vaccine through your local or state health department.

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

“You would still need to take all the preventative measures for a few weeks after vaccination,” said Dr. Sharone Green, an infectious disease expert at the Chan School of Medicine at the University of Massachusetts Worcester. Whether before or after exposure, individuals 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 may help slow the spread of monkeypox.

A few states with high numbers of monkeypox cases have expanded their vaccine eligibility criteria to include anyone at high risk of contracting it. For example, in New York and New Jersey, you can also get vaccinated if you attended an event where known exposure to monkeypox occurred or if you identify as gay, bisexual, male with sex with other men, transgender, gender non-conforming or non-binary and having had multiple sex partners, or anonymous partners, in the past 14 days. But it can be difficult to get an appointment for the vaccine as the distribution has faced several hurdles and delays.

Experts agree that vaccination and prevention must be prioritized to slow the pace of the current outbreak. But if you start noticing red lesions, pimples or pustules, you should contact your GP and let them know that you suspect monkeypox infection. Your doctor will remove a lesion and order a monkeypox test. You can also get tested at urgent care centers or sexual health clinics and through other healthcare providers.

The test is a polymerase chain reaction, or PCR, much like those for Covid-19 that detect a piece of the virus’s genetic material. But testing 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, healthcare workers need a swab lesion to perform 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 diagnostic tests for monkeypox. If you have no symptoms, or just fever and flu-like symptoms, there’s no way to test for monkeypox yet, Dr. Morice said.

Another issue is that some healthcare workers may not be aware of or able to recognize monkeypox when patients present for diagnosis. Monkeypox lesions, especially in the genital areas, can look very similar to symptoms of more common illnesses, such as herpes or syphilis.

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

Finally, some healthcare workers may not know how contagious the lesions are. “I hear anecdotal reports of patients being turned down,” Dr. Camins said. “People have never seen this disease before, you know, and there’s just the fear of the unknown. But transmission of monkeypox through healthcare is so rare that healthcare workers shouldn’t worry about contracting monkeypox on the job as long as they wear the proper personal protective equipment.

After receiving a diagnosis, treating monkeypox primarily involves managing the symptoms, Dr. Camins said. Patients with anal or rectal lesions may experience a lot of pain, especially when defecating, and in these cases a doctor may prescribe pain medication or recommend stool softeners and shallow sitz baths, which are used for pain relief or the itching in the genital area, he said. Patients with mouth sores may have difficulty swallowing and can get medication to help. Some may develop secondary bacterial infections and require antibiotic treatment, especially if they have large open lesions.

Antivirals, such as tecovirimat or TPOXX, are generally only recommended for people who have more systemic symptoms or a body-wide rash and a high risk of complications from monkeypox. Doctors must request the drug from the government stock, complete numerous paperwork, and obtain informed consent from patients in order to obtain the treatment.

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

Whether or not they are able to receive antiviral treatment, patients should isolate themselves at home as soon as they develop symptoms of monkeypox. As with Covid-19, they should avoid close contact with friends, family members and pets, cover all rashes as much as possible and wear good quality masks if they must come into contact with other people for medical care. The CDC recommends limiting your exposure to others and staying isolated until the lesions have completely healed. You are only out of the woods after the lesions have crusted over, the crusts fall off, and a new layer of intact skin has formed. And it can take a long time – two to four weeks.

“It puts us in a real dilemma,” Dr Camins said. While health experts may hope that people will be able to take necessary sick days or work from home, it is unrealistic to expect anyone infected to be able to strictly follow these guidelines. “It makes it even more important that people be aware and watch out for the spread of the virus.”

Leave a Comment