The outbreak of monkeypox continues to increase worldwide, and the World Health Organization declared a public health emergency of international concern on Saturday. The designation means a coordinated international response is needed to prevent the virus from spreading further and may push member countries to invest more in vaccines, treatments and other resources to curb the disease.
Many of these critical tools are not yet widely available, even in the United States. Public health messages about individual risk and access to care have not always been clear; testing clinics and health department officials tracking patients often lack coordination; vaccine distribution has been delayed; and treatment options remain obscure.
To complicate matters, the symptoms of monkeypox can look different in some cases. People who get sick don’t always have the traditional fever, aches and rashes all over the body. Many patients have developed only a few pustules, mainly in the genital area. And according to health officials, the disease is spreading primarily through the networks of men who have sex with men.
While prevention is still 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.
Who is eligible for the vaccine? And where can you get it?
Two vaccines originally developed for smallpox and held in the U.S. National Reserve may help prevent monkeypox infections. The one most commonly used for monkey pox is called Jynneos. It consists of two doses administered 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 largely been offered to two groups of people: health care or laboratory workers who might handle infected samples, and people who have had confirmed or suspected exposure to smallpox.
The vaccine can work even if given after someone is exposed, and the Centers for Disease Control and Prevention recommends that people get vaccinated within four days of the date of exposure for the best chance of prevent monkey pox. You can make an appointment for the vaccine through your local or state health department.
You can also get a vaccine up to two weeks after an exposure to help reduce symptoms, although vaccination more than four days after an exposure may not prevent the disease.
“You should still take all preventive measures for a few weeks after vaccination,” said Dr. Sharone Green, an infectious disease expert at the University of Massachusetts Chan School of Medicine in Worcester. Whether before or after exposure, people are generally considered fully protected two weeks after receiving the second dose, he said. However, some researchers have suggested that even a single dose of Jynneos can help slow the spread of monkeypox.
Some states with high monkeypox cases have expanded their eligibility criteria for the vaccine to include anyone at high risk of contracting it. For example, in New York and New Jersey, you can also get the vaccine if you attended an event where there was known exposure to monkeypox, or if you identify as gay, bisexual, a man who has sex with other men, transgender, non-conforming or non-bisexual. and having had multiple sexual partners, or anonymous partners, during the last 14 days. But it can be difficult to get an appointment for the vaccine because distribution has been hit by several roadblocks and delays.
When should you take the test?
Experts agree that vaccination and prevention must be prioritized to slow the pace of the current outbreak. But if you start to notice red lesions, pimples, or pustules, you should contact your primary care doctor and let them know that you suspect a monkeypox infection. Your doctor will swab a sore and ask for a chicken pox test. You can also get tested at urgent care centers or sexual health clinics and through other health providers.
The test is a polymerase chain reaction, or PCR, like those for Covid-19 that detect part of the genetic material of the virus. 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 response time has improved, results can take anywhere from 24 hours to three days or more.
There is no home test for monkey pox. And even in a clinic, health care workers need a swab to perform a smallpox test, said Dr. William Morice, chairman of the department of laboratory medicine and pathology at the Mayo Clinic and chairman of the Clinic Laboratories Mayo, who developed one of the commercial monkeypox diagnostic tests. If you have no symptoms, or just a fever and flu-like symptoms, there’s still no way to test for monkeypox, Dr. Morice said.
Another problem is that some healthcare workers may not be aware or able to recognize monkeypox when patients present for diagnosis. Monkey pox lesions, especially in the genital areas, can look very similar to symptoms of more common diseases, such as herpes or syphilis.
“If a lesion looks like it could be monkey pox, people should just get it tested,” 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’m hearing anecdotal reports of patients being turned away,” Dr. Camins said. “People haven’t seen this disease before, you know, and there’s just fear of the unknown. But the health transmission of monkeypox is so rare that health workers shouldn’t worry about getting monkeypox. monkey at work as long as they wear the appropriate personal protective equipment.”
What is the process for getting treatment for monkey pox?
After you get a diagnosis, treatment for monkeypox is mostly about managing symptoms, Dr. Camins said. Patients with anal or rectal injuries may experience a lot of pain, especially while defecating, and in these cases a doctor may prescribe pain relievers or recommend stool softeners and shallow sitz baths, used to relieve pain or itching in the genital area, he said. Patients with mouth sores may have difficulty swallowing and may be given medication to help. Some may develop secondary bacterial infections and require treatment with antibiotics, especially if they have large, open lesions.
Antivirals, such as tecovirimat or TPOXX, are usually recommended only for people who have more systemic symptoms or a full-body rash and are at high risk for complications from monkeypox. Doctors must request the drug from government stockpiles, fill out extensive paperwork and obtain informed consent from patients to receive the treatment.
“It’s not a drug that sits on the pharmacy or clinic shelf,” said Dr. Sandro Cinti, an infectious disease physician at the University of Michigan in Ann Arbor.
Regardless of whether they can receive antiviral treatment, patients should isolate at home as soon as they develop symptoms of monkeypox. As with Covid-19, they should avoid close contact with friends, family and pets, cover all skin rashes as much as possible and wear good quality masks if they have to come into contact with others for medical care . The CDC recommends limiting exposure to other people and staying in isolation until the lesions are completely healed. You’re only out of the woods after the lesions slough off, the scabs fall off, and a new layer of intact skin has formed. And this can take a long time, between two and four weeks.
“It puts us in a real dilemma,” Dr. Camins said. While health experts may hope that people can take necessary sick days or work from home, it is unrealistic to expect that everyone who becomes infected can strictly follow these guidelines. “This makes it even more important for people to be aware and be careful about spreading the virus.”