Monkeypox | Infographics - American College of Chest Physicians

Epidemiology and virology

Very large, enveloped, double-stranded DNA virus (can be seen with light microscopy):

First identified in research primates, but natural reservoir may actually be rodents
Transmission via close contact with skin lesions, body fluids, respiratory droplets, and contaminated materials (such as linen)
First human case identified in Democratic Republic of Congo (DRC) in 1970; endemic in DRC, Nigeria, Sierra Leone
Approximately 200 cases in Nigeria reported since 2017
Prior US outbreak in 2003 (47 confirmed and probable cases associated with exposure to imported animals)

Symptoms similar to classic smallpox but milder
Incubation usually 7 to 14 days before onset of fever
Fever, myalgia, and lymphadenopathy, followed 1 to 2 days later by lesions in mouth and on skin
Rash presents sequentially with macules, then papules, followed by vesicles or pustules that are deep-seated, firm, and well-circumscribed
Genital lesions reported in recent outbreak
Illness typically lasts 2 to 4 weeks
Contagious from the onset of the rash and oral lesions, and lasts until these lesions have scabbed over
Case fatality rate in West Africa estimated at 3% to 4%, with risk highest in children, young adults, immunocompromised persons

Contact local public health authorities immediately for suspected cases and to coordinate testing
Standard, contact, and airborne precautions recommended in all health care settings for suspected cases
Although airborne transmission is not described, similarly presenting pathogens (eg, varicella, other poxviruses) could be airborne
Drug treatment for severe cases:
- Tecovirimat
- Cidofovir
- Brincidofovir

Smallpox vaccination is estimated to be at least 85% protective against monkeypox
Vaccination can be effective as postexposure prophylaxis
Two approved vaccines in the US, Europe:
- Jynneos (Bavarian Nordic) – nonreplicating vaccinia virus vector, two-dose series, approved for smallpox and monkeypox
- ACAM2000 – live attenuated vaccinia strain; contraindicated in immunocompromised hosts, persons with eczema, and their close contacts
Vaccinia immune globulin (VIG)