As the outbreak of monkeypox continues across the United States, health experts said expanding testing, vaccination and treatment would be important to curbing the disease. But these important tools are still not widely available, and it can be difficult to try to get a diagnosis and find access to medications that may help treat symptoms.
Public health messaging in the United States about individual risks and access to care has not always been clear; Clinics that perform screening and health department officials who follow up on patients often lack coordination; delayed distribution of the vaccine; And treatment options remain vague.
To make things more complicated, monkeypox symptoms may look different in some cases. People who get sick do not always have the typical fever, aches and rashes all over the body. Many patients have only developed a few pustules, especially in the genital area. According to health officials, the disease is primarily spread in the networks of men who have sex with men.
While prevention is still critical, we asked the experts to explain the steps you need to take to get vaccinated, tested and treated if you suspect an infection or have recently been exposed to monkeypox.
Who is eligible to get the vaccine? And where can you get it?
Two vaccines originally developed for smallpox and kept in the US national stockpile can help prevent monkeypox infection. The most commonly used type of monkeypox is called Jynneos. It consists of two doses 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 was largely offered to two groups of people: health care or laboratory workers who might handle infected specimens and people with confirmed or suspected exposure to monkeypox.
What do you know about the monkeypox virus?
What is monkeypox? Monkeypox is a virus endemic to parts of central and western Africa. It is similar to smallpox, but less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research, according to the Centers for Disease Control and Prevention.
The vaccine can work even if it’s given after someone has been exposed, and the Centers for Disease Control and Prevention recommends vaccinating people within four days of exposure to get the best chance of preventing monkeypox. You can schedule a vaccination appointment with your local or state health department.
You can also get an injection up to two weeks after exposure to help reduce symptoms, although vaccinating more than four days after exposure may not prevent the disease from developing.
“You still need to take all precautions for a few weeks after vaccination,” said Dr. Sharon Green, an infectious disease expert at the University of Massachusetts School of Medicine in Worcester. Both before and after exposure, she said, individuals are generally considered fully protected two weeks after receiving their second dose. However, some researchers have suggested that even a single dose of Jynneos may help slow the spread of monkeypox.
Some states with high numbers of monkeypox cases have expanded the eligibility criteria for the vaccine to include anyone at high risk of getting it. For example, in New York and New Jersey, you can also get vaccinated if you attend an event where you have a known exposure to monkeypox or if you know that you are gay, bisexual, a man who has sex with other men, transgender, gender non-conforming, or nonbinary people. And he has had multiple sexual partners, or anonymous partners, in the past 14 days. But it can be difficult to get a vaccine appointment because distribution has faced many obstacles and delays.
When should you be tested?
Experts agree that vaccination and prevention should be prioritized to slow the current outbreak. But if you begin to notice red lesions, blisters, or blisters, you should contact your primary care physician and let your doctor know that you suspect a monkeypox infection. Your doctor will scan the lesion and order a monkeypox test for you. You can also get the test at urgent care centers or sexual health clinics and through other health care providers.
The test is a polymerase chain reaction, or PCR, much like the Covid-19 test detects a piece of the virus’ genetic material. But testing capacity is still limited. Samples may only be sent to a public health laboratory or one of five commercial laboratories for analysis. And although response time is improved, results can take anywhere from 24 hours to three days or longer.
There is no home test for monkeypox. Even in a clinic, health care workers need a lesion to scan for monkeypox testing, said Dr. William Morris, chief of Mayo Clinic’s Department of Laboratory Medicine and Pathology and chief of Mayo Clinic Laboratories. One of the commercial diagnostic tests for monkeypox. Dr. Morris said that if you don’t have any symptoms, or you only have fever and flu-like symptoms, there’s no way to test for monkeypox yet.
Another problem is that some health care workers may not be familiar with or cannot recognize monkeypox when patients come in for a diagnosis. Monkeypox lesions, especially in the genital areas, may appear very similar to symptoms of more common diseases, such as herpes or syphilis.
“If a lesion looks like monkeypox, people should just get it tested,” said Dr. Bernard Cummins, medical director for infection prevention at Mount Sinai Health System.
Finally, some health care workers may be unsure of the extent of the pest’s infection. “I hear anecdotal reports of patients being rejected,” Dr. Cummins said. “People have never seen this disease before, you know, and there is just the fear of the unknown. But transmission of monkeypox in healthcare is so rare that healthcare workers shouldn’t worry about getting monkeypox at work as long as they are wearing proper PPE “.
What is the treatment process for monkeypox?
After you get the diagnosis, Dr. Cummins said, treatment for monkeypox mainly involves controlling your symptoms. He said that patients with lesions of the anus or rectum may experience a lot of pain, especially during defecation, and in those cases the doctor may prescribe pain relievers or recommend stool softeners and shallow sitz baths, which are used to relieve pain or itching in the genital area. Patients with mouth sores may have difficulty swallowing and can get medication to help with this. Some may develop a secondary bacterial infection and require treatment with antibiotics, especially if they have large, open lesions.
Antiviral drugs, such as tecovirimat or TPOXX, are usually only recommended for people who have more systemic symptoms or a body-wide rash with a high risk of developing monkeypox complications. Physicians must order the drug from the government’s stockpile, fill out extensive paperwork and obtain informed consent from patients in order to receive treatment.
“It’s not a drug that goes on the shelf at the pharmacy or in the clinic,” said Dr. Sandro Sinti, an infectious disease physician at the University of Michigan in Ann Arbor.
Regardless of whether they are able to obtain antiviral treatment, patients should be isolated at home as soon as monkeypox symptoms develop. 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 masks if they have to contact others for medical care. The CDC recommends limiting your exposure to others and staying isolated until any lesions have completely healed. You only emerged from the woods after the lesions had crusted over, the crust shedding and forming a new layer of healthy skin. And this can take a long time – from two to four weeks.
“It puts us in a real dilemma,” Dr. Cummins said. While health experts hope that people will be able to take necessary sick days or work from home, it is unrealistic to expect that everyone with the infection will be able to follow these guidelines precisely. “And that makes it even more important for people to be aware and be careful about spreading the virus.”
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