Monkeypox

11/08/2022 08:00:00 Comments From Costa Gavrielides

In recent months, and especially after the announcement of the first confirmed case in Cyprus, there has been an intense debate about how to spread and protect against the monkeypox virus. It is now a serious challenge for health professionals to properly manage the misinformation that was created in the first place, in ways that remind us of similar outbreaks.


Contrary to what may be spreading, it is a disease that for decades has afflicted men and women mainly in regions of Central and West Africa. At the moment it seems to be spreading among certain groups in the Western world and if quick action is not taken it may spread more generally.


Although remote, the possibility for any person to become infected exists since the spread occurs either by simple physical contact with the skin lesions of a patient, or through the respiratory system through small droplets after prolonged close contact at a short distance, or even by sharing contaminated items.


The Ministry of Health has already issued a protocol (in greek) for the management of possible and confirmed cases of monkey blessing, which can be found in the following link. At the same time there is an update from both the European Centre for Disease Prevention and Control (ECDC) in the following syndbut also from other bodies. 


Personally, I found the information material provided by the American Center for Disease Prevention and Control (CDC)   that one finds here quite good. I quote a part here, with some changes specific to Cyprus, for those people who are interested in being informed.
ABOUT MONKEYPOX
Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox virus is part of the same family of viruses as variola virus, the virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder, and monkeypox is rarely fatal. Monkeypox is not related to chickenpox.

Monkeypox was discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. Despite being named “monkeypox,” the source of the disease remains unknown. However, African rodents and non-human primates (like monkeys) might harbor the virus and infect people.

The first human case of monkeypox was recorded in 1970. Prior to the 2022 outbreak, monkeypox had been reported in people in several central and western African countries. Previously, almost all monkeypox cases in people outside of Africa were linked to international travel to countries where the disease commonly occurs or through imported animals. These cases occurred on multiple continents.
SIGNS AND SYMPTOMS

Symptoms

People with monkeypox get a rash that may be located on or near the genitals (penis, testicles, labia, and vagina) or anus (butthole) and could be on other areas like the hands, feet, chest, face, or mouth.
  • The rash will go through several stages, including scabs, before healing.
  • The rash may initially look like spots and papules (circumscribed, solid patches without liquid), pimples or blisters, and can be painful or itchy.

Other symptoms of monkey smallpox may include:
  • Fever
  • Chills
  • Swollen lymph nodes
  • Exhaustion
  • Muscle aches and back pain
  • Headache
  • Respiratory symptoms (e.g. sore throat, nasal congestion, or cough)

You may experience all or only a few symptoms
  • Sometimes, people have flu-like symptoms before the rash.
  • Some people first develop a rash, followed by other symptoms.
  • Others only experience a rash.

How long do monkeypox symptoms last?

Monkeypox symptoms usually start within 3 weeks of exposure to the virus. If someone has flu-like symptoms, they will usually develop a rash 1-4 days later.

Monkeypox can be spread from the time symptoms start until the rash has healed, all scabs have fallen off, and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks.
If you have a new or unexplained rash...
  • Avoid close contact, including sex with anyone, until you are examined by a doctor. 
  • Contact your personal doctor
HOW IT SPREADS
Smallpox of monkeys spreads in various ways.
  • Monkey pox can spread to anyone through close, personal, often skin-to-skin contact, including:
  • Direct contact with a rash, pustules (kakati) or body fluids from a person with monkey smallpox.
  • Touching objects, fabrics (clothes, bedding or towels) and surfaces that have been used by a person with smallpox of monkeys.
  • Contact with respiratory secretions.

  • This direct contact can occur during close contact, including:
  • Oral, and vaginal sex or touching the genitals (penis, testicles, lips and vagina) or the person with monkey pox.
  • Hugs, massages and kisses.
  • Prolonged face-to-face contact.
  • Touching fabrics and objects during sex that were used by a person with monkey smallpox and that have not been disinfected, such as bed linen, towels, fetish equipment and sex toys.
  • A pregnant woman can transmit the virus to her fetus through the placenta.

It is also possible for people to catch the smallpox of infected animals, either scratched or bitten by the animal, or preparing or eating meat, or using products from an infected animal.

A person with monkey pox can transmit it to others from the moment the symptoms begin until the rash completely heals and a new layer of skin is formed. The disease usually lasts 2-4 weeks.

Scientists are still researching:
  • If the virus can be transmitted when someone has no symptoms
  • How often monkeypox is transmitted through respiratory secretions or when a person with symptoms of monkeypox may be more likely to transmit the virus through respiratory secretions.
  • If monkeypox can be transmitted through sperm, vaginal fluids, urine or feces.
PREVENTION

How to protect yourself

Steps to prevent monkeypox

Follow the following three steps to prevent monkeypox infection:

1 - Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox.
  • Do not touch the rash or scabs of a person with monkeypox.
  • Do not kiss, hug, cuddle or have sex with someone with monkeypox.

2 - Avoid contact with objects and materials that a person with monkeypox has used.
  • Do not share eating utensils or cups with a person with monkeypox.
  • Do not handle or touch the bedding, towels, or clothing of a person with monkeypox.

3 - Wash your hands often.
  • Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom.


Vaccines

Vaccination is an important tool to prevent the spread of monkey smallpox. However, given the current limited supply of vaccine, for now, this is only available in:
  • People who have been identified by public health officials as a contact of someone with monkeypox
  • People who know that one of their sexual partners in the last 2 weeks has been diagnosed with monkeypox
  • Healthcare professionals and healthcare employees

Safer Sex, Social Gatherings, and Monkeypox

The following can help you make informed choices when you are in situations or places where monkeypox can spread. Monkeypox is not considered a sexually transmitted disease but is often transmitted through close, prolonged physical contact, which may involve sexual intercourse.

How can a person reduce the risk during sex?


Vaccination is an important tool to prevent the spread of monkeypox. However, given the current limited supply of a vaccine, consider temporarily changing certain behaviours that may increase the risk of exposure. These temporary changes will help slow the spread of monkeypox until the supply of a vaccine is sufficient.


Exchange contact information with any new partners as much as possible to allow sexual health monitoring, if needed.


Talk with your partner about any monkeypox symptoms and be aware of any new or unexplained rash or lesion on either of your bodies, including the mouth, genitals (penis, testicles, vulva, or vagina), or anus. If you or your partner has or recently had monkeypox symptoms, or you have a new or unexplained rash anywhere on your body, do not have sex and see a healthcare provider. In some cases, symptoms may be mild, and some people may not even know they have monkeypox.


If you or a partner has monkeypox or think you may have monkeypox, the best way to protect yourself and others is to avoid sex of any kind (oral, anal, vaginal) and kissing or touching each other’s bodies—while you are sick. Especially avoid touching any rash. Do not share things like towels, fetish gear, sex toys, and toothbrushes.


Even if you feel well, here are some ways to reduce your chances of being exposed to monkeypox if you are sexually active:
  • Limit your number of sex partners to reduce your likelihood of exposure.
  • Spaces like back rooms, saunas, sex clubs, or private and public sex parties, where intimate, often anonymous sexual contact with multiple partners occurs—are more likely to spread monkeypox.
  • Condoms (latex or polyurethane) may protect your anus, mouth, penis, or vagina from exposure to monkeypox. However, condoms alone may not prevent all exposures to monkeypox since the rash can occur on other parts of the body.
  • Gloves (latex, polyurethane, or nitrile) might also reduce the possibility of exposure if inserting fingers or hands into the vagina or the anus. The gloves must cover all exposed skin and be removed carefully to avoid touching the outer surface.
  • Avoid kissing or exchanging spit since monkeypox can spread this way.
  • Masturbate together at a distance without touching each other and without touching any rash.
  • Have virtual sex without personal contact.
  • Consider having sex with your clothes on or covering areas where rash is present, reducing as much skin-to-skin contact as possible. Leather or latex gear also provides a barrier to skin-to-skin contact; just be sure to change or clean clothes/gear between partners and after use.
  • Be aware that monkeypox can also spread through respiratory secretions with close, face-to-face contact.
  • Remember to wash your hands, fetish gear, sex toys, and any fabrics (bedding, towels, clothes) after having sex.  
What should a person do if they have a new or unexplained rash?
  • Avoid close contact, including sex with anyone, until you are examined by a doctor. 
  • Contact your personal doctor

How can a person lower the chance of getting monkeypox at places like raves, parties, clubs, and festivals?

        

When thinking about what to do, seek out information from trusted sources like the local health department. Second, consider how much close, personal, skin-to-skin contact is likely to occur at the event you plan to attend. If you feel sick or have a rash, do not attend any gathering, and contact your personal doctor.

        

Festivals, events, and concerts where attendees are fully clothed and unlikely to share skin-to-skin contact are safer. However, attendees should be mindful of activities (like kissing) that might spread monkeypox.


A rave, party, or club where there is minimal clothing and where there is direct, personal, often skin-to-skin contact has some risk. Avoid any rash you see on others and consider minimizing skin-to-skin contact.


Enclosed spaces, such as back rooms, saunas, sex clubs, or private and public sex parties where intimate, often anonymous sexual contact with multiple partners occurs, may have a higher likelihood of spreading monkeypox.

PETS AT HOME
Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food.

People with monkeypox should avoid contact with animals, including pets, domestic animals, and wildlife to prevent spreading the virus. If your pet is exposed to monkey pox:

  • Do not surrender, euthanize, or abandon pets just because of a potential exposure or Monkeypox virus
  • Do not wipe or bathe your pet with chemical disinfectants, alcohol, hydrogen peroxide, or other products, such as hand sanitizer, counter-cleaning wipes, or other industrial or surface cleaners.

If the person with monkeypox did NOT have close contact with pets after symptom onset, ask friends or family members who live in a separate home to be the animal’s caretaker until the person with monkeypox fully recovers. Close contact includes petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food.

After the person with monkeypox is recovered, disinfect your home before bringing healthy animals backs.

Pets that had close contact with a symptomatic person with monkeypox should be kept at home and away from other animals and people for 21 days after the most recent contact. Infected people should not take care of exposed pets. The person with monkeypox should avoid close contact with the exposed animal, and when possible, ask another household member to care for the animal until the person with monkeypox is fully recovered.

In some cases, it may be necessary to isolate and care for animals that have been exposed to monkey smallpox in a location other than home. For example, people who are immunocompromised, pregnant, have young children (8 years old) or with a history of atopic dermatitis or eczema, should not care for animals that have had close contact with a person with monkey pox, as they may be at increased risk for serious results from monkey smallpox disease.

If you have monkeypox and must care for your healthy pets during home isolation, wash your hands, or use an alcohol-based hand rub, before and after caring for them. It is also important to cover any skin rash to the best extent possible (i.e. long sleeves, long pants), and wear gloves and a well-fitting mask or respirator while providing care for your animals.

  • Do not put a mask on your pet.
  • Avoid close contact with your pet.
  • Ensure your pet cannot inadvertently come into contact with contaminated articles in the home such as clothing, sheets, and towels used by the person with monkeypox.
  • Do not let animals come into contact with rashes, bandages, and body fluids.
  • Ensure food, toys, bedding, or other items that you provide for your animal during its isolation do not come in direct contact with skin or uncovered rash.

In case you believe that your pet is infected with the virus, contact the veterinary services for help.

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