Monkeypox is a viral zoonotic disease caused by the monkeypox virus. It was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. The first case in humans was reported in 1970 in the Democratic Republic of Congo. Since then, monkeypox has been reported in other central and western African countries with the majority of cases in the Congo Basin.

VACCINES

Vaccines can prevent monkeypox infection if given before exposure to the virus. The smallpox vaccine was shown to be 85% effective in preventing monkeypox. This vaccine was developed for smallpox but also provides protection against monkeypox as the two viruses are closely related. There are currently two vaccines licensed by the U.S. Food and Drug Administration (FDA) for prevention of monkeypox - JYNNEOS and ACAM2000.

JYNNEOS is a two-dose vaccine approved in 2019 for prevention of both smallpox and Monkeypox in adults 18 years of age and older determined to be at high risk for smallpox or monkeypox infection. It has fewer side effects than the older generation smallpox vaccine ACAM2000. JYNNEOS is administered subcutaneously in two doses spaced four weeks apart.

ACAM2000 is a live replication-competent vaccine that was approved in 2007 under the FDA Animal Rule for prevention of smallpox disease in people determined to be at high risk for smallpox infection. It provides protection against monkeypox. As it contains live vaccinia virus, it carries more risk of side effects compared to JYNNEOS.

Antivirals

For persons with suspected or confirmed monkeypox infection, antiviral treatment may be offered, depending on severity of illness, likelihood of severe disease, and risk of complications. The antiviral drugs tecovirimat, brincidofovir, and cidofovir may offer benefits for treatment of monkeypox virus infections.

Tecovirimat was approved by the FDA for treatment of smallpox in 2018 under the Animal Rule. It interrupts the ability of the monkeypox virus to exit infected cells by blocking a protein essential for its release. Tecovirimat appears to be effective against monkeypox based on animal studies. Treatment courses range from 14 days for mild cases to 21 days for severe cases. Common side effects are mild and include headache.

Brincidofovir is an antiviral developed to treat DNA viruses like smallpox. Although not FDA approved, it has been used under expanded access for monkeypox treatment. Early administration of brincidofovir may reduce the severity and length of illness. Common side effects are mild and gastrointestinal in nature. Treatment duration is 7-10 days.

Cidofovir is FDA approved for cytomegalovirus retinitis in HIV/AIDS patients but has also been used off-label for treating smallpox and monkeypox under special circumstances. It works by inhibiting viral DNA replication. Possible side effects include kidney toxicity requiring monitoring during therapy spanning 7-21 days.

Supportive Care

Those afflicted with monkeypox may also receive supportive therapies to relieve symptoms and prevent complications. Healthcare providers will monitor for secondary bacterial infections and treat with appropriate antibiotics if needed. Pain management with analgesics can help address pain from skin lesions and other symptoms. Intravenous fluids are given for severe cases involving extensive rash and dehydration. Steroids can reduce inflammation and ease discomfort. Anti-itch medications provide relief from intense pruritus.

Isolation

People diagnosed with monkeypox should isolate until all scabs from lesions have fallen off and a fresh layer of skin has formed. This is important to prevent spreading the virus to others. Identifying and monitoring close contacts for symptoms and offering JYNNEOS vaccine if given within 14 days of exposure reduces community transmission. Countries affected have instituted contact tracing programs to control outbreaks. Strict isolation protocols continue until the risk of transmission is negligible.

Preventing Zoonotic Transmission

Reducing risk factors linked to spillover of monkeypox virus from animal reservoirs to humans is pivotal for outbreak prevention. Public education on avoiding contact with sick or dead monkeys, rodents, or bushmeat is necessary, especially in endemic regions. Handwashing is equally important after interacting with potentially infected animals or their environments. Controlling poaching and illegal wildlife trade would block exposure opportunities. Surveillance of wildlife can identify areas where the virus is circulating to guide policy interventions aimed at limiting human-animal contact.

Successful management of monkeypox involves a multi-pronged approach leveraging antiviral drugs, vaccines, isolation practices, contact tracing, and environmental controls to disrupt transmission chains. By containing it early through prompt diagnosis, treatment, and public health response tools, we can prevent localized outbreaks from spreading further. Ongoing research also seeks more options to combat this challenging zoonotic infection. Collective global vigilance remains key to curbing monkeypox incidence worldwide over the long term.

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