Monkeypox: what veterinarians should know

Monkeypox is the most important orthopoxviral for public health since smallpox was eradicated in 1980, according to the World Health Organization (WHO).¹ This month, there have been multiple monkeypox cases reported—with at least 19 confirmed cases in the United States this year²—and undergoing studies are currently helping to further understand this disease by studying its transmission patterns, epidemiology, and source of infection.

However, as these studies strive to answer questions about this disease, there is still much to be learned about monkeypox. Because it can be spread through human-to-human contact and animal-to-human, what does this mean for veterinary professionals?

Monkeypox overview

In 1958, two colonies of monkeys kept for research began showing signs of a pox-like condition, which gave the disease its name.³ Twelve years later, the first human monkeypox case was reported in the Democratic Republic of Congo (DRC) as the country tried to eliminate smallpox.

Monkeypox is usually found in countries in central and western Africa. The DRC reported an outbreak in the late 1990s with a low fatality ratio and a higher attack rate than usual. Nigeria has also experienced a large outbreak. Since 2017, this outbreak has more than 500 suspected cases, 200 confirmed, and a case fatality ratio of 3%.¹

Although more common in certain countries, monkeypox has spread to other areas across the world like Singapore, Israel, the United Kingdom, and the United States. In 2003, an outbreak began in the United States after prairie dogs showed symptoms of the disease.

The cause of monkeypox currently remains unknown, but CDC reported that African rodents and nonhuman primates could possibly harbor the disease and then infect people.³ If you encounter a patient or client who has monkeypox, the incubation period is typically 6 to 13 days, but sometimes it can range from 5 to 21 days, and the infection is split into 2 periods¹:

The invasion period

The invasion period lasts anywhere from 0 to 5 days, and anyone infected can experience fever, intense headache, lymphadenopathy, back pain, myalgia, and intense asthenia. One distinct feature is lymphadenopathy when compared to other diseases that may initially appear similar such as chickenpox, measles, and smallpox.

The skin eruption

Usually beginning within 1 to 3 days after having a fever, the skin eruption with rash tends to be more concentrated on the face and extremities. In these cases, 95% of cases affect the face, and 75% affect the palms of the hands and the soles of the feet. Oral mucous membranes (in 70% of cases), genitalia (30%), conjunctivae (20%), as well as the cornea are also affected.² The number of lesions varies with some cases having only a few and some several thousands. In severe cases, lesions can come together until large sections of skin are shed off.

What does this mean for veterinarians?

Veterinary professionals should consider any mammal susceptible to monkeypox. Along with following CDC and WHO guidelines, knowing the symptoms linked with monkeypox can also provide a jump start on protecting yourself, your staff, patients, and clients. The symptoms are fever, cough, rash, respiratory signs, conjunctivitis, and lack of appetite.³ Although these are common symptoms, milder cases have shown fewer symptoms.

If you suspect a monkeypox case at your clinic, do not allow the animal to enter the waiting room, and treatment should be limited to an examination room. The CDC also recommends clinics limit the staff that has contact with suspected monkeypox patients. This will help decrease the number of veterinary professionals exposed to the disease.⁴

Image courtesy of the CDC

To prevent future monkeypox infection, the CDC recommends veterinary professionals wear personal protective equipment and wash any towels or clothing involved in the patient’s care. Clinics should also clean and disinfect the contaminated surfaces with an EPA-registered hospital detergent-disinfectant, contain and dispose of any waste after discussing with state or local health officials, and be diligent about hand hygiene.

Conclusion

As cases continue to rise, being prepared can keep everyone safe. When more information becomes available, communicate with your staff. Establishing monkeypox protocols and staying up to date with CDC and WHO guidelines are also recommended.

References

1. Monkeypox. World Health Organization. Accessed June 2, 2022. https://www.who.int/news-room/fact-sheets/detail/monkeypox
2. U.S. monkeypox 2022: situation summary. Centers for Disease Control and Prevention. Reviewed June 1, 2022. Accessed June 2, 2022. https://www.cdc.gov/poxvirus/monkeypox/response/2022/index.html
3. About Monkeypox. Centers for Disease Control and Prevention. Published May 27, 2022. Accessed June 2, 2022. https://www.cdc.gov/poxvirus/monkeypox/about.html
4. Examining animals with suspected Monkeypox. Centers for Disease Control and Prevention. Published November 19, 2021. Accessed June 2, 2022. https://www.cdc.gov/poxvirus/monkeypox/veterinarian/examination.html