Many people infected during an international outbreak of monkeypox had a single lesion or sore in the mouth or on the genitals, a departure from typical symptoms of the virus that could lead clinicians to misdiagnose monkeypox as a other sexually transmitted infection (STI).
This is one of the main lessons of New England Journal of Medicineit is (NEJM‘s) new international study on the current epidemic, which is the largest case study on the virus.
“This truly global case series has allowed physicians from 16 countries to share their vast clinical experience and many clinical photographs to help other physicians in places where there are fewer cases. We have shown that case definitions current standards should be expanded to add symptoms that are not currently included, such as sores in the mouth, on the anal mucosa and simple ulcers,” said Chloe Orkin, PhD, of Queen Mary University of London, in a university press release.
13% required hospitalization
The study included clinical observations of 528 confirmed infections at 43 sites from April 27 to June 24 this year. The median incubation period is 7 days in this outbreak and the median age of a case-patient was 38 years. No deaths occurred, but 70 patients (13%) required hospitalization.
In the study, the authors share that many patients present to clinics and hospitals for management of pain or difficulty swallowing. Simple anal wounds have been recorded in several cases. One in 10 people had only one skin lesion in the genital area, and 15% had anal and/or rectal pain, a symptom not typically seen in other monkeypox outbreaks.
A total of 98% of documented cases were in gay or bisexual men, and although monkeypox is not an STI per se, the authors said 95% of documented transmissions occurred during sex. Seventy-five percent of cases are white and 41% are HIV-positive.
The study authors also reported that semen samples collected showed high amounts of virus, but said more research needed to be done to understand whether semen could actually transmit the virus.
Symptoms vary depending on sexual practice
In a second study, published as a Lancet preprint, similar conclusions were drawn based on the clinical presentations of 181 cases of monkeypox in Spain.
In this group, 91.7% of patients were men who have sex with men (MSM), and detailed sexual histories showed that those who reported receptive anal sex had longer incubation periods. (8 versus 6 days) and a higher rate of systemic symptoms before the rash (62.0% versus 27.6%) and had proctitis more frequently (32.9% versus 6.9%) than MSM who did not engage in this type of sexual practice.
“Due to the variability in clinical presentations, clinicians should have a low threshold for suspicion of disease,” the authors concluded. This report, unlike the NEJM study, has not yet been peer reviewed.
CDC makes it even easier to use Tpoxx
After multiple news outlets reported that doctors were filling out paperwork for 3-4 hours to prescribe the antiviral drug Tpoxx to patients with monkeypox, the Centers for Disease Control and Prevention (CDC) announced new plans to streamline access to the drug, which must be obtained from the National Stock Center and is only approved for smallpox cases.
Patient case photos and samples are no longer required, and paperwork has been reduced to four forms, which can be returned to the CDC once treatment is prescribed.
In a statement on the change in protocols, the Infectious Diseases Society of America (IDSA) said, “Reducing paperwork and other documentation required to get treatment is good news, and we anticipate it will accelerate the access to treatment. what remains is to streamline and expand access to treatment and collect data to better inform the use of tecovirimat.
The CDC is now reporting 270 more cases of monkeypox in 46 states, bringing the national total to 2,593.
In other US news, the White House released its research priorities for monkeypox. They include a better understanding of transmission, modeling and forecasting, vaccine efficacy and the development of new diagnostics, among others.
Madrid reports monkey pox in baby
Following a report yesterday of monkeypox in a child in Amsterdam, a baby in Madrid has also been diagnosed with the virus.
The child is 7 months old and contracted the virus at home, officials said. Both of her parents were infected; baby and parents isolated at home with mild illness.
Finally today, the European Medicines Agency approved monkeypox as an additional indication for Bavarian Nordic’s (Jynneos in the US) smallpox vaccine Imvanex.