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Human monkeypox: diagnosis and management

On 23 July 2022, the World Health Organisation (WHO) declared monkeypox a public health emergency of international concern. By 15 December, over 82 500 confirmed cases of human monkeypox across 110 countries had been identified, with 98% of cases emerging in 103 non-endemic countries. Notably, most patients present without clear epidemiological links and non-specific clinical characteristics. We offer an overview of human monkeypox and of the assessment, diagnosis, and management of confirmed cases and at-risk patients based primarily on guidance from the WHO and the UK Health Security Agency (UKHSA).

What is monkeypox?

The monkeypox virus is a zoonotic orthopoxvirus related to the variola virus that causes smallpox. Its main reservoirs are rodents, apes, and monkeys. It was first described in humans in 1970 in the Democratic Republic of Congo (DRC). The following 11 countries have historically reported cases of monkeypox (that is, considered endemic for monkeypox virus): Benin, Cameroon, Central African Republic, Congo, Côte d’Ivoire, DRC, Gabon, Liberia, Nigeria, Sierra Leone, and South Sudan. However, there are insufficient data to delineate the differences between endemic and non-endemic regions. Further, the mode of transmission, presentation, and management during the current outbreak is similar in all regions.

Key management points

  • Consider coinfections with monkeypox and other sexually transmitted infections among patients presenting with an acute rash or skin lesions and systemic symptoms
  • While it is safe to manage monkeypox patients virtually, they may need advice to maintain infection control measures and interventions to manage complications
  • A specialist infectious disease unit with access to novel antivirals such as tecovirimat and cidofovir should manage high risk patients
  • Healthcare workers should be aware of the stigma surrounding monkeypox, which may result in reduced health-seeking behaviours; healthcare staff should screen patients sensitively, using inclusive language to avoid alienating patients

Read more in our article in the British Medical Journal.

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