Local health care providers are on alert for monkeypox cases after Shelby County reported its first confirmed case on Monday, July 25, marking the 18th reported case in Tennessee. 

“I have not yet taken care of a patient with monkeypox and we do not have, at the present time, any patients with monkeypox hospitalized in the Methodist Le Bonheur Health Care system or seen in any of our clinics, but it’s something that we are monitoring very closely,” said Dr. Shirin Mazumder, an infectious disease physician at Methodist University Hospital. “And we want to bring awareness to the community because I anticipate that we will see more cases of monkeypox.”

Shelby County reports first case of monkeypox

Since the first U.S. case of monkeypox was confirmed on May 18, the number of cases nationwide has grown to 3,487, according to the Centers for Disease Control and Prevention. 

On July 23, the World Health Organization declared monkeypox a global health emergency. 

In response to that announcement, Xavier Becerra, the Biden administration’s secretary for the Department of Health and Human Services, tweeted: “Monkeypox has spread around the world and we will continue to take decisive action to tackle it both here in the U.S. and, working in concert with our partners abroad, globally.”

Dr. Stephen Threlkeld, an infectious disease expert at Baptist Memorial Hospital, said the monkeypox outbreak looks different from what the nation experienced during COVID-19 outbreaks. 

“The difference is that we know about this infection, it’s been here since 1950,” he said. “We’ve seen it in humans. We know a lot about it. We have a vaccine that prevents it. We even have some antiviral medications that are probably effective. We’re so far ahead with monkeypox, compared to where we were with COVID. But it makes it just truly a different type of problem altogether.”

Monkeypox is a rare disease in the same family of viruses as smallpox, but the symptoms are much milder than smallpox and the fatality rate is low. 

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Monkeypox was first reported in a colony of monkeys in the 1950s, and the first human case was identified in the 1970s in an infant in the Democratic Republic of the Congo. 

Mazumder said that although the virus is more commonly seen in Western and Central Africa, the U.S. has experienced occasional outbreaks, including one in 2003. 

“There was an outbreak of about 50 patients at that time that developed monkeypox after contact with prairie dogs,” she said. “So, there have been some smaller outbreaks here and there in areas where it’s not endemic. But what we’re seeing right now with the global outbreak is certainly much larger than what we’ve ever seen before.”

The last smallpox vaccine was administered in the U.S. in 1972. People ages 50 and older who were vaccinated as children have some protection against the virus. 

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“It’s not 100 percent, but there is still some protective activity,” Mazumder said. “And because of that, one of the preventative measures that we have available right now is one of the smallpox vaccines — it’s called Jynneos — that is being distributed to areas here in the United States to use as a post exposure prophylaxis. If someone does have contact with a known monkeypox exposure to prevent the illness from developing and to prevent the symptoms from becoming severe.”

Shelby County Health Department said there’s no recommendation for the vaccine, which is not available to the general public. 

Mazumder said the federal government is releasing doses of the vaccine, but those doses are headed to densely populated areas. 

“Right now most of the doses are going to areas that have a high number of cases, so a lot of the doses of the vaccine have been allocated to places like Chicago, New York, California, Florida, Chicago, Illinois, where a lot of the cases are occurring,” she said. “And so I think that with greater availability of the vaccine and with increased production of the vaccine, we will see more doses in other areas.”

The vaccine is the most effective form of prevention, but there is an antiviral medication called tecovirimat reserved for high-risk individuals at risk of developing severe complications. 

Among those who might qualify are the immunocompromised and individuals with a history of atopic dermatitis. 

“It has not been approved for monkeypox but it is being used for monkeypox because it is effective,” Mazumder said. “And because of that status, it’s considered an investigational new drug, and that’s relevant because physicians have to contact the CDC if they want access to this drug.”

In order to prescribe tecovirimat, health care practitioners must obtain informed consent from patients and fill out paperwork requesting the medication directly from the CDC. 

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Monkeypox is spread through close, direct contact, such as contact with infectious rash, scabs or body fluids and through respiratory secretions during prolonged face-to-face contact or intimate physical contact. 

With the current outbreak, the majority of cases are being reported in gay and bisexual men. 

“There was actually a recent report in the New England Journal of Medicine last week that reported on 500 cases, and 98% of those cases were in men who have sex with men,” Mazumder said. 

“But that being said, anyone is really at risk, and we want to make sure that everyone is aware because really anyone can be affected,” Mazumder said. “In the last few days, there have been reports of two children here in the United States that have developed monkeypox, and there are reports of women and also heterosexual individuals developing monkeypox.”

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Infection can also spread by touching items, such as clothing, linens and towels, that previously touched the infectious rash or body fluids. 

And pregnant individuals can spread the virus to their fetus through the placenta. 

“I think it’s important for people to be aware of what the symptoms consist of and how it is spread,” Mazumder said. “And we certainly recommend that anyone that has come in contact with a known case of monkeypox reach out to their physician and health care team, because they will be asked to monitor for symptoms very closely. 

Symptoms include fever, headache, muscle aches and exhaustion that occur before a rash develops. Rashes can be sores, bumps or fluid-filled bumps. 

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Many cases associated with this outbreak have reported very mild or no symptoms other than a rash. 

The virus can be transmitted from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. 

Only those who are symptomatic can spread the virus, and it can take as long as three weeks after exposure for symptoms to develop.

“And if anyone does develop symptoms, because we want to contain this and not spread this, that they reach out to their health care teams,”Mazumder said. “Because there is an isolation period that is necessary to prevent the spread to others if somebody does test positive for monkeypox.”

Monkeypox testing consists of swabbing the skin lesions, then sending the swabs to a testing company. 

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Mazumder said most testing companies are reporting a turnaround of three to four days. 

“We’re not just relying on the health department to perform testing. So, it has improved in terms of testing availability recently.”

Most people recover from monkeypox within two to four weeks. However, the disease can be serious in rare instances, particularly for immunocompromised individuals, children and those who are pregnant.

Threlkeld, the infectious disease expert at Baptist Memorial, reiterated that the health care system is far better prepared to treat the monkeypox cases that do occur. 

“Thankfully, it’s an entirely different level of risk, danger and understanding with monkeypox than what we had with COVID-19,” he said.