August 3, 2022



Monkeypox cases on the rise


Infectious disease specialist talks about risks


While Covid-19 is still present and spreading, Monkeypox is quickly becoming the most discussed disease in United States. However, much of the information being passed around may not be the most accurate. Dr. Brian Metzger, medical director of infectious diseases for all of the St. David's HealthCare system, spoke with the Sun to share information on the virus. 

“There has been a definite rise in cases [in the last two weeks],” he said, though this may be due to increased testing and awareness of the virus. “Austin has seen cases, Travis County has definitely seen cases.”

Monkeypox is a cousin to Smallpox, and presents with initial symptoms of a viral infection — fever, body aches and headaches. 

Usually after the first one-to-two days of these symptoms, a tell-tale rash will appear. This rash presents at first as small bumps on the skin. After a few days, these evolve into larger, raised nodules that may appear to have fluid in them. After a few more days, the bumps will generally have grown into larger pustules that can take a few weeks to scab over. 

“The rash can pop up anywhere,” Dr. Metzger said. “The trunk, extremities, palms, soles [of feet], and unfortunately, a lot of the time on the genitalia and anus, which can be very painful.”

He said there have been definite variances in the way the rash presents, so it is always best to talk with a health care provider if any strange rashes have presented on the body. 

While the rash is painful and tedious, the good thing about Monkeypox is that it is rarely fatal. 

“Fortunately, it's not an illness that results in a high level of mortality,” Dr. Metzger said. “However, it does have quite high morbidity — it’s pretty uncomfortable for anyone who acquires it. 

“The rash, sometimes due to location, can cause a considerable amount of pain. Good news is it does not lead to serious illness or death in the vast majority of cases, but it is still very uncomfy for those couple of weeks.” 

The rash may be closely tied to this virus, but Monkeypox is in no way related to Chickenpox. Monkeypox is an “orthopox” virus which affects vertebrates. It’s in the same group as the Smallpox virus, but it does not cause the more serious illness.

Dr. Metzger said that humans were accidental hosts of the illness, and the current theory is that it was passed from rodents. Previously, it had only been seen in certain central and western countries in Africa. 

It is because of its close relation to Smallpox that the treatment of Monkeypox already has a leg up. 

“Unlike what we went through with Covid, we have a head start with this in that we have a vaccine,” Dr. Metzger said. “The problem is there aren't many of those [available]. It will take some time to ramp those up and also the treatment.”

For the prevention of Monkeypox, he said the most effective vaccine has been the Smallpox vaccine. These were held in the Strategic National Stockpile in case of a biowarfare incident or something similar to the current Monkeypox outbreak were to take place. The issue, he said, is that there were not many of them, so mass production may take some time. 

For treatment, he said the use of the antiviral TPOXX has been observed to shorten the duration of Monkeypox symptoms. The qualifiers for the use of this, however, can be restrictive. 

When it comes to who is at risk of contracting the virus, Dr. Metzger said everyone is equally vulnerable. 

“While it’s predominantly being seen right now in men who have sex with men, that is not the only group that is at risk,” he said. “We’re all at risk because it is spread through direct contact. I don’t expect it to be isolated to any one group of people for very long.” 

The virus spreads through skin-to-skin contact, which draws into debate the popular theory that this is a sexually transmitted infection. He said it has led to discussions in academic circles and is a controversial topic.

“We don’t know if it is directly transmitted sexually in the way we would typically think — through bodily fluid,” Dr. Metzger said. “It’s definitely more transmissable through sex because of close skin-to-skin contact, but not exclusive. Just a particularly high risk right now.” 

He said it is unknown if it can be passed through bodily fluids the way it is passed by skin contact, but noted that the use of condoms would not be effective to protect against the virus. 

With cases continuing to be seen and recorded, Dr. Metzger said the most important thing the public can do is to stay vigilant of their own personal health — be wary of any fever, muscle aches, swollen lymph nodes and headaches, and get tested even if the rash has not yet appeared. 

“We have a lot of tests available right now,” he said. “They can be ordered from offices and sent to a commercial lab, which will get results pretty quickly.” 

If any of these symptoms appear, especially if accompanied by a rash within 1-3 days, he urges residents to talk to their doctors and self-isolate to cut down on transmissions. 

“That’s the most important thing we can do right now,” he said. “It will be interesting to see how [cases] trend over the next few weeks.”