Human monkeypox disease has most commonly occurred following the consumption of an infected food source (such as primates or rodents in Africa) or from the direct contact with body fluids from an infected individual or animal. Our understanding of the histopathology of monkeypox virus infections in humans is limited but it is believed to be similar to that observed with smallpox. The incubation period of the disease following exposure to the onset of fever is about 12 days. The disease course progresses quickly once the patient becomes viraemic. Clinical signs include:

• Fever of >99.30F/37.40C
• Productive cough, sore throat, shortness of breath, headache, backache, malaise, chills and/or sweats, vomiting
• Generalized lymphadenopathy (not observed with smallpox) is more frequently observed in primary cases.
• Centralized or localized rash which evolves shortly after the onset of fever (macular, papular, vesicular then pustular).
• Hyper-pigmentation or scarring are uncommon following the desquamation of resolved lesions, and corneal lesions leading to blindness occur rarely
• Enanthem in the oral cavity may occur more often in primary than secondary cases
• Like smallpox infection, patients should be considered infectious until all scabs separate

Diagnostic Samples : Pharyngeal swab, scab material, serum.

Differential Diagnosis : varicella, molloscum contagiosum, measles.

Isolation/Decon Precautions

• Victim (overt attack): Undress, soap, and shower.
• Responder: Surveillance and containment (maintain minimum 17d or until all scabs separate)
• Environment: 0.5% bleach or hot soapy water
• Fomites: Exercise respiratory and skin contact precautions when handling infected bedding or clothing prior to laundering.
• Scabs separated from patients may remain infectious for several days or longer under ideal conditions.

Therapy

• Smallpox vaccine Give immediately, unless contraindicated, if previous vaccination was > 3y before. Even in previously unvaccinated individuals, effective if given within 3 to 4 days following exposure.
• Cidofovir (pediatric dosage is not yet established) possibly effective, at least prophylactically, based on in vitro and animal data. Cidofovir therapy is not FDA licensed for the treatment of Orthopoxvirus infections.
• Supportive therapy plus antibiotics to preclude secondary infection may be indicated.
• Steroid therapy may exacerbate the disease and is contraindicated for Orthopoxvirus infections.

Prophylaxis

• " Vaccination with the smallpox vaccine. A single dose (0.5ml) by scarification using a bifurcated needle in the upper left deltoid following the WHO guidance for smallpox vaccine administration is recommended: (http://www.who.int/emc/diseases/smallpox/factsheet.html)