Three months after the World Health Organization declared monkeypox a public health emergency, clinical presentations and vaccination strategies are evolving.and severe cases in immunocompromised persons.
"There's a lot of emphasis right now at CDC to try to understand these spreads, whether they are household or another contact. We know that some of the women have had sexual contact with men who were diagnosed with monkeypox," Rao said. However, healthcare workers are another group that was suspected to be at higher risk given close contact with patients, although there have only been three confirmed exposures. Sharps injuries from unroofed lesions are tied to some of those confirmed or suspected cases.
"We are working to try to understand the exposures that have occurred to those individuals and whether transmission has occurred person-to-person," Rao said.Also of concern are people with compromised immune systems owing to advanced HIV or organ or stem cell transplants. She said the main distinction is the extent of the lesions. Patients with AIDS and very low CD4 counts, for instance, are presenting with more lesions and have a longer course of illness."It's really important to understand someone's immune status and understand whether they are severely immunocompromised. If there is a concern that a person has monkeypox, also testing for HIV concurrently may be important.
There are also more cases of presentations with only single lesions, which were infrequent in past epidemics, she said."We have expanded the clinical descriptions to include presentations that involve isolated rectal presentation — individuals presenting solely with rectal pain as the primary manifestation of monkeypox — or presenting with a sore throat as the only manifestation," she said."Monkeypox is an incredible clinical mimic," Titanji said.