Monkeypox information for HIV+ folks

Table of Contents: Symptoms Spread Risks Exposure Vaccine Q & A

The following is a summary of what we know today about monkeypox and what its spread mean for HIV folks in the San Diego area. We’ll try and answer some of the more common questions and offer some clear information that people need to know.

What is Monkeypox?

According to the CDC, “Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox virus is part of the same family of viruses as the virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder, and monkeypox is rarely fatal. Monkeypox is not related to chickenpox.

Monkeypox was discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. Despite being named “monkeypox,” the source of the disease remains unknown. However, African rodents and non-human primates (like monkeys) might harbor the virus and infect people.

 

The first human case of monkeypox was recorded in 1970. Prior to the 2022 outbreak, monkeypox had been reported in people in several central and western African countries. Previously, almost all monkeypox cases in people outside of Africa were linked to international travel to countries where the disease commonly occurs or through imported animals. These cases occurred on multiple continents.”

The CDC web site is: https://www.cdc.gov/poxvirus/monkeypox/index.html

 

What are the symptoms of Monkeypox?

The CDC states that “People with monkeypox get a rash that may be located on or near the genitals (penis, testicles, labia, and vagina) or anus (butthole) and could be on other areas like the hands, feet, chest, face, or mouth.

  • The rash will go through several stages, including scabs, before healing.
  • The rash can initially look like pimples or blisters and may be painful or itchy.
  • Other symptoms of monkeypox can include:
  • Fever
  • Chills
  • Swollen lymph nodes
  • Exhaustion
  • Muscle aches and backache
  • Headache
  • Respiratory symptoms (e.g. sore throat, nasal congestion, or cough)

You may experience all or only a few symptoms

  • Sometimes, people have flu-like symptoms before the rash.
  • Some people get a rash first, followed by other symptoms.
  • Others only experience a rash.”
  • While Monkeypox has been fatal in only a very few isolated cases, it is generally not life threatening.
  • The blisters can reportedly be very painful, especially when located on sensitive areas (eyes, penis, anus). In some cases strong pain medication has been required.

How is Monkeypox spread?

Monkeypox is spread most effectively through sustained contact with the blisters or rash, allowing the virus to enter an uninfected person. It can be spread through extended contact with infected clothing or surfaces.

While it can be spread via quick casual contact with fluids, it is most likely to be transmitted through sustained contact rather than brief contact. For example, it is unlikely to be transmitted through a quick brush past someone in a bar, but continually rubbing against someone in a crowded bar over a longer period of time increases the odds or infection.

While Monkeypox is not a classic STD, having sex would normally include sustained skin to skin contact, maing it a very effective mode of transmission. Much of the spread in the gay community is thought to be tied to networks of people having sex with each other.

Here is a chart that illustrates some of the risk levels of various modes of transmission:

How can I reduce my risk?

Take the following three steps to prevent getting monkeypox:

  1. Avoid close, skin-to-skin or face to face (think fluid transmission) contact with people who have a rash that looks like monkeypox.

    • Do not touch the rash or scabs of a person with monkeypox.
    • Do not kiss, hug, cuddle or have sex with someone with monkeypox.
    • Look before you touch, the person you are with may not be aware yet.
  1. Avoid contact with objects and materials that a person with monkeypox has used.

    • Do not share eating utensils or cups with a person with monkeypox.
    • Do not handle or touch the bedding, towels, or clothing of a person with monkeypox.
  1. Wash your hands (and other body parts that contact others) often.

    • Wash your hands and other body parts potentially exposed often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom or have sex.
    • Wash sex toys, bedding, towels, clothing or other matierial that may have been exposed before reusing these objects.

Get vaccinated.

While those born before 1973 in the U.S have most likely received the smallpox vaccine, protection probably still exists but may have waned. This is particularly true of those with weakened immune systems. Current guidance given limited knowledge is to get vaccinated with a current vaccine.

What about those with HIV?

Of those people diagnosed with Monkeypox whose HIV status is known, a disproportionately high number (28-51%) are HIV+, mostly with lower CD4 counts. This is of concern and has driven vaccine prioritization to focus on those with weakened immune systems as the availability of vaccine is limited at this time.

It is recommended that HIV+ folks with lower CD4 counts (<200) refrain from risky behaviors until a sufficient dose of vaccine is administered and has reached peak effectiveness. See the chart below for information on timing:

What do I do if I think I have been exposed or have symptoms?

Call your healthcare provider.

If you do not have one, call the county help line at 211. They can guide you through the proper steps to take. The county can also provide supportive housing during any quarantine period.

Isolate until such time as you are cleared if you have active symptoms. The course of the disease can be up to 4 weeks.

There is treatment available for Monkeypox as this is not a new virus, unlike COVID. Your healthcare provider can make this available if your condition warrants.

Q&A

If you have questions we have not addressed, send me an   and we will work to get answers.

Q: Where can I find information about vaccine availability in San Diego?

The San Diego Health and Human Services Agency has a website that contains all of the latest information https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/human-monkeypox/

In addition, they provide resources through the 211 call center.

Q: Can people other than members of the LGBTQ+ community contract Monkeypox?

Yes. This is a virus that is transmitted by physical contact. So far, most of those infected have been gay men having sex with men and has been confined to those neworks of people. Anyone who comes in contact with an infected person and experienced prolonged contact with reservoirs of virus can be infected.

REFERENCES
ADAP Explained
Covered California Insurance
OA-HIPP Insurance
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