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Monkeypox

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Village Medical, formerly Morrow Family Medicine, is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Village Medical one that will remind you of the way healthcare should be.  At Village Medical, we like to say we are “bringing the care back to healthcare!”  The practice has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Village Medical offers a comprehensive suite of primary care services including preventative care, treatment for illness and injury, and management of chronic conditions such as diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD) and kidney disease. Atlanta-area patients can learn more about the practice here.

Dr. Jim Morrow, Village Medical, and Host of To Your Health with Dr. Jim Morrow

Dr. Jim Morrow is the founder of Morrow Family Medicine. He has been a trailblazer and evangelist in healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

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The complete show archive of To Your Health with Dr. Jim Morrow addresses a wide range of health and wellness topics.

Dr. Morrow’s Show Notes

Monkeypox

• An ongoing outbreak of monkeypox was confirmed in May 2022,
  • beginning with a cluster of cases found in the United Kingdom.
  • The first recognized case was confirmed on 6 May 2022 in an individual with travel links to Nigeria (where the disease is endemic),
    • but it has been suggested that cases were already spreading in Europe in the previous months.
  • From 18 May onwards, cases were reported from an increasing number of countries and regions,
    • predominantly in Europe, but also in North and South America, Asia, North Africa, and Australia. 
    • 1,033 cases had been confirmed as of 6 June.

• The outbreak marked the first time the disease has spread widely outside Central and West Africa.
  • Cases have mainly but not exclusively been identified amongst men who have sex with men(MSM),
    • but health authorities emphasized that anyone can catch the disease, particularly if they have close contact with a symptomatic person.
    • Initial WHO assessments expressed the expectation of the outbreak to be contained,
      • and of low impact to the general population in affected countries.
    • A more recent statement acknowledged that undetected transmission had occurred for some time
      • and called for urgent action to reduce transmission.

Signs and symptoms

Monkeypox is an infectious viral disease that can occur in both humans and some other animals.

Early symptoms include

•  fever, headache, muscle pains, shivering, backache, and feeling extremely tired.

Typically there are swollen lymph nodes behind the ear, below the jaw, in the neck or in the groin.

This is followed by a rash that forms blisters and crusts over;

• most frequently in the mouth, on the face, hands and feet, genitals and eyes.

The time from exposure to onset of symptoms is on average 12 days; though ranges from 5-to-21 days.

• The duration of symptoms is typically two to four weeks.
• Cases may be severe, especially in children, pregnant women or people with suppressed immune systems.
• Three-quarters of affected people have lesions on the palms and soles,
  • more than two-thirds in the mouth,
  • a third on the genitals and one in five have lesions in the eyes.
  • They begin as small flat spots,
    • before becoming small bumps which then fill with at first clear fluid and then yellow fluid,
      • which subsequently burst and scab over.
      • There may be a few lesions or several thousand, sometimes merging to produce large lesions.

• In each part of the body affected,
  • the lesions evolve in the same stage.
  • It looks identical to the rash of smallpox.
    • The rash typically lasts around 10-days.
    • An affected person may remain unwell for two to four weeks.
    • After healing, the lesions may leave pale marks before becoming dark
• Limited person-to-person spread of infection has been reported in disease-endemic areas in Africa.
• Monkeypox may be spread
  • from handling bushmeat,
  • an animal bite or scratch,
  • body fluids,
  • contaminated objects,
  • or close contact with an infected person.
  • The virus normally circulates among certain rodents.
  • Diagnosis can be confirmed by testing a lesion for the virus’s DNA.
    • The disease can appear similar to chickenpox.

• The smallpox vaccine can prevent infection with 85% effectiveness,
  • but smallpox vaccination stopped in most parts of the world in the late 1970s,
    • resulting in very little immunity against monkeypox.
    • In 2019, a monkeypox vaccine, Jynneos, was approved for adults in the United States.
    • The current standard for treatment is tecovirimat, an antiviral that is specifically intended to treat infections with orthopoxviruses such as smallpox and monkeypox.
    • It is approved for the treatment of monkeypox in the European Union and the United States.
      • Cidofovir or brincidofovir may also be useful.
      • Reports of the risk of death, if untreated, are as high as 10% to 11% in the Congo Basin(Central African) clade of monkeypox.

• Monkeypox was first identified in 1958 among laboratory monkeys in Copenhagen, Denmark.
  • Monkeys are not a natural reservoir of the virus.
  • The first cases in humans were found in 1970 in the Democratic Republic of the Congo.
  • An outbreak that occurred in the United States in 2003 was traced to a pet store where rodents imported from Ghana were sold.
    • The 2022 monkeypox outbreak represents the first incidence of widespread community transmission outside of Africa,
      • which began in the United Kingdom in May 2022,
      • with subsequent cases confirmed in at least 20 countries, in Europe, North America, South America, Asia, North Africa, and Australia

Complications

• Complications include secondary infections, pneumonia, sepsis, encephalitis, and loss of vision if severe eye infection.
  • If infection occurs during pregnancy, stillbirth or birth defects may occur.
  • The disease may be milder in people vaccinated against smallpox in childhood.

Causes

• Monkeypox in both humans and animals is caused by infection with the monkeypox virus– a double-stranded DNA virus.
  • The virus is found mainly in tropical rainforest regions of Central and West Africa.
  • The virus is split into Congo Basin and West African clades, matching the geographical areas.

• Most human cases of monkeypox are acquired from an infected animal,
  • though the route of transmission remains unknown.
  • The virus is thought to enter the body through broken skin, the respiratory tract, or the mucous membranes of the eyes, nose, or mouth.
  • Once a human is infected, transmission to other humans is common, with family members and hospital staff at particularly high risk of infection.

• Human-to-human transmission is thought to occur primarily through close contact with an infected subject.
  • There are indications that transmission occurs during sexual intercourse.

• Monkeypox symptoms tend to begin 5 to 21 days after infection.

Prevention

• Vaccination against smallpox is assumed to provide protection against human monkeypox infection
  • because they are closely related viruses
    • and the vaccine protects animals from experimental lethal monkeypox challenges.
    • This has not been conclusively demonstrated in humans because routine smallpox vaccination was discontinued following the eradication of smallpox.

Treatment

• In the European Union and the United States, tecovirimat is approved for the treatment of several poxviruses, including monkeypox.
  • Best Practice recommends tecovirimat or the smallpox treatment brincidofovir as the first line antiviral treatment if required,
    • alongside supportive care(including antipyretic, fluid balance and oxygenation).
    • Empirical antibiotic therapy or aciclovir may be used if secondary bacterial or varicella-zoster infection is suspected, respectively.