On July 23, 2022 the World Health Organization declared a monkeypox outbreak a public health emergency of international concern. In 2002 the U.S. reported more than 18,000 cases of the disease, far surpassing other countries; Spain has the second-highest recorded case count with 6,459 confirmed.
On August 14, 2024 the WHO determined that an upsurge of mpox in the Democratic Republic of the Congo and a growing number of countries in Africa constitutes a public health emergency of international concern.
With cases expected to rise, what should providers look for if a call for suspected mpox comes in? In this article, learn the most common symptoms, how to identify any potential spots as mpox and how to care for patients in the prehospital setting.
What is mpox?
In November, 2022 the World Health Organization changed the name of the disease called Monkeypox to mpox after countries came to the WHO with reports of racism associated with monkeypox — a name established in 1970.
Mpox is a disease caused by the mpox virus, similar to smallpox, but more mild and less lethal, according to the CDC. It was first discovered in 1958 after an outbreak among a colony of research monkeys, with the first human case recorded in the Democratic Republic of the Congo in 1970.
Prior to the current outbreak, most infections outside of Africa were found in individuals who had recently traveled to places where the disease commonly occurs, which is why the current outbreak is concerning to public health experts.
What are the most common mpox symptoms?
Symptoms of mpox generally show up one to two weeks after infection and can vary by individual, as well as by what stage of the disease an individual is currently in. They include:
- Fever
- Headache
- Muscle aches and backache
- Swollen lymph nodes
- Chills
- Exhaustion
- A rash that looks like pimples or blisters on the face, inside the mouth or elsewhere, to include hands, feet, chest and genitals
While some individuals will experience the entire spectrum of symptoms, others may only experience the tell-tale rash.
A mpox rash can look different for each person, as well as at different stages of the disease cycle.
What do mpox blisters/rashes look like?
#Monkeypox can spread in different ways, such as person to person through direct contact with infectious rash, scabs, or body fluids, or respiratory droplets during prolonged, face-to-face contact or during intimate physical contact. Learn more: https://t.co/rLdwnOMvsZ. pic.twitter.com/575jW6XiB7
— CDC (@CDCgov) July 22, 2022
How does mpox spread?
The disease can be spread by direct contact with the rash or bodily fluids, as well as by respiratory droplets during prolonged face-to-face contact. The disease can also be transmitted during physical or sexual contact, and pregnant women are at risk of contracting the virus and passing it along to their fetus through the placenta.
Mpox can also spread indirectly if someone touches clothes or other items that had direct contact with the rash or bodily fluids.
Only individuals exhibiting symptoms can spread the disease to others, and a typical case usually takes two to four weeks to recover from. Experts warn that individuals are contagious until the rash has fully healed with a new layer of skin covering all blisters.
How is mpox treated?
There are no medical treatments for mpox specifically, but many antiviral drugs that are used to treat smallpox may be used to treat mpox, as well.
There are also two vaccines available in the U.S. – JYNNEOS and ACAM2000 – that may prevent individuals from becoming infected with the disease after being exposed to the virus. Individuals interested in the vaccine should contact their public health department.
What PPE should EMS providers wear for a suspected case of mpox?
In a recent article, “EMS Response to the Current Outbreak of Mpox,” the National Emerging Special Pathogens Training and Education Center recommends that EMS providers wear:
- N-95 respirator
- Gown
- Gloves
- Eye protection with face shields or goggles
How should EMS handle a suspected case of mpox?
The NETEC recommends a number of safeguards to prevent the spread of mpox in the event EMS needs to transport a patient by ambulance:
- Separate the driver compartment from the patient compartment
- Turn the exhaust fan on high in the patient compartment, if available
- Use the setting to introduce fresh air, versus recycling air within the rig
- Providers driving the ambulance should wear N-95s if the driver compartment cannot be closed off
- Limit how many providers interact with the patient
- Use PPE checklists for donning and doffing gear
- Clean and disinfect all surfaces with a hospital grade disinfectant following transport
- Dispose of mpox-contaminated waste as a Category A waste pathogen
Following a response, providers should monitor for signs and symptoms of illness for 21 days after a confirmed mpox transport.
This article, originally published on July 23, 2022, has been updated.
