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Monkey POX management and Tecovirimat (TPOXX)

The global monkeypox outbreak has been declared a public health emergency of international concern by the WHO.

Monkeypox is a smallpox-like illness that can be accompanied by a range of significant medical complications. Monkeypox is less dangerous and contagious than smallpox. To date there are no standard or optimized guidelines for the clinical management of monkeypox

Photo credit: UK health security agency



Symptoms of monkeypox can include:

  • Fatigue
  • Fever
  • Headache
  • Muscle aches and backache
  • Swollen lymph nodes
  • Chills
  • A rash that can look like pimples or blisters that appears on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus.

 The virus can spread from person-to-person through:

  • direct contact with the infectious rash, scabs, or body fluids
  • respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex
  • touching items (such as clothing) that previously touched the infectious rash or body fluids
  • pregnant people can spread the virus to their fetus through the placenta

Infection is also possible from infected animals, either by contact or bitten by the infected animal 

Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox

Monkeypox can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks. People who do not have monkeypox symptoms cannot spread the virus to others.

Symptoms normally resolve in two-four weeks, treatment usually helps manage them. 

Treatment and Management:

Acetaminophen, Ibuprofen, famotidine, plus lidocaine cream and honey for the rash. 

Avoid scratching, Epsom salt warm bath can help with lesions on the body. Lidocaine and baking soda can help oral lesions. Saline and lidocaine/benadryl/maalox gargle helps oral lesions. 

Antivirals, such as tecovirimat (TPOXX) 200 mg capsules, may be recommended for people who are more likely to get severely ill, like patients with weakened immune systems



ADVERSE REACTIONS: Common adverse reactions in healthy adult subjects (≥ 2%) were headache, nausea, abdominal pain, and vomiting

How to obtain TPOXX

TPOXX is available through the Strategic National Stockpile. To request TPOXX, clinicians and pharmacists can contact their state/territorial health department or CDC (Emergency Operations Center 770-488-7100; Poxvirus@cdc.gov)


References: 

1. https://www.cdc.gov/poxvirus/monkeypox/symptoms.html

2. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/208627s000lbl.pdf

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