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Monkeypox

Monkeypox

In August 2022, the U.S. declared monkeypox a public health emergency shortly after WHO named monkeypox a global health emergency. The outbreak is impacting patients, communities, pharmacists, and other health care professionals worldwide.
Under the PREP Act, HHS authorizes pharmacists, pharmacy interns and pharmacy technicians, as appropriate, to order and administer monkeypox vaccines and therapeutics, under certain conditions.
Hot Topic Webinar

    October 12th from 1:00 – 2:00pm ET

    Monkeypox: Considerations for Pharmacists

    Is monkeypox the next big superbug? Should I receive a vaccine for monkeypox? Many questions still exist, but one thing is for sure that pharmacists have been getting questions from patients about Monkeypox and some pharmacists have already started vaccinating patients, identifying patients with symptoms and dispensing treatment. This webinar will review all things monkeypox, including epidemiology, pathophysiology, signs and symptoms, transmission, treatment and vaccines and recommendations for use in preventing monkeypox.

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Intradermal Injection Technique Training

    This course reviews appropriate technique for administering intradermal injections.

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Background

The monkeypox virus is an orthopoxvirus and belongs to the same family of viruses as smallpox. Symptoms of monkeypox resemble those of smallpox, although they are less severe and seldom deadly.

For individuals at high risk of contracting monkeypox, taking steps to reduce transmission is key. Vaccination strategies are critical for prevention (pre-exposure prophylaxis) and following exposure (postexposure prophylaxis) to prevent the disease or reduce symptom severity. Testing and treatment are available for individuals who believe they may have contracted the virus.

Signs and symptoms

  • Lesions are a key characteristic of monkeypox. The lesions form a rash that may be limited to a few lesions or more widespread across the body. The lesions are commonly located on or near the genital regions and can present on other areas like the hands, feet, chest, face, or mouth. Rashes associated with monkeypox can initially appear like pimples or blisters and may be painful or itchy, and they will go through several stages, including scabs, before healing.
  • Other symptoms include fever, chills, swollen lymph nodes, exhaustion, muscle aches and backache, headache and respiratory symptoms (e.g., sore throat, nasal congestion, or cough).

Vaccines

CDC recommends vaccination for

  1. People who have been exposed to monkeypox
    • Administer within 4 days from the date of exposure to prevent onset of the disease.
    • If it is given within 4–14 days from the date of exposure, vaccination may reduce symptoms of disease but may not prevent the disease.
  2. People who may be more likely to get monkeypox, including
    • People who have been identified by public health officials as a contact of someone with monkeypox
    • People who are aware that at least one of their sexual partners in the past two weeks has been diagnosed with monkeypox
    • People who had multiple sexual partners in the past two weeks in an area known to have monkeypox infections
    • People whose jobs may expose them to orthopoxviruses

Two vaccines are available to protect against monkeypox:

  • JYNNEOS (preferred)
    • Under its EUA, Jynneos is recommended to be administered intradermally rather than intramuscularly or subcutaneously. APhA’s 15-minute course reviews appropriate techniques for administering intradermal injections.
  • ACAM2000

While many states already allow pharmacists the authority to administer the monkeypox vaccines, 12 states and the District of Columbia do not give clear authority or have barriers for pharmacists to administer these vaccines. APhA and several other national pharmacy associations are calling on the Department of Health and Human Services to grant this authority under the PREP Act.

Testing and treatment

Testing can be used to confirm a monkeypox infection if a rash is present. Pharmacists and pharmacy team members can encourage patients to reach out to their local health department if the patient believes they may have monkeypox or have been exposed to someone who has monkeypox.

Currently, there are no therapies approved for monkeypox infections. However, antivirals used to treat smallpox may be beneficial against monkeypox. Available treatments are largely reserved for individuals at risk of severe disease.

Pharmacists should be aware of the following treatment options:

Addressing stigma

It is important that pharmacists promote accurate and appropriate information to patients and use language that is medically appropriate and unbiased. To learn more about addressing the stigma around monkeypox, reference CDC’s resources on reducing stigma in monkeypox communication and community engagement and health equity guiding principles for inclusive communication.