How you can prepare for the monkeypox public health emergency

Even before the Aug. 4 declaration of a national public health emergency for monkeypox, the disease outbreak was on the radar of doctors of optometry.

“As health care professionals, we understand the societal public health concerns of these types of public health emergencies, and we should always know those who might be at risk and encourage them to continue their health care journey with proper vaccinations and follow-up with their primary care providers,” says Sue Lowe, O.D., chair of the AOA’s Clinical Content Development Committee.

In general, according to the Centers for Disease Control and Prevention, monkeypox symptoms include:

• A rash that goes through stages
• Fever
• Chills
• Swollen lymph nodes
• Exhaustion
• Muscle aches and backache
• Headache
• Respiratory symptoms (e.g., sore throat, nasal congestion or cough)

The CDC says that monkeypox can be spread from “person to person through direct contact with the infectious rash, scabs or body fluids. It also can be spread by respiratory secretions during prolonged, face-to-face contact or during intimate physical contact, such as kissing, cuddling or sex.”

Manifesting in the eye

In the journal Eye, an editorial titled “Ophthalmic Manifestations of Monkeypox Virus” refers to a number of conditions linked to the disease, including conjunctivitis, blepharitis, corneal ulcerations, focal conjunctival lesions, photophobia, keratitis and vision loss to varying degrees.

“We can treat these common ophthalmic manifestations of human monkeypox,” Dr. Lowe says, “allowing the patient to be more comfortable and preventing any late-stage corneal scarring or vision loss as the disease progresses.”

The incubation period of monkeypox is between 3-17 days and lasts from two to four weeks, the CDC says. Often patients present with lymphadenopathy, including pre-auricular nodes, which will differentiate human monkeypox from smallpox and chickenpox, Dr. Lowe says.

How should doctors of optometry proceed?

Be proactive: Dr. Lowe says, “Continue to collect excellent case histories and encourage vaccinations for any patient you may feel is at risk for exposure. Reiterate, as with the COVID vaccine, that the progression and severity of the disease can be greatly reduced with vaccination.”

Review the infection protocols in your practice, Dr. Lowe says, noting that the processes are still in place due to COVID-19. “Our protocols are the same as they were for COVID,” she says. “In our practice, we recommend masks to our patients but do not require them. Our technicians wear masks whether patients have theirs on or not.”

Communicate with patients, Dr. Lowe says. “Communicate with those patients who may have been exposed to the human monkeypox virus or at-risk for the virus—through either examination or their case history—and encourage them to be vaccinated,” she says. “We can identify a sequela of ophthalmic manifestations we must treat. We can tell them some of the ocular signs and visual symptoms that occur with monkeypox. That knowledge of ocular manifestations is often a great motivator for vaccination. Certainly, have them contact their primary care physician for treatment and vaccination.”

Past outbreaks, such as the Zika virus and COVID-19, have brought to the forefront public health and optometry’s critical role.

“It is important that we stay abreast of all the latest health care information,” Dr. Lowe says, “especially now that the Department of Health and Human Services has declared monkeypox a public health emergency.”

The public health declaration

Said White House National Monkeypox Response Coordinator Robert Fenton, “We are applying lessons learned from the battles we’ve fought—from COVID response to wildfires to measles and will tackle this outbreak with the urgency this moment demands.”

The unusual designation, preceded by last month’s announcement by the World Health Organization of a global health emergency, means that the virus represents a “significant risk to Americans” and triggers measures to contain monkeypox’s spread.

The announcement dovetailed with the Food and Drug Administration’s effort to produce fresh strategies to deliver vaccines to impacted U.S. communities. As of the announcement, the Department of Health and Human Services had shipped over a million doses of the JYNNEOS vaccine to states and jurisdictions with more on the way. Plans also called for increasing production of vaccine doses and expanding test capacity and availability, as well as outreach to at-risk communities.

Helpful resources

• Read CDC guidance on monkeypox for health care professionals.
• Access resources on infection control in the AOA’s EyeLearn Professional Development Hub.