Monkeypox 2022 Identify-Isolate-Inform: A 3I Tool for frontline clinicians for a zoonosis with escalating human community transmission

Abstract

Monkeypox 2022, a zoonotic virus similar to smallpox, presented as a rapidly escalating human outbreak with community transmission outside endemic regions of Africa. In just over one month of detection, confirmed cases escalated to over 3300, with reports of patients in at least 43 non-African nations. Mechanisms of transmission in animals and the reservoir host remain uncertain; spread from humans to wild or domestic animals risks the creation of new endemic zones. While initial cases were reported in men who have sex with men (MSM), monkeypox is not considered a sexually transmitted infection. Anyone with close contact with an infected person, aerosolized infectious material (e.g., from shaken bedsheets), or contact with fomites or infected animals is at risk. In humans, monkeypox typically presents with a non-specific prodromal phase followed by a classic rash with an incubation period of 5-21 days (usually 6-13 days). The prodrome may be subclinical, and the monkeypox virus may be transmissible from person-to-person before observed symptom onset. Most clinicians are unfamiliar with monkeypox. Information is rapidly evolving, producing an urgent need for immediate access to clear, concise, fact-based, and actionable information for frontline healthcare workers in prehospital, emergency departments/hospitals, and acute care/sexual transmitted infection clinics. This paper provides a novel Identify-Isolate-Inform (3I) Tool for the early detection and management of patients under investigation for monkeypox 2022. Patients are identified as potentially exposed or infected after an initial assessment of risk factors and signs/symptoms. Management of exposed patients includes consideration of quarantine and post-exposure prophylaxis with a smallpox vaccine. For infectious patients, providers must immediately don personal protective equipment and isolate patients. Healthcare workers must report suspected and confirmed cases in humans or animals to public health authorities. This innovative 3I Tool will assist emergency, primary care, and prehospital clinicians in effectively managing persons with suspected or confirmed monkeypox.

Keywords: 3I; Climate change; Clinical; Identify-isolate-inform; Monkeypox; Orthopox virus; Outbreak; Prodrome; Quarantine; Rash; Smallpox; Transmission; Worldwide; Zoonotic virus.

Fig. 1

Monkeypox 2022 Identify-Isolate-Inform (3I) Tool.

Fig. 2

A: Classic Presentation of Monkeypox (DRC, 1997). B: Monkeypox 2022 Clinical Presentation. Daily progression of lesions, which began 1-3 days after the prodrome (Italy, 2022). Pictures used with permission from Emanuele Nicastri, MD, PhD.

Fig. 3

A: Sample Infections in Monkeypox Differential Diagnosis. Pictures courtesy of Michael J. Burns, MD. B: Sample Sexually Transmitted Infections in Monkeypox Differential Diagnosis. Pictures courtesy of Michael J. Burns, MD, unless otherwise denoted.