The monkeypox outbreak now seems to be spreading beyond countries where it is endemic. Although there are still many questions, we are learning lessons that will inform us about communicable diseases and sustained immunity from vaccination.
Monkeypox cases have been on the rise, even though smallpox was declared to be eradicated in 1980. This disease is a close relative of smallpox, and the smallpox vaccine also prevents monkeypox infection. Smallpox vaccination was deemed unnecessary about 40 years ago, after about 80% of the populations were vaccinated. Today, that figure is only about 30%.1 So, it seems we have a growing population of people who may be susceptible to both smallpox and monkeypox!
The first US case of monkeypox was diagnosed in May 2022 in Boston at Massachusetts General Hospital. A patient arrived with vague symptoms and a rash. The sequence of events that unfolded is a lesson to all providers. Our generation of health care providers has never seen smallpox or followed the course of the disease. The rash and navel-like blisters may be something seen only in textbooks. The team at Massachusetts General Hospital, led by infectious disease specialist Dr Nesli Basgoz, had a puzzle to solve. Aware of the possibility of a new, exotic, or novel disease such as COVID-19, the team went to work, networking with local and global public health agencies-while trying antibiotics and antiviral therapies.2
Dr Basgoz knows that to understand the whole body we must think broadly about infections that take many forms, viral, bacterial, and parasitic. Autoimmune or allergic reactions are also considered. The team would ask question after question, about travel, contacts, exposures, food, medications, and work and living situations. Basgoz guided her team diligently, reminding them, "We must listen deeply to our patients. The detective work really starts with listening very carefully to what people say and letting them tell their stories." She said, "Those stories include the many ways a patient might have been exposed to an infectious agent. Does their dog lick their face? Do they eat raw seafood? Where have they traveled?"2
COVID-19 improved disease surveillance and strengthen our awareness. Dr Bosgoz and her team reminded us to listen deeply to our patients.
Kathleen Ahern Gould, PhD, RN
Wolters Kluwer Health
Duxbury, Massachusetts
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