Monkeypox, Misinformation, and a Growing Public Health Emergency | What Nurses Need to Know

Meg Lambrych, BSN, RN

In high school or college, you may have shared in the very common, and unpleasant, experience of contracting a disease called mono (short for infectious mononucleosis) often dubbed ‘the kissing disease.’ Mono is a contagious disease usually caused by the Epstein-Barr virus. When I caught Mono at the age of seventeen, I remember the looks I received from my fellow students and even some teachers. The subtle implication was clear, “What have you been doing?”

As a nurse with training in epidemiology, I now know that mono can be spread through things like kissing and sex, but it can also be spread through the sharing of food or drinks, silverware, or even children’s toys. Even though I understand that now, I’ll never forget the way the stigma around the disease, and the treatment I received, made me feel.

Today we face a new public health challenge, one that carries a similar stigma, with the rapid rise of monkeypox.

An Evolving Crisis

Monkeypox is an infection caused by the monkeypox virus (also known as orthopoxvirus), which is in the same viral family as smallpox. Monkeypox causes a painful rash and flu-like symptoms¹ and has typically been found in central and western African countries.

Worldwide, as of August 1, 2022, there have been 23,620 confirmed cases of monkeypox globally, in 80 different countries². There have been 5,811 confirmed cases in the United States³, and overwhelmingly this outbreak has affected men who have sex with men, most frequently those with multiple or anonymous partners. On July 23, 2022, the World Health Organization (WHO) declared monkeypox a public health emergency⁴, a significant action that signals a serious global threat. The Biden administration, on Thursday, August 4, officially declared monkeypox a public health emergency, a move that’s aimed at freeing up emergency funding and improving distribution of vaccines and treatments.

Regardless of our area of practice, nurses are tasked with battling the misinformation/disinformation that inevitably arises with a new health threat. Dealing with monkeypox may then jeopardize the care of an already marginalized community with good reason not to trust us. We must acknowledge that men who have sex with men (MSM) have been disproportionately harmed by the United States (US) government's inexcusable lack of action during the HIV crisis⁵, and that understandable mistrust lingers.

A Few Essential Truths

Monkeypox is NOT a sexually transmitted infection (STI), it’s a bit more complicated than that. According to the CDC⁶, it is spread through:

direct contact with an 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 objects or fabrics (such as clothing or linens) that previously touched the rash or body fluids of someone infected with monkeypox
being scratched or bitten by an infected animal
While the current outbreak in the US predominantly affects men who have sex with men (including gay, bisexual, transgender, non-binary, and gender non-conforming communities, among others), transmission has nothing to do with any inherent qualities or traits of this patient population.

The fact that the virus is spread mainly through prolonged direct contact or through respiratory droplets means that it is more likely to first circulate between members of close-knit communities such as these, as well as members of the same household. Anyone can get monkeypox, regardless of gender identity or sexual orientation, and unless we take steps to provide evidence-based and compassionate information to all of our patients, transmission is likely to spread beyond these initially identified populations.

The Nurse’s Role

When a disease affects a marginalized community like men who have sex with men (MSM), it is inevitable that politics can, and will, interfere with patient care. It is our job as nurses, to fight these forces wherever we encounter them.

Nurses are the single largest group of healthcare workers in America, who have been consistently ranked as the most trusted profession⁷. We are at the center of the care team. We spend the most time with patients and have the greatest opportunity to impact their education in a positive and supportive way. We also interact with other members of the care team most frequently and thus have opportunities to educate them on issues faced by the LGBTQIA+ community. Nurses can explain why it is essential that we utilize the proper language and are up to date on the latest evidence regarding care for these communities. Nurses can model correct and appropriate management of patient care, ensuring that we do not contribute to stigmatization of LGBTQIA+ groups⁸.

Tips for Communicating Without Stigma

DO

1. Introduce yourself using your pronouns to all of your patients. This normalizes the practice and creates a welcoming environment for others to do the same.

2. Provide evidence-based information regarding Monkeypox transmission, prevention, and treatment. Safe sex practices are still important too!

DON’T

1. Make assumptions about gender, identity, lifestyle, or patient history. When necessary, ask direct, clear questions and explain why the care team needs that information.

2. Don’t be lax with your personal protective equipment! It is human nature to lower our standards the more comfortable we get with a new disease state. I know it’s exhausting (and sweaty) to gown up again and again, but wear your equipment the right way. EVERY time. It is in the best interest of yourself, your family, and your patients. This is not a disease you want to catch or transmit.

Vaccines and Treatment

Unlike three years ago, when we first confronted the Covid-19 virus, we have effective vaccines and viral treatments⁹ available to fight monkeypox.

As of now, two vaccines exist to prevent smallpox and monkeypox. The newest vaccine, Jynneos, is currently being distributed¹⁰ across the US in an effort to combat the spread of the virus, and protect those who are most at risk.

While there are no medications to treat monkeypox specifically, there are multiple antiviral medications that exist to treat smallpox (its viral cousin), such as Tecovirimat (TPOXX, ST-246), that we can use to treat those with a monkeypox infection and who meet other clinical criteria. Criteria that will likely change¹¹ as we learn more about the progression of this disease, cope with supply chain barriers, and increase production, etc.

Nursing Pearls

Nurses are exhausted. After three consecutive years of living with a novel virus, and resulting pandemic, our weariness is understandable. The monkeypox crisis is striking long after the public has grown tired of public health interventions, or outright rejected them from the beginning, and apathy is a natural endpoint for the burnout that many of us feel.

As nurses, we must dig deep and commit to providing two things to our patients:

1. Accurate, evidence-based information regarding disease prevention and available treatments. There are vaccines, treatments, and hope.

2. Culturally competent care. Now more than ever, our patients depend on us to cut through the noise, and provide them with compassionate care that acknowledges their identity, history, and background fully.

Armed with good information, effective vaccines, and treatments, we can meet this crisis head-on and protect the communities most affected.

References

1. CDC: About Monkeypox

2. CDC: 2022 Monkeypox Outbreak Global Map

3. CDC: 2022 U.S. Map & Case Count

4. WHO Declares Global Health Emergency Over Monkeypox Outbreak

5. The LGBTQ Health Clinic That faced a Dark Truth About the AIDS Crisis

6. CDC: How it Spreads

7. Gallup: Nurses are Most Trusted Profession for 20th Straight Year

8. Reducing Stigma in Monkeypox Communication and Community Engagement

9. CDC: Treatment Information for Healthcare Professionals

10. U.S. to Release 786,000 Additional Monkeypox Vaccine doses as Outbreak Spreads