Monkeypox: An Overview and the Role of Radiologic Technologists and Sonographers in the U.S.
Infection Prevention Measures and Control (IPC Measures) in the Radiology Department for COVID-19
- Introduction
- Understanding Monkeypox: A Brief Overview
- The Role of Radiologic Technologists in Monkeypox Diagnosis and Management
- The Role of Sonographers in Monkeypox Diagnosis and Management
- Collaboration of Rad Techs and Sonographers with Other Healthcare Professionals
- Training and Education
- The Future Role of Radiologic Technologists and Sonographers in Emerging Infectious Diseases
- Conclusion
Introduction
Monkeypox, a rare but potentially serious viral illness, has emerged as a significant public health concern in recent years, especially with its spread beyond endemic regions in Central and West Africa to other parts of the world, including the United States. Healthcare professionals, radiologic technologists, and sonographers are critical for diagnosing, managing, and containing monkeypox. This article provides a comprehensive briefing on monkeypox and highlights the vital contributions of radiologic technologists and sonographers in the U.S. healthcare system’s response to this emerging threat.
Understanding Monkeypox: A Brief Overview
Monkeypox, caused by the monkeypox Avirus, is a member of the Orthopoxvirus genus, which also includes the variola virus (causing smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus. Monkeypox was first identified in 1958 in monkeys kept for research, hence the name. The first human case was recorded in 1970 in the Democratic Republic of the Congo.
Monkeypox is zoonotic, meaning it can be transmitted from animals to humans, with rodents being the primary reservoir. Human-to-human transmission occurs through close contact with respiratory secretions, skin lesions of an infected person, or recently contaminated objects. The virus can also be transmitted via respiratory droplets during prolonged face-to-face contact.
The incubation period typically ranges from 6 to 13 days, though it can vary from 5 to 21 days. The disease presents with fever, headache, muscle aches, and lymphadenopathy, followed by a rash that progresses from macules to papules, vesicles, pustules, and scabs. The rash often starts on the face and spreads to other parts of the body. Monkeypox is usually self-limiting, with symptoms lasting 2 to 4 weeks, but severe cases can occur, particularly in immunocompromised individuals, children, and pregnant women.
- Monkeypox in the United States
- 2024 Mpox Outbreak: Global Impact and U.S. Response
Although monkeypox was initially confined to Central and West Africa, sporadic outbreaks have been reported in other regions due to international travel and the global trade of exotic pets. The United States experienced its first monkeypox outbreak in 2003, linked to imported African rodents. More recently, in 2021 and 2022, cases were reported in travelers returning from Nigeria.
In 2022, the World Health Organization (WHO) declared the monkeypox outbreak a Public Health Emergency of International Concern (PHEIC), following a significant increase in cases across multiple countries, including the United States. This declaration underscored the need for a coordinated global response, including enhanced surveillance, public health measures, and research into vaccines and treatments.
As of 2024, the global mpox (formerly known as monkeypox) situation remains concerning, with over 102,000 confirmed cases reported across 121 countries since the outbreak began in 2022. The disease continues to primarily affect countries in Africa, where over 20,000 new cases have been reported this year alone, particularly from 13 African Union Member States. The case fatality rate (CFR) in these regions is around 2.9%, with over 500 deaths reported. Efforts to control the outbreak are ongoing, but challenges remain, especially regarding vaccine distribution, which has been slow and inadequate in affected areas.
As of September 2024, the United States has reported over 30,000 cases of mpox (formerly known as monkeypox) since the 2022 outbreak began. The majority of these cases have occurred among individuals who were either unvaccinated or had received only one dose of the JYNNEOS vaccine. The Centers for Disease Control and Prevention (CDC) continues to update case data monthly and stresses the importance of completing the two-dose JYNNEOS vaccination regimen for optimal protection.
While the mpox situation in the U.S. has stabilized compared to the peak of the outbreak in 2022, vigilance remains essential. Domestic measures have focused on preventing resurgence, and vaccination campaigns, along with public health interventions, have been crucial in curbing the spread. The U.S. has also donated vaccines to assist affected countries. Public health officials are continuing to monitor the situation closely, particularly among vulnerable populations. The global response, including vaccine donations and research into effective treatments, is vital for managing the ongoing threat.
The Role of Radiologic Technologists in Monkeypox Diagnosis and Management
Radiologic technologists are essential members of the healthcare system, responsible for performing diagnostic imaging procedures that assist in diagnosing and managing various diseases, including infectious diseases like monkeypox. While the diagnosis of monkeypox primarily relies on clinical presentation and laboratory testing, imaging plays a supportive role in assessing complications and guiding treatment.
- Imaging in Monkeypox:
Although monkeypox primarily affects the skin and mucous membranes, severe cases can lead to complications involving the lungs, brain, and other organs. Radiologic imaging, including chest X-rays, computed tomography (CT), and magnetic resonance imaging (MRI), can be instrumental in identifying and evaluating these complications.
- Chest X-rays and CT Scans: In patients with monkeypox who present with respiratory symptoms, chest imaging may be necessary to assess for pneumonia, a known complication of severe monkeypox. Radiologic technologists are responsible for obtaining high-quality images that can reveal patterns of lung involvement, such as interstitial infiltrates or consolidation, which may indicate viral pneumonia or secondary bacterial infection.
- MRI Scans: In cases where monkeypox leads to neurological complications, such as encephalitis or myelitis, MRI is the preferred imaging modality. Radiologic technologists skilled in MRI can help detect brain lesions, edema, or other abnormalities that may require urgent medical intervention.
- Infection Control Practices:
- Patient Care and Communication:
Radiologic technologists must adhere to stringent infection control protocols to prevent the spread of monkeypox within healthcare settings. Given the contagious nature of the virus, technologists should be trained in the proper use of personal protective equipment (PPE), including gloves, gowns, masks, and eye protection. They should also be aware of the need for meticulous cleaning and disinfection of imaging equipment and surfaces after each patient.
Effective patient communication is crucial, especially when dealing with infectious diseases like monkeypox. Radiologic technologists should be prepared to explain the imaging procedures, address patient concerns, and provide reassurance. They must also be sensitive to the potential stigma associated with monkeypox and treat all patients with compassion and respect.
The Role of Sonographers in Monkeypox Diagnosis and Management
Sonographers, who specialize in using ultrasound technology to create images of the body’s internal structures, also play a role in the care of patients with monkeypox. While ultrasound is not typically used for diagnosing monkeypox, it can be valuable in assessing complications and guiding treatment in certain situations.
- Ultrasound in Assessing Lymphadenopathy:
- Soft Tissue Ultrasound:
- Training and Education:
One of the hallmark features of monkeypox is lymphadenopathy, which can occur in the cervical, axillary, or inguinal regions. Sonographers can use ultrasound to evaluate the size, shape, and characteristics of affected lymph nodes, helping to distinguish between reactive lymphadenopathy and other causes of lymph node enlargement. Ultrasound-guided fine-needle aspiration (FNA) may also be performed to obtain samples for laboratory testing.
Cracolici, Vincent & Gurbuxani, Sandeep & Ginat, Daniel. (2019). Head and Neck Sinus Histiocytosis with Massive Lymphadenopathy Radiology–Pathology Correlation. Head and Neck Pathology. 13. 10.1007/s12105-018-0941-3.
In cases where monkeypox leads to secondary bacterial infections, such as abscesses or cellulitis, ultrasound can be a valuable tool for assessing soft tissue involvement. Sonographers can identify fluid collections, determine the extent of infection, and assist in ultrasound-guided drainage procedures.
Sonographers should be educated about monkeypox, including its clinical presentation and potential complications. This will enable them to recognize cases where ultrasound may be beneficial and perform the necessary imaging procedures with adequate confidence and precision.
Collaboration of Rad Techs and Sonographers with Other Healthcare Professionals
Radiologic technologists and sonographers do not work in isolation; their contributions are part of a larger, multidisciplinary effort to manage monkeypox. Collaboration with other healthcare professionals, including physicians, nurses, infection control specialists, and laboratory personnel, is essential to ensure comprehensive care for patients with monkeypox.
- Coordinated Care:
- Reporting Unusual Findings:
In the context of monkeypox, coordinated care involves timely communication and collaboration between radiologic technologists, sonographers, and different healthcare professionals. For example, technologists and sonographers may work closely with infectious disease specialists to ensure that imaging findings are promptly communicated and that patients receive appropriate treatment based on those findings.
Radiologic technologists and sonographers can also contribute to public health efforts by reporting unusual findings or reoccurrences in imaging studies that may indicate an emerging outbreak of monkeypox. Early detection and reporting are critical for initiating public health interventions and preventing further spread of the virus.
Training and Education
Given the evolving nature of infectious diseases like monkeypox, ongoing training, and education are essential for radiologic technologists and sonographers. Staying informed about the latest developments in monkeypox diagnosis, management, and infection control practices will ultimately enable these professionals to provide an elevated patient care service.
- Infection Control Training:
- Continuing Education in Imaging Techniques:
Radiologic technologists and sonographers should receive regular training on infection control practices specific to monkeypox and other infectious diseases. This training should include the proper use of PPE, cleaning and disinfection protocols, and strategies for minimizing the risk of transmission within the imaging suite.
Continuing education courses focused on imaging techniques relevant to monkeypox, such as chest imaging for pneumonia or MRI for neurological complications, can help technologists and sonographers maintain and enhance their skills. CE courses can also provide updates on new imaging modalities or protocols that may be beneficial in diagnosing and managing monkeypox.
Here is a list of courses we offer to help refresh your knowledge and get prepped for another outbreak:
- Radiographic imaging of the thorax
- CT Procedures
- CT Basics
- Infection Control in Radiology
- Ultrasound of the Pulmonary System
- Technical basis of ultrasound
- Chest-Abdomen-Pelvis Imaging Package for R.R.A.s®
The Future Role of Radiologic Technologists and Sonographers in Emerging Infectious Diseases
As emerging infectious diseases like monkeypox, COVID-19, and others continue to pose challenges to public health, the role of radiologic technologists and sonographers will become increasingly important. These professionals should always be prepared to face new technologies, protocols, and public health strategies to continuously and effectively respond to outbreaks and protect themselves and their patients.
- Preparedness for Future Outbreaks:
- Research and Innovation:
The experience gained from managing monkeypox can inform preparedness efforts for future outbreaks of other infectious diseases. Radiologic technologists and sonographers should be involved in disaster preparedness planning, including developing protocols for imaging patients during outbreaks and pandemics.
Radiologic technologists and sonographers can also contribute to research efforts to improve the diagnosis and management of monkeypox and other emerging infectious diseases. By participating in clinical trials, collaborating with researchers, or exploring innovative imaging techniques, these professionals can help advance the field and enhance patient care.
Conclusion
Monkeypox presents a unique challenge to the healthcare system, requiring a coordinated response from multiple disciplines. Radiologic technologists and sonographers are integral to this response, providing critical imaging services, ensuring infection control, and contributing to the overall care of patients with monkeypox. By staying informed, adhering to best practices, and collaborating with other healthcare professionals, radiologic technologists, and sonographers can help manage the current monkeypox outbreak and prepare for future public health challenges.
References
- Centers for Disease Control and Prevention (CDC) cdc.gov
- World Health Organization (WHO) who.int
- U.S. Food and Drug Administration (FDA) fda.gov
- National Institutes of Health (NIH) nih.gov
- Occupational Safety and Health Administration (OSHA) osha.gov
- The Joint Commission jointcommission.org
- Cracolici, Vincent & Gurbuxani, Sandeep & Ginat, Daniel. (2019). Head and Neck Sinus Histiocytosis with Massive Lymphadenopathy Radiology–Pathology Correlation. Head and Neck Pathology. 13. 10.1007/s12105-018-0941-3.
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