Advance Online
A needle pierces a vial of monkeypox vaccine.
Advance Online

Health Care Provider Q&A: Monkeypox and Psoriatic Disease

The NPF Medical Board addresses questions and considerations for those treating people with psoriatic disease.

As recent outbreaks of monkeypox have become more and more common, the National Psoriasis Foundation's Medical Board has come together to answer questions that patients and health care providers may have. Read below for special considerations for treating and vaccinating for monkeypox in those living with psoriatic disease.

Q: What is monkeypox?

A: Monkeypox is a rare disease caused by infection with the monkeypox virus. The monkeypox virus belongs to the Orthopoxvirus genus in the family Poxviridae, the same family of viruses as variola virus, the virus that causes smallpox. The symptoms of monkeypox are similar to smallpox, but milder.

Infections with the type of monkeypox virus identified in this outbreak—the West African type—are rarely fatal, but people with weakened immune systems may be more likely to get severely ill. Monkeypox is not related to chickenpox.

While monkeypox can infect anyone, most of the recent cases in 2022 have occurred among persons self-identifying as men who have sex with men (MSM). [1, 2]

Q: What are the symptoms of monkeypox?

A: Fever, headache, muscle aches and backache, swollen lymph nodes, chills, exhaustion, and a rash that can look like pimples or blisters that appears on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. [3, 4]

If you suspect a patient may have a monkeypox infection, contact your state health department or the CDC Emergency Operations Center (770-488-7100). You should advise the patient to isolate at home while a diagnosis is being confirmed. Clinicians should follow CDC Guidance for Infection Prevention and Control of Monkeypox in Healthcare Settings. [5]

Q: How is monkeypox spread?

A: Monkeypox is spread through skin-to-skin contact. This means it can be contracted through touching an infected persons rash, scabs, or bodily fluids. It can also be spread through items that have touched an infected persons’ rash or bodily fluids. [3, 6]

Q: Are patients with psoriatic disease (psoriasis and/or psoriatic arthritis) at a higher risk of contracting the monkeypox virus?

A: There is no evidence currently to show that individuals with psoriatic disease are at a higher risk of contracting the monkeypox virus. Individuals who are vaccinated for smallpox may be at reduced risk for monkeypox. [7, 8]

While monkeypox can infect anyone, most of the recent cases in 2022 have occurred among persons self-identifying as men who have sex with men (MSM). [1, 2]

Q: Are patients with psoriatic disease at a higher risk of having a severe monkeypox infection?

A: Patients with psoriasis, including children under the age of 8, and those taking oral or injected medications for psoriasis that may suppress the immune system, could potentially be at higher risk of severe disease with monkeypox, although more data is needed. [9]

Q: Is there a vaccine to protect against a monkeypox infection?

A: Yes, there are 2 vaccines approved by the U.S. Food and Drug Administration (FDA) to prevent monkeypox infections, JYNNEOS (also known as Imvamune or Imvanex) and ACAM2000. Individuals with psoriasis should not use the ACAM2000 vaccine. [7, 10]

Q: Should patients with psoriatic disease get a monkeypox vaccine?

A: The CDC is currently recommending individuals who have been exposed to the monkeypox virus or are at a higher risk of being exposed to get vaccinated. Eligibility for vaccination may change as more vaccines becomes available. For local vaccine availability, contact your local health department.

Q: Is it safe for patients with psoriatic disease to receive a monkeypox vaccine?

A: Based on CDC guidance, the ACAM2000 vaccine is contraindicated for many patients with psoriasis, especially those with severe disease or on any form of immunosuppression. The ACAM2000 vaccine should not be given to individuals who have cardiac disease, an eye disease treated with topical steroids, are pregnant, have a weakened immune system – including those taking a medication that suppresses the immune system, individuals who are living with HIV, or an acute, exfoliative skin condition such as psoriasis. [10]

The JYNNEOS vaccine can be safely administered to individuals who are pregnant, have a weakened immune system, or an exfoliative skin condition such as psoriasis, and children under 18 years of age who have been exposed to monkeypox. [9, 11]  However, individuals with immunocompromising conditions may be less likely to have an effective response after any vaccination, including JYNNEOS. [10] 

Shared decision-making between clinician and patient is recommended. Health care providers should discuss the use of vaccine in a child under 18 years of age with the state or local health departments and CDC.

Q: How can a patient with psoriatic disease get a vaccine for monkeypox?

A: Patients should talk with their health care provider to assess their risk of contracting the monkeypox virus. Current CDC recommendations for vaccination for monkeypox only extends to people who have been exposed to monkeypox and those who may be more likely to contract monkeypox. [12]

People more likely to get monkeypox include:

  • People who have been identified by public health officials as a contact of someone with monkeypox
  • People who are aware that one of their sexual partners in the past 2 weeks has been diagnosed with monkeypox
  • People who had multiple sexual partners in the past 2 weeks in an area with known monkeypox

People whose jobs may expose them to orthopoxviruses, such as:

  • Laboratory workers who perform testing for orthopoxviruses
  • Laboratory workers who handle cultures or animals with orthopoxviruses
  • Some designated healthcare or public health workers

Q: Does the smallpox vaccine prevent monkeypox infections?

A: The smallpox vaccine may reduce your risk of developing a monkeypox infection, however the US stopped vaccinating individuals for smallpox in 1972, so those under the age of 50 are likely to not have received a smallpox vaccine. [8]

Q: What should I do to treat a patient with psoriatic disease who is infected with the monkeypox virus?

A: If you suspect a patient may have a monkeypox infection, contact your state health department or the CDC Emergency Operations Center (770-488-7100). You should advise the patient to isolate at home while a diagnosis is being confirmed. Clinicians should follow CDC Guidance for Infection Prevention and Control of Monkeypox in Healthcare Settings. [5]

Q: Is there a treatment for a monkeypox infection?

A: There is no treatment specifically for monkeypox infections. There is a treatment, tecovirimat (also known as TPOXX or ST-246), that is approved to treat smallpox infections. Because smallpox and monkeypox infections have similarities, this drug may be used to help treat monkeypox infections. Per CDC guidance, it is recommended that this treatment be given to patients who have severe disease or are at risk of severe disease. This includes people with exfoliative skin conditions like psoriasis, immunocompromising conditions, pediatric populations – particularly those under 8 years of age, individuals who are pregnant, or have 1 or more complication. [9, 11, 13]

NPF Monkeypox Q&A

The NPF Medical Board addresses key questions about monkeypox for people living with psoriatic disease.

Read more

References

1. Iñigo Martínez J, Gil Montalbán E, Jiménez Bueno S, Martín Martínez F, Nieto Juliá A, Sánchez Díaz J, et al. Monkeypox outbreak predominantly affecting men who have sex with men, Madrid, Spain, 26 April to 16 June 2022. Euro Surveill. 2022;27(27) https://pubmed.ncbi.nlm.nih.gov/35801519/.

2. Liu X, Zhu Z, He Y, Lim JW, Lane B, Wang H, et al. Monkeypox claims new victims: the outbreak in men who have sex with men. Infect Dis Poverty. 2022;11(1):84 https://pubmed.ncbi.nlm.nih.gov/35871003/.

3. Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, et al. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022 https://pubmed.ncbi.nlm.nih.gov/35866746/.

4. Prevention CfDCa. Monkeypox - Signs and Symptoms 2022 [Available from: https://www.cdc.gov/poxvirus/monkeypox/symptoms.html.

5. Prevention CfDCa. Infection Prevention and Control of Monkeypox in Healthcare Settings 2022 [Available from: https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html.

6. Centers for Disease Control and Prevention NCfCDPaHP. Monkeypox - How it Spreads 2022 [Available from: https://www.cdc.gov/poxvirus/monkeypox/transmission.html.

7. Prevention CfDCa. Monkeypox and Smallpox Vaccine Guidance 2022 [Available from: https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html.

8. McCollum AM, Damon IK. Human Monkeypox. Clinical Infectious Diseases. 2013;58(2):260-7 https://doi.org/10.1093/cid/cit703.

9. Pediatrics AAo. Monkeypox 2022 [Below are answers from AAP experts on some of the most frequently asked questions about how to prevent, recognize, test for and treat monkeypox. Additional resources, including details from Red Book Online, are listed below.]. Available from: https://www.aap.org/en/patient-care/monkeypox/.

10. Rizk JG, Lippi G, Henry BM, Forthal DN, Rizk Y. Prevention and Treatment of Monkeypox. Drugs. 2022;82(9):957-63.

11. Centers for Disease Control and Prevention NCfEaZID. Clinical Considerations for Monkeypox in Children and Adolescents 2022. Available from: https://www.cdc.gov/poxvirus/monkeypox/clinicians/pediatric.html#anchor_1658856112226.

12. Prevention CfDCa. Vaccines 2022 [Available from: https://www.cdc.gov/poxvirus/monkeypox/vaccines.html.

13. Prevention CfDCa. Treatment Information for Healthcare Professionlas 2022 [Available from: https://www.cdc.gov/poxvirus/monkeypox/clinicians/treatment.html.

Stay in the Know.

Expert tips, can’t-miss events and the latest news, straight to your inbox.

National Health Council Standards of ExcellenceCharity NavigatorCommunity Health Charities logoTwill Care logo

Copyright © 1996-2022 National Psoriasis Foundation/USA


Duplication, rebroadcast, republication or other use of content appearing on this website is prohibited without written permission of the National Psoriasis Foundation (NPF).


NPF does not endorse or accept any responsibility for the content of external websites.


NPF does not endorse any specific treatments or medications for psoriasis and psoriatic arthritis.

We use cookies to offer you a better experience and analyze our site traffic. By continuing to use this website, you consent to the use of cookies in accordance with our Privacy Policy.