Recent media reports document an increase in suspected and confirmed cases of the monkeypox virus. Monkeypox, first detected in lab monkeys in 1958, may have earned its moniker from the lab monkeys, but it’s actually thought it originally spread to humans from wild animals like rodents; today’s thinking is that it’s either spread by wild animals or from contact with other infected humans. Historically, most cases were confined in countries located on the African continent; however, cases outside of Africa have recently been confirmed in EU/EEA countries like Denmark, Sweden, and the Netherlands. As of May 16, 2022, Portugal had five confirmed cases and more than 20 suspected cases. *

Thinking about the word “pox”, I decided to do a little research (certainly not scientific) myself, starting with the definition of the word “pox.” According to Google’s English dictionary, Oxford Languages, the word “pox” is a noun that means, “any of several viral diseases producing a rash of pimples that become pus-filled and leave pockmarks on healing.” Sounds delightful – NOT!

According to Wikipedia, there are 83 species in the poxvirdae family which are divided into 22 genera (plural of genus). Four genera of these poxviruses can infect humans. They are as follows:

• Orthopox – most commonly includes: smallpox virus; vaccinia virus; cowpox virus; monkeypox virus; and rabbitpox virus.
• Parapox – includes: orf virus; pseudocowpox virus, and bovine papular stomatitis virus – BPSV. BPSV is a mild “farmyard” pox which can spread from infected cattle to milkers, farmers, and veterinarians.
• Yatapox – including tanapox virus and yaba monkey tumor virus. Diseases associated with this genus include histiocytomas.
• Molluscipox – which includes only molluscum contagiosum virus (MCV). MCV affects approximately 200,000 humans annually; it is also known as “water warts.”

You may be wondering why you didn’t see chickenpox listed in any of the above four genera. Chickenpox is not really a true pox virus and it is actually caused by herpesvirus varicella zoster.

Monkeypox and smallpox share the same genus – that of Orthopox. Cases of monkeypox were usually “kept under control” by the smallpox vaccination because of the viruses shared makeup. History cannot positively identify when the first case of smallpox was identified, though the earliest suspected case was diagnosed circa 1150 BCE in Pharaoh Ramses V, who is thought to have died from the disease. It is also thought smallpox transferred to Europe around the early 8th century and then to the Americas in the early 16th century, where it is thought to have caused the deaths of 3.2 million Aztecs within the first 2 years of its introduction. The high death toll is believed to be due to the population’s total lack of exposure to the disease before then. The last recorded case of smallpox occurred in Somalia in 1977, after a world-wide effort was made to vaccinate everyone.

Current thinking is that monkeypox is spread by close contact to bodily fluids, such as saliva. Almost all recently reported cases involve men aged 20-50, many of whom are identified as men who have sex with men (MSM), though monkeypox is not currently considered an STD.

Several poxviruses, including the vaccinia, myxoma, tanapox and raccoon viruses are presently being studied for their therapeutic potential in treating various human cancers.

Even though the reported cases of suspected/confirmed cases of monkeypox are rising, health authorities around the globe are not expecting an epidemic nor pandemic. Most cases of monkeypox are mild and improve without treatment, though it remains contagious, until the poxes scab, the scabs fall off, and a new layer of skin forms.

Human Poxvirus Infections 

https://www.sciencedirect.com/topics/medicine-and-dentistry/poxviridae

ICD-10-CM Coding Examples For Poxviruses

The ICD-10-CM codes noted on above chart pertain to the poxviruses discussed in the blog and are examples only. The list of codes is in no way complete. As always, coders should review chart documentation and refer to the ICD-10-CM book (or encoder) to make certain the correct code is assigned, based on documentation found in the patient record, and following any instructional notes found in the coding book (or encoder) itself. 

References:

• https://www.ecdc.europa.eu/en/news-events/monkeypox-cases-reported-uk-and-portugal#:~:text=All%20cases%20reported%20on%2016,more%20than%2020%20suspected%20cases 
• https://en.wikipedia.org/wiki/Poxviridae 
• https://media.nature.com/original/magazine-assets/d41586-022-01421-8/d41586-022-01421-8.pdf 

Key Words/ Abbreviations

BC – Before Christ

BCE – Before the Common Era

EU – European Union

EEA – European Economic Area

Pox – In addition to “any of several viral diseases ….”, “pox” can also mean a disastrous evil or curse.