An international monkeypox outbreak, which began in May, has prompted the World Health Organization to declare a global health emergency.
“We have an outbreak that has spread around the world rapidly through new modes of transmission, about which we understand too little,” WHO Director-General Tedros Adhanom Ghebreyesus said Saturday during a briefing in Geneva, adding that the current situation meets the criteria for “a public health emergency of international concern.”
More than 19,000 cases have been reported in at least 76 countries so far, according to the Centers for Disease Control and Prevention. And in the U.S., cases are on the rise. Last Friday the CDC reported a total of 2,891 monkeypox cases since May. By Tuesday that number had increased 24% to 3,590 cases across 46 states, Washington, D.C., and Puerto Rico.
According to health officials, more than 97% of patients who have tested positive for monkeypox since the onset of the outbreak identify as gay or bisexual men, or as men who have sex with men. However, health experts have warned that anyone — regardless of gender or sexual orientation — can develop and spread the disease. On Friday the CDC said two cases of monkeypox in children had been identified in the U.S.
Dr. Ashish Jha, the White House’s COVID-19 response coordinator, told reporters during a briefing Friday that the Biden administration was considering declaring the current monkeypox outbreak a public health emergency. He added on Monday that the administration was “working around the clock” to ramp up the U.S. response.
To help offer guidance on monkeypox, Yahoo News spoke with Luis Ostrosky-Zeichner, chief of the infectious diseases division at the McGovern School of Medicine at the University of Texas.
What is monkeypox?
Monkeypox is a zoonotic disease, meaning it can be transmitted from animals to humans. The monkeypox virus is part of the same family of viruses that causes smallpox. It has existed for decades in West and Central African countries, where it has spread to people mainly when they have come into contact with infected wild animals, particularly rodents.
Since the first human case of monkeypox was detected in Africa in 1970, the virus has caused small outbreaks through the years. However, most have been limited to a few hundred cases in about 11 African countries, according to the New York Times.
Some cases have been reported outside of Africa before, brought by travelers or from the import of wild animals that were sold as pets and passed the virus to their owners. Never had there been significant international outbreaks like the one this year, however.
Ostrosky-Zeichner told Yahoo News that the current global outbreak of monkeypox is different from other historical occurrences because the disease is spreading rapidly among a certain group of people with no links to recent travel to Africa, where the disease is endemic.
“The concerning part is that, you know, initially at least for us in the U.S., all of the cases were imported. They had a travel history to Europe, where this outbreak started,” Ostrosky-Zeichner said. “But now we have local transmission. We’re having transmission in multiple cities in the U.S.”
Currently, the states with the most cases are New York, California, Illinois, Florida and Georgia, along with Washington, D.C.
What are the symptoms?
Monkeypox symptoms can include fever, severe headaches, muscle aches, back pain, exhaustion, swollen lymph nodes and skin rashes or lesions.
The lesions can look like pimples or blisters and can appear “on the face, inside the mouth, and on other parts of the body like the hands, feet, chest, genitals or anus,” according to the CDC.
Ostrosky-Zeichner said that “the lesions are highly infectious,” so people should avoid touching others until these have healed.
“Most people resolve them within two to three weeks ... and basically you’re considered infectious until all the lesions have crusted and all the crust has fallen off,” he said.
“They are really painful,” he said of the lesions, which people have described as itchy and irritating. “When we talk to patients, they have excruciating pain and we do need to do some heavy pain control with them. So it’s not a walk in the park when you have the lesions.”
Although the virus can cause painful and debilitating symptoms, it is rarely fatal, and around 90% of people usually survive it on their own without any complications. Based on the cases reported in recent years in African countries, the case fatality ratio of monkeypox has been around 3% to 6%, according to the WHO.
How does it spread from person to person?
Monkeypox can spread through physical contact with an infected person, particularly if people come in direct contact with their skin lesions, or with body fluids such as blood or saliva. Scientists are still studying whether it can be spread through people who have no symptoms.
It’s notable, however, that in 91% of cases reported to the WHO since the onset of the outbreak, sexual contact has been the main mode of transmission.
The virus can also spread through respiratory droplets or aerosols produced by sneezing or coughing. However, that requires “very prolonged contact in close quarters,” Ostrosky-Zeichner said. “We’re talking about six to eight hours in a closed room with somebody to get it that way.”
Touching or sharing items used by an infectious person, such as clothing, linens or utensils, can also put people at risk of contracting monkeypox.
The CDC recommends a thorough home cleaning after someone has monkeypox, because the virus can live on surfaces for up to 15 days. The agency also notes that orthopoxviruses like monkeypox can survive in an environment “similar to a household, for weeks or months.”
According to the CDC, it’s also possible for a pregnant person to spread the virus to their fetus through the placenta.
Who’s at risk of contracting monkeypox right now?
Ostrosky-Zeichner told Yahoo News that because monkeypox is primarily spreading “through sexual contact ... within the community of men who have sex with men,” that particular segment of the population is currently most at risk.
However, anyone who comes into close contact with an infected person is at increased risk of infection, regardless of gender or sexual orientation.
Other people at higher risk of exposure include health care personnel, due to the nature of their work, and people who live with others who have become infected, according to the WHO.
Is monkeypox an STD?
In the current monkeypox outbreak, the virus has mostly shown up in men who have sex with men, and in some cases, lesions have been observed primarily in the genital area. Because of this, there has been some debate about whether monkeypox is a sexually transmitted disease.
But Ostrosky-Zeichner told Yahoo News that technically it is not, because monkeypox does not exclusively spread as a result of sexual activity.
“Normally, STIs, we think of syphilis, gonorrhea, things like that, that exclusively transmit in the sexual way,” he said, adding that people can get monkeypox from simply touching people who are infected and have lesions, and also via respiratory droplets.
Additionally, the CDC said it has not determined whether monkeypox can spread through semen or vaginal fluids.
How can I protect myself and others?
Ostrosky-Zeichner said limiting contact with people who are infected is key. “We strongly recommend people who have it to stay at home, isolate from others and, obviously, not to be out in the community,” he said.
For those who live with an infected person, the WHO encourages the infected individual to self-isolate and cover their skin lesions. It is also recommended to wear a face mask around someone who is sick, to disinfect contaminated surfaces and to discard items used by infected people.
Another crucial tool to stop the spread of monkeypox is testing.
“Testing is key to identifying, and identifying is key to isolating, which breaks the transmission chain,” Ostrosky-Zeichner said, adding that there had been some challenges in the past but that it has gotten much easier to test patients in recent weeks. This is part of a federal effort to increase available testing through commercial labs. According to the Department of Health and Human Services, the U.S. now has the capacity to conduct 80,000 monkeypox tests a week.
“We can see a patient in our office, swab the lesions and send them to the commercial laboratories like Quest or Labcorp and get a result fairly quickly,” Ostrosky-Zeichner said.
Vaccines and treatments
There are two vaccines that have been approved by the Food and Drug Administration available in the U.S. to prevent monkeypox infection. However, demand is outstripping the supply, which has led to long lines and frustration among doctors and people seeking to get vaccinated.
At a White House press briefing on Monday, Jha said that to date, the U.S. had distributed more than 300,000 vaccines to jurisdictions around the country and that the FDA was working ceaselessly to finalize the approval of nearly 800,000 additional doses, which could become available as early as next week.
According to Health and Human Services, another 5 million doses have been ordered by the federal government. Those are expected to be delivered through the middle of 2023.
“At this point, we don't have nearly enough, so health departments are prioritizing high-risk populations and high-risk behaviors,” Ostrosky-Zeichner said.
He explained that there are currently two uses for the vaccine: to get it once a person is exposed to monkeypox, and to get it before exposure as a preventive measure.
For people who are immunocompromised and those who are more likely to get severely ill, there are some treatments used to treat smallpox that also work for monkeypox. One of those is an antiviral medication called tecovirimat, or TPOXX.
Finally, Ostrosky-Zeichner said that people should remain calm right now but that it is important to contain the current outbreak before the virus spreads more widely to the general population.
“You're not going to go to the grocery store and get it from touching produce or anything like that,” he said. “But we are at a very crucial point where we need to contain it and eradicate it within this current group of transmission before it makes the jump into household transmission and community transmission. So no cause for alarm right now, but we do have a small window of opportunity to sort of squash it.”