Less than eight weeks ago, the Florida Department of Health reported the state’s first presumptive case of monkeypox — a viral disease that was once rare in the United States.
Now, as the number of new monkeypox cases has risen rapidly in the United States and more than 50 other countries, Florida’s case count is also surging, to 73 as of Thursday, the third most of any state, after California and New York, according to the Centers for Disease Control and Prevention. There were 700 confirmed U.S. cases as of Thursday, the CDC said.
And South Florida is the epicenter of the state’s outbreak, with Miami-Dade and Broward counties accounting for more than 70% of all reported cases in Florida. Broward is leading the state with 40 cases, while Miami-Dade is second with 14 cases, according to the Florida Department of Health.
“Anyone who is doing healthcare right now should absolutely be concerned and we should be very aware that this is happening,” says Dr. Aileen Marty, professor of infectious diseases in the Department of Medicine at FIU Herbert Wertheim College of Medicine.
Most Floridians diagnosed with monkeypox are middle-aged, with more than 70% of cases occurring in people between the ages of 35 and 54, according to the Florida Department of Health. They usually acquired the disease in Florida, as opposed to coming here from elsewhere with the virus, according to the department’s disease repository.
Monkeypox can spread from person to person through contact with the infectious rash, scabs or body fluids of someone who is infected with the virus, and the disease can also be transmitted via “respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact” with a symptomatic person, according to recent guidance from the CDC.
Though anyone can contract monkeypox, in the United States the “main population we’ve seen so far has been in men having sex with men,” FIU’s Marty said. “Not because it’s a sexually transmitted disease, but rather because they’ve been having the kinds of interactions with each other in large party settings. That’s basically a super spreader.”
More than 6,000 cases worldwide
Worldwide, epidemiologists are seeing the same trends. Of the more than 6,000 monkeypox cases that have been reported in 58 countries as of Wednesday, 99 percent of the cases have been in men — with the majority in men who have sex with men, the World Health Organization’s Europe chief said Friday, the Associated Press reported.
But others are increasingly at risk, too: children, pregnant women, the immunocompromised and the elderly must remain particularly cautious, Marty said.
Symptoms include a rash, fever, muscle pain, vomiting and chills. No deaths have been reported.
Florida’s health department and the CDC are urging people at risk to get vaccinated and they’re distributing the CDC’s monkeypox detection test more widely through commercial labs. To get this test, people must first visit their healthcare provider, who will collect samples and start the testing process.
Why is monkeypox dangerous?
Monkeypox was first noticed in 1958 among a colony of monkeys used for medical research, according to the CDC. The first human case was recorded in 1970 in the Democratic Republic of Congo.
The virus belongs to a group called orthopoxviruses, which include a number of species that can infect animals and humans, such as the viruses that cause smallpox, horsepox, camelpox and cowpox.
“There’s different kinds of humans: tall ones, short ones, fat ones, and thin ones [...] germs, too, come in different flavors and different styles,” says Marty. Although there’s more than one type of monkeypox virus circulating the world, the predominant one is the clade 3B.1.
Public health experts were “more than a bit surprised,” Marty said, when they analyzed the “book of life” or the genetic sequencing of the monkeypox strain currently spreading across the globe, finding it to be much different than earlier variants. In particular, experts found a change in a particular enzyme called APOBEC3 that allows the virus to mutate faster.
The enzyme APOBEC3 is also found in the Hepatitis B virus and the herpes virus, as well as in the HIV virus that causes AIDS.
Although scientists do not yet fully understand how this enzyme impacts the current monkeypox variant, mutations generally allow viruses to more easily enter human cells, spread from person to person, replicate inside a host and evade the immune system.
How does it spread?
The monkeypox virus spreads from person to person via direct contact with infected areas, respiratory droplets and genital secretions, and even touching items used by infected individuals. People can also contract the virus by being bitten or scratched by an infected animal, particularly rodents.
Marty said there have been documented cases in Europe of healthcare sanitation workers who contracted monkeypox after handling the sheets and towels of infected patients.
But the disease is rarely if ever fatal.
Fortunately, “most of the cases that we’ve seen have not been very severe except for the blisters that it causes,” said Marty, although rare cases of blindness, severe respiratory problems and sepsis have occurred.
Vaccines, testing and treatment
There are two vaccines licensed by the Food and Drug Administration for preventing monkeypox infection: JYNNEOS and ACAM2000. The former vaccine is a “very safe” vaccine that contains a virus that cannot replicate effectively inside our bodies. The latter, however, has a virus that is replication competent.
In addition to vaccines, testing protocols are being ramped up. As of yesterday, Labcorp, a company that operates one of the largest clinical lab networks in the world, began testing for monkeypox using the CDC’s orthopoxvirus test. This will increase the current testing capacity by the CDC’s Laboratory Response Network by twofold.
“The ability of commercial labs to test for monkeypox is a key pillar in our comprehensive strategy to combat this disease,” said CDC Director Dr. Rochelle Walensky in a statement to the press Wednesday. “This will not only increase testing capacity but will make it more convenient for providers and patients to access tests by using existing provider-to-lab relationships.”
Although there are no treatments approved specifically for monkeypox, many antivirals developed for smallpox may work for monkeypox, as well. The CDC’s interim clinical guidance for the treatment of monkeypox suggests four different antivirals that physicians may use.
Prioritizing vaccines for LGBTQ community
Florida’s health department is working with the CDC in South Florida to raise awareness in the community and among medical providers, said Olga Connor, director of communications and legislative affairs for the state health department’s office in Miami-Dade.
“It is imperative that medical providers are aware of clinical manifestations for early identification and treatment. Furthermore, DOH-Miami-Dade has been distributing educational material to various community organizations to increase awareness,” Connor said.
The health department has also been “distributing treatment and vaccines from the National Strategic Stockpile to individuals who meet the criteria for treatment and vaccination and following the guidelines from the CDC for monitoring individuals who have identified as a close contact.”
Due to a shortage of the JYNNEOS vaccine and the prevalence of monkeypox in the LGBTQ community, public health officials are prioritizing vaccinations for gay, bisexual, and other men over the age of 18 who have sex with men or transgender, non-conforming, or gender non-binary people over 18 with multiple or anonymous sex partners in the last two weeks.
Nina Levine, public information officer at the health department’s Broward County office, said individuals who are concerned about contracting monkeypox should contact a medical provider, adding that DOH epidemiologists are also available 24/7 for consultation with healthcare providers.
If public health officials cannot contain the monkeypox outbreak quickly, then the disease can become a long-term risk.
“We are very concerned that with so much human-to-human transmission, rodent pets that people have in homes can get infected and wild rodents like squirrels can get infected. Then it becomes endemic in our country and other countries. And then it becomes an ongoing problem which we’re all going to be faced with for a long time,” she said.
But the tide is rising quickly against those racing to contain the monkeypox virus’s spread.
“In the entire 20th century, there were 917 cases,” Marty said. “In two months, we’ve had over 7,000 confirmed cases [globally].”