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As monkeypox spreads throughout the United States, many health care professionals are sounding an alarm. Scientists at the Centers for Disease Control and Prevention are tracking multiple cases of the virus that have been reported in several countries.
According to the CDC, more than 40 cases have been reported in 15 states with the most cases now in California. No known cases have been reported in Connecticut as of yet. One case was confirmed in Boston last month after an individual had traveled to Canada. Another probable case has also been announced in Rhode Island after a man in his 30s traveled to Massachusetts.
What is monkeypox?
Monkeypox is a viral disease that occurs mostly in central and western Africa. It got its name because it was first identified in laboratory monkeys in the early 1950s. The first human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo (DRC) during a period of intensified effort to eliminate smallpox.
The virus is closely related to the smallpox virus which was eradicated from the United States in the 1970s and officially declared eradicated by the World Health Assembly in 1980.
“This is not an unknown virus. This is a well understood pathogen and it’s doing exactly what we expected it would do,” said Dr. Anne Rimoin, UCLA Fielding School of Public Health, speaking during a panel discussion hosted by the Yale Institute for Global Health Thursday. “Our African colleagues have been seeing monkeypox for a while in places that it is endemic. Now we’re just seeing it on a larger scale. We know where it comes from but it’s just always been low on the list of priorities. The squeaky wheel gets the grease but monkeypox was never high enough on the list.”
While considered a rare disease, it can spread throughout Central and West Africa, often near tropical rain forests. After decades without cases, Nigeria experienced a monkeypox outbreak starting in 2017 that continues to this day. Nigeria has detected 558 suspected cases — 241 of them confirmed — since the current outbreak began in 2017.
“A lot of the concern now is that we’re not just seeing this in one country but now multiple countries,” said Dr. Scott Roberts, associate medical director at Yale School of Medicine. “We’ve seen a few cases pop up here and there over the last few years but not to the extent we’re seeing now.”
How does monkeypox spread?
People become infected with the monkeypox virus through contact with the bodily fluids of infected animals or humans, including respiratory droplets, or through contact with materials contaminated with the virus.
Monkeypox spreads most easily through direct contact with infectious sores, scabs, or body fluids but it also can be spread by respiratory secretions during prolonged, face-to-face contact.
“While touch is the primary way it spreads, it can spread through droplet transmission as well,” said Roberts. “The good news is that it does not transmit as well as COVID. We have all heard of the 6-foot, 15-minute rule of transmissibility for COVID-19 but for monkeypox it is more like 6-foot, three hours. So it really requires prolonged contact.”
The CDC has also warned that it can be transmissible during intimate contact between people, including during sex, as well as activities like kissing, cuddling, or touching.
“One thought is that it can be sexually transmitted but I strongly doubt that,” said Roberts. “My thinking is it is transmitted during sexual activity simply because of the close proximity to someone who is infected.”
Can vaccines prevent monkeypox?
Most older Americans will remember receiving a smallpox vaccine as part of eradication efforts in the 1960s and 1970s. The last smallpox vaccine was administered in the United States in 1972 after the disease was eradicated in the United States.
There are three different smallpox vaccines that each can be used in a smallpox emergency vaccination strategy, two of which have some efficacy against monkeypox. A third, JYNNEOS is licensed by the FDA for the prevention of smallpox and monkeypox and offers about 85% protection against the monkeypox virus.
“We have effective smallpox vaccines that also share efficacy against monkeypox,” said Roberts. “For right now the CDC recommends that only people who are exposed get vaccinated at this point because the incubation period is so long that you can actually get the virus two weeks before getting any symptoms.”
Symptoms of monkeypox
The CDC estimated the incubation period (time from infection to symptoms) for monkeypox is usually 7 to 4 days but can range from 5 to 21 days.
“This can make it difficult for someone to know if they have the virus,” Roberts said. “But usually symptoms begin as a fever and turn into a rash within a few days. Once you start experiencing symptoms it is important to see your medical provider right away.”
Monkeypox begins with fever, headache, muscle aches, and exhaustion. The main difference between symptoms of smallpox and monkeypox is that monkeypox causes lymph nodes to swell while smallpox does not. Within 1 to 3 days after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body.
The CDC estimates that older Americans who were vaccinated prior to 1972 still have immunity against monkeypox.
“A big outstanding question is how long can that immunity last and I don’t think there is a great answer,” Roberts said. “Some studies have suggested 85% immunity in people who got inoculated for smallpox and others have shown less or greater immunity. The general thought is that there is some protection for older Americans who got vaccinated.”
The U.S. has begun releasing monkeypox vaccines from the Strategic National Stockpile to protect high-risk people or those already exposed.
The White House has not revealed how large the national stockpile of monkeypox vaccines and therapeutics is but the CDC estimated more than 100 million doses of ACAM2000 and APSV are in the national stockpile. The JYNNEOS vaccine, first developed in 2019, has far fewer doses in the stockpile but no exact numbers have been reported.
“Current estimates are there is enough smallpox vaccines for about a third of the U.S. population,” Roberts said. “But no one really knows for sure just how many vaccines we have.”
The CDC advises practicing good hygiene and safe sex to reduce your risk of contracting the virus. This includes washing hands, wearing masks in close proximity or at large gatherings and using condoms during sexual activity. Individuals should also keep an eye out for symptoms if they recently changed sexual partners.
“We can do things to help minimize the spread,” Roberts said. “The biggest thing is just practicing good hygiene and safe sex practices. We can all do our part to help limit the outbreak.”