HERSHEY, Pa. — For those already weary of the COVID-19 pandemic, a new illness making headlines — monkeypox — comes as even more unwelcome news.
Cases of the disease, which are usually confined to West and Central Africa, are on the rise worldwide, including in the U.S. Unlike COVID-19, comparatively few people have died from monkeypox, and transmission of the illness requires prolonged close contact to spread. However, like the coronavirus pandemic, misinformation about monkeypox is mounting along with the number of cases.
In this week’s Medical Minute, Dr. Catharine Paules, an infectious diseases physician at Penn State Health Milton S. Hershey Medical Center, offers answers to key questions, cutting through the white noise about the disease.
Two important ones at the outset: Contrary to rumor, monkeypox is not a sexually transmitted disease. Anyone can get it, and any group activity can serve as the petri dish.
While the illness is passing some of the same signposts as COVID-19, it’s not a pandemic. But that doesn’t mean it can’t become one. Or that you shouldn’t take it seriously.
What is monkeypox?
Paules: It’s a type of virus called an orthopoxvirus, which is in the same family as smallpox. In the past, we’ve seen cases primarily in parts of Africa where it is endemic. However, since about April, we’re seeing a much larger global outbreak with cases in countries where monkeypox is not usually seen, including the U.S.
How long have we been aware of monkeypox?
Paules: For a very long time. Decades. Usually it causes sporadic cases in an isolated geographic region with most cases linked to contact with infected animals. The current outbreak is different because the virus is spreading among infected people, in countries all over the world.
So, it starts with transmission from animal to human, but humans can eventually spread it among themselves?
Paules: Yes. Through sustained close contact. So, it’s not as readily transmissible as something like the virus that causes COVID-19, but people with sustained close contact can transmit it among themselves.
I’ve heard it’s a sexually transmitted disease? Is that true?
Paules: Not in the way that you’re thinking, which is a big misnomer that needs to be made very clear. The key point here is that monkeypox is transmitted by close contact; particularly direct contact with a rash or sores of someone who has the virus. It has also occasionally been spread from contact with contaminated bedding or other objects or through respiratory droplets. So, it’s not a sexually transmitted disease per say, but with intimate close contact, transmission can occur.
So sexual intercourse isn’t required to spread the disease.
Paules: It’s not. At this time, we do not know if monkeypox can be spread through saliva, semen or vaginal fluids, but we do know it spreads through prolonged close contact.
Am I at risk of getting monkeypox?
Paules: Right now, the risk of catching monkeypox in the U.S. is low. Monkeypox does not spread easily from person to person. Although anyone can get and spread monkeypox, right now, gay, bisexual or other men who have sex with men have an increased likelihood of exposure as cases are spreading among these social networks.
But all of us need to be watching monkeypox and understanding that prolonged, close contact of any sort could potentially spread monkeypox. Thinking that an infectious disease will be limited to only one social network is short-sighted.
What are the symptoms of monkeypox?
Paules: Monkeypox usually has a prodrome ― that’s a flulike illness that starts everything off. Symptoms include a fever, body aches and fatigue. A hallmark of this disease is swollen lymph nodes. Then a couple of days after the prodrome, people develop a characteristic rash that looks like pimples or blisters. Usually the rash covers most of the body starting with the face, although the current outbreak has been a bit atypical. (For more on the disease, including photos of the rash, check out this page from the U.S. Centers for Disease Control and Prevention [CDC]).
What makes this outbreak atypical?
Paules: A lot of people aren’t experiencing the prodrome ― fever and chills ― before the rash. And in many cases, the rash has been isolated to the genital region.
Is it a fatal disease?
Paules: Most descriptions of monkeypox have been from reports in Africa where there are two different clades, or types, of the virus. The clade causing the current outbreak is the less severe of the two and is rarely fatal. There haven’t been any U.S. deaths since this current outbreak started. But many of the infected people have fortunately been low risk for severe monkeypox infections. People who may be at risk for severe monkeypox are pregnant persons, children under 8 years old and the severely immunocompromised.
How long after you’re diagnosed can you continue to infect others with monkeypox?
Paules: People become contagious once they start to have any symptoms and are contagious for a long time. The rash has to completely heal before they’re not contagious, so isolation can last for several weeks.
Is there a vaccine?
Paules: Yes. There are two vaccines, initially developed for smallpox, that are available to prevent monkeypox infection. In the U.S. they are being used mostly in post-exposure prophylaxis — meaning if you had an exposure to monkeypox you could be given the vaccine to prevent or decrease the severity of infection. Some regions with the most monkeypox cases are also starting to give vaccine to those at high risk for exposure. This is not yet an option in Pennsylvania.
Is this the first time we’ve been using a smallpox vaccine in the U.S. since…
Paules: …smallpox was eradicated. Yes. A lot of people have asked, if I was vaccinated against smallpox as a child, am I protected against monkeypox? We don’t know for sure but there may be some protection.
Are there other treatments aside from the vaccine?
Paules: Most people will not need to be treated for monkeypox and will recover on their own. There is a medication, Tecovirimat, that was developed for smallpox that may also help people with monkeypox. This treatment may be recommended if you have severe monkeypox or if you are at risk for getting seriously ill.
What should I do to protect myself – if anything?
Paules: If you are in a high-risk social network, you should be aware of an increased risk of exposure. This is particularly important when planning for close physical contact. The CDC has developed guidance for safer social gatherings and sex.
But everybody really needs to be paying attention; although this virus is very different than the one that causes COVID-19, and much less likely to spread rapidly, there are still important lessons from the COVID-19 pandemic that we should be applying. Primarily, we must increase awareness both among health care workers and the community so that cases are quickly diagnosed and isolated. Increased awareness will also allow us to treat people at risk for severe monkeypox and to identify close contacts of cases so that they can be vaccinated if needed.
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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.