As the CDC loosens COVID-19 restrictions and the nation continues its ongoing transition into a post-pandemic world, a new virus has been on the forefront of Americans’ minds: monkeypox. Unlike COVID, however, monkeypox has been circulating in other countries for decades, and there is already a protective vaccine.
Monkeypox was first identified in humans in the Democratic Republic of the Congo in 1970 and most outbreaks have been concentrated in central and west African nations until recently. As the name of the virus suggests, it was first transmitted to humans by monkeys, making it a zoonotic virus.
In May 2022, a case of monkeypox was diagnosed in Boston, Massachusetts. Since then, the virus has spread to 49 states. Several other countries around the globe are also facing outbreaks, and many fear another extreme, life-changing pandemic. However, unlike COVID, monkeypox is primarily transmitted through close contact and skin-to-skin touching, and so it is significantly less contagious and less likely to cause a COVID level pandemic.
The most heavily affected community thus far has been men in the LGBTQ+ community with multiple sexual partners. Although there have been several cases spread through sexual contact, monkeypox is not classified as a sexually transmitted infection. In recent weeks, the virus has impacted several other groups, and is predicted to spread throughout other populations if preventive measures are not implemented.
Dr. Robert Grossberg, an infectious disease doctor and HIV specialist who works in an infectious disease clinic at Montefiore Medical Center, has seen several patients with monkeypox in the Bronx. “About a month ago we started to see patients coming in who were either diagnosed in the emergency room or who were coming in to be evaluated by us for the first time. All of these patients were men who have sex with men and were in the population that the epidemic seems to be focused in at the moment,” Grossberg said.
Nonetheless, Grossberg advises to “be conscious when you’re having skin-to-skin or other intimate contact with people, and that you should consider with whom you’re having the contact and in what settings. That is not just an issue for men who have sex with men, it is potentially an issue for everyone.”
The virus can incubate for up to 21 days (average is 6-13) after exposure before symptoms begin, which means that it may be able to be spread unknowingly. The symptoms of monkeypox often start with a fever, body aches, and fatigue for a few days during what is called the “invasion period.” Within three days of fever, patients may notice blister-like eruptions on their skin. Eventually, the lesions turn into pustules and can cause permanent scarring when they scab. Most patients experience the rash on their hands, feet, chest, and face, but it is also common to encounter the rash inside of the mouth or on genitals. The rash can be incredibly painful and itchy, but the virus rarely leads to death. In fact, there has yet to be a monkeypox related death in the United States during this outbreak despite 11,890 confirmed cases as of August 15, 2022. Thus far, New York State has been the epicenter of this outbreak, accounting for 2,376 of those cases.
Graph from CDC. Reported number of cases has increased throughout the summer.
For healthcare workers, the risk of infection is relatively low. “Unlike some infections, monkeypox does not appear to be a significant risk to healthcare workers. As of recently, there have been no cases that have been transmitted in the healthcare setting. However, we do take extra precautions and wear a gown, gloves, a mask, and eye protection. Whether that is totally necessary is not completely understood. This is very different from SARS-Cov-2 or other viruses where healthcare workers are at high risk for infection,” Grossberg described.
If a person is experiencing these symptoms and has a positive test for monkeypox, the case is reported and the person advised to isolate until they have recovered completely, which is usually between two and four weeks.
Dr. Grossberg discussed the risk for hospitalization from monkeypox. “There have only been a few patients admitted to the hospital with monkeypox. In general it has been because of severe symptoms, particularly severe pain. The lesions of monkeypox can be extremely painful, especially in sensitive parts of the body.” However, he resolved that “Typically monkeypox resolves on its own without any specific treatments. Most of the treatment is based on symptom relief to help with pain or itching.”
Despite the low risk for severe illness and death, “For patients with weakened immune systems or with lesions in parts of the body that could lead to further complications there is a drug called tecovirimat, which is an antiviral drug that can be used to treat monkeypox. We don’t have a great sense of how well it works but from our limited experience it seems to help in shortening the illness,” Grossberg continued.
The monkeypox virus is part of the Poxviridae family, the same viral family as smallpox. Therefore, the vaccine that protects against smallpox also provides some protection against monkeypox. Smallpox was a once common disease that was completely eradicated by 1980 thanks to a vaccine program. Though its symptoms and lesions were somewhat similar to monkeypox, smallpox was far more fatal and killed over 300 million people. Two smallpox vaccines: Jynneos and ACAM2000 have been approved by the FDA to prevent monkeypox. However, due to a limited supply of vaccines, only certain groups are eligible to receive it. According to an information page on nyc.gov, in order to be eligible for monkeypox vaccinations in New York City, one must be a “gay, bisexual, or other man who has sex with men, and/or transgender, gender non-conforming, or gender non-binary” who is “age 18 or older” and has “had multiple or anonymous sex partners in the last 14 days.”
“If someone is in a category where they meet criteria to receive the vaccine I would strongly recommend that they do so,” Grossberg advised.
For the population that is ineligible for the vaccine, preventative measures might include frequent hand-washing, practicing safe sex, and avoiding unnecessary skin-to-skin contact.
