Monkeypox cases, rarely seen outside of countries in Africa, are rising rapidly, including in Texas, where 485 cases had been reported as of Aug. 2. As a result, physicians may be fielding questions from concerned patients.
Trish Perl, MD, a professor of infectious diseases at UT Southwestern Medical Center in Dallas and a member of the Texas Medical Association’s Committee on Infectious Diseases, and John Carlo, MD, a public health specialist in Dallas, encourage their fellow physicians to be on the lookout for symptoms – and offer some suggested answers.
The Texas Medical Association also has compiled a four-page fact sheet, Monkeypox: What Physicians Need to Know, with basic guidance.
What is monkeypox and why have I not heard of it before? I thought smallpox was eradicated.
Monkeypox is a rare viral disease linked to the same family of viruses as smallpox, according to the Centers for Disease Control and Prevention (CDC).
The World Health Organization (WHO) declared smallpox eradicated in 1980 because of widespread vaccination. The U.S. stopped routine smallpox vaccination even earlier, in 1972, just two years after the first monkeypox case was recorded in humans. Because the two viruses are closely related, the smallpox vaccine can protect people from getting monkeypox, and stockpiled vaccines and treatments are proving useful amid the current outbreak.
CDC began investigating monkeypox cases in the U.S. in mid-May. The Biden administration designated the outbreak a public health emergency in early August, shortly after WHO declared a global health emergency related to the virus in late July.
Dr. Perl says it’s “very unusual” to see monkeypox in countries outside of Africa, where it’s endemic. She adds that the current outbreak is concerning because of the way it’s spreading – largely from person to person, whereas previous outbreaks have been linked to travel or infected animals – and because of the exponential growth in new confirmed cases.
What are the symptoms and how does it spread?
Monkeypox typically presents symptoms similar to smallpox – including a characteristic rash that may look like pimples or blisters accompanied by fever, headache, muscle aches, swollen lymph nodes, chills, and exhaustion – but is often milder and rarely fatal.
Symptoms usually start one to two weeks after exposure, with a rash appearing one to three days after symptom onset. During the current outbreak, monkeypox cases have often included a rash in the genital region, which may be confused with common sexually transmitted diseases, and which sometimes appears without any other symptoms.
Monkeypox can spread through direct contact with infected people or animals, primarily through skin-to-skin contact. Dr. Perl says patients often ask how much skin-to-skin contact is required for the virus to spread. For example, will a handshake put someone at risk?
“You need to have contact with the lesions,” she explained.
An infected person can spread monkeypox from the time their symptoms start to when any scabs heal and fall off. Most cases in the current outbreak have developed after prolonged skin-to-skin contact among sexual partners or household contacts.
How does monkeypox compare with COVID-19?
There are some key differences between the two viruses.
Unlike COVID-19, monkeypox isn’t known to “linger in the air and is not transmitted during short periods of shared airspace,” as CDC reported in June. The federal agency adds that, in cases where people with monkeypox have traveled by plane, they have not spread the disease to those sitting around them.
Dr. Perl reiterates: “It’s not transmitted at all in the same way that COVID is transmitted.”
Still, CDC recommends people with monkeypox wear a mask when in close contact with others because the virus can be found in their saliva and mucus.
Dr. Perl also points out it’s unlikely that patients can contract monkeypox more than once, since pox viruses typically confer lifelong immunity. Also, effective vaccines can protect against monkeypox infections, an important resource that was not available during the first year of the COVID-19 pandemic.
Who’s most at risk of contracting monkeypox? Can I prevent it?
During the current outbreak, nearly all the monkeypox cases in the U.S. have been in cisgender men who have sex in men, as CDC reported during a July 26 webinar.
But Dr. Carlo, whose health center had treated roughly a dozen monkeypox patients as of late July, stresses that anyone can get monkeypox.
“The reality is there’s nothing unique about the risks of monkeypox to people who identify as gay or men who have sex with men,” he said, adding that early cases in the current outbreak were linked to social events in Europe and the U.S. largely attended by these groups. “It’s just about what was going on socially in the moment.”
To prevent monkeypox, CDC recommends avoiding close, skin-to-skin contact with people who have a rash that resembles monkeypox. This includes intimate and sexual activity, as well as contact with bedding, towels, clothing, eating utensils, and other personal items.
People who develop a new rash or symptoms associated with monkeypox should avoid close contact with others and visit their physician or a health care clinic as soon as possible.
Is there a vaccine? How can I get one?
There are two vaccines licensed by the U.S. Food and Drug Administration for the prevention of monkeypox: JYNNEOS and ACAM2000. CDC only recommends these vaccines for those who are at high risk of getting monkeypox through exposure from their job or from being in close contact with an infected person.
The Texas Department of State Health Services recently received a shipment of 14,780 doses of the JYNNEOS vaccine from the federal government and does not expect additional supply until late August or early September. Until then, the state agency will allocate doses to local health departments to vaccinate people with a documented or presumed exposure to monkeypox. Some Texas counties – including Houston and Dallas – have expanded eligibility to include those at high risk of contracting the virus.
Although a large supply of ACAM2000 is available, the vaccine isn’t recommended for use in people who are immunocompromised or who have certain health conditions, according to CDC.
Are there treatments for monkeypox?
Most people with monkeypox experience mild disease that can be treated with over-the-counter and topical medications.
There are no pharmaceutical treatments specifically for monkeypox, but antiviral drugs developed to treat smallpox may be used for high-risk patients, such as people who are immunocompromised or may be pregnant; children under 8 years old; and those with severe pain from infection.
Should I be worried this monkeypox outbreak is going to turn into another pandemic like COVID?
For now, monkeypox is largely contained to certain high-risk groups. But Dr. Perl cautions that this could change.
“Unless we have a more aggressive response, there’s certainly a risk that it could spread into other populations,” she said. “The fact that people are asking for a much more aggressive response from various health agencies is appropriate.”