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May 23, 2022

How big is the threat from monkeypox? Here's what experts say.

Daily Briefing

    While public health experts have voiced concern over the recent monkeypox outbreak, many say the public does not need to worry about the virus becoming an epidemic that mirrors the Covid-19 pandemic, Keren Landman writes for Vox.

    Monkeypox is in the US. Here's what you need to know.

    Recent monkeypox cases

    Monkeypox—so called because it was first identified in laboratory monkeys—is a rare viral infection that begins with flu-like symptoms and progresses to a distinctive rash on the face and body. Most infections resolve within weeks, but some cases can be fatal, according to the World Health Organization.

    People can catch monkeypox through contact with infected animals or animal products. Human-to-human transmission, meanwhile, can occur via contact with bodily fluid, sores, or items contaminated by bodily fluid, but most often occurs via large respiratory droplets, which rarely travel more than a few feet.

    Symptoms of monkeypox are typically mild, including headaches, muscle pain, chills, and swollen lymph nodes. Patients can also develop rashes on their face and body that then turn into skin lesions that eventually fall off.

    Although there are no specific treatments for monkeypox, at least one vaccine has been approved in the United States to protect against both monkeypox and smallpox.

    Last Wednesday, the Massachusetts Department of Public Health (MDPH) reported the first confirmed case this year of monkeypox in the United States in a man who had recently traveled to Canada. According to MDPH, "The case poses no risk to the public, and the individual is hospitalized and in good condition."

    MDPH said it's "working closely with the CDC, relevant local boards of health, and the patient's health care providers to identify individuals who may have been in contact with the patient while he was infectious. This contact tracing approach is the most appropriate given the nature and transmission of the virus."

    Monkeypox cases have also been popping up recently around the world. The United Kingdom has reported nine monkeypox cases, Spain has reported 23 suspected cases, Portugal has reported five and is investigating another 15, and Canadian health officials are investigating at least 15 potential cases in Montreal.

    The recent outbreak is different from previous cases because it involves many concurrent infections beyond the African countries where the disease circulates in wild animals. In addition, British officials noted that four of the nine cases it identified were among men who have sex with men, suggesting that the virus could be spreading through sexual contact—a notion that was not previously known.

    Will this outbreak turn into a pandemic?

    Amid the current international string of monkeypox cases, public health officials are questioning whether the cases are related, and whether monkeypox is circulating undetected in other communities.

    "The worldwide concern from public health authorities is trying to understand how these are related to each other and what the causes are," said Agam Rao, an infectious disease specialist and poxvirus expert at CDC.

    According to Rao, the general public does not need to be particularly concerned at this point.  "The risk is still very rare," she said, especially since the strain of the virus currently being detected is relatively mild.

    While experts have acknowledged that news of another pathogen circulating during an existing global pandemic could cause panic, they have noted stark differences between the current monkeypox outbreak and the Covid-19 pandemic.

    Unlike the Covid-19 pandemic, monkeypox is a known pathogen. There are more tools—including vaccines—available to prevent and treat monkeypox than existed when the coronavirus first emerged.

    In addition, some studies have suggested monkeypox's R0—the number of people who could contract a communicable disease from an infected individual—falls somewhere between one and two, which is relatively low.

    "It's not as highly transmissible as something like smallpox, or measles, or certainly not Covid," said Anne Rimoin, an infectious disease epidemiologist at the University of California Los Angeles with expertise in emerging diseases, including monkeypox.

    Because monkeypox "does not spread easily from person to person, the risk to the general public is low," said Rimoin. With so many public health experts on alert, the virus is more likely to be recognized quickly among those who get infected, which will further restrict the chains of transmission.

    "We'd have to see a significant cluster of cases events and ongoing transmission" before public health officials will place any widespread preventive measures in place, said Rimoin.

    Still, even a large monkeypox outbreak would likely be much easier to control than Covid-19. The virus is not considered contagious until people show symptoms, which means it could be more difficult for people to accidentally spread it. 

    Ultimately, experts say because of the Covid-19 pandemic, public health officials around the world are already in a strong place to control any sort of disease outbreak.

    "I think we're in a good position to respond to monkeypox because most health departments have staffing, lab networks, and funding from Covid that can be used for emergency response," said Jay Varma, a physician and epidemiologist based in New York City who recently served as senior advisor to the Africa Centers for Disease Control and Prevention. "The real risk is what happens when that funding runs out over the next few years." (Landman, Vox, 5/19)

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