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August 25, 2022

Monkeypox roundup: Viral transmission likely driven by sexual intercourse, not skin contact

Daily Briefing

    The World Health Organization (WHO) reports a 20% increase in monkeypox cases for the second week in a row, a CDC investigation finds traces of PCR-detected virus on frequently used household surfaces, and more in this week's roundup of monkeypox news.

    • In an Aug. 17 news conference, WHO reported a 20% increase in monkeypox cases for the second week in a row. "More than 35,000 cases of monkeypox have now been reported to WHO, from 92 countries and territories, with 12 deaths," said WHO Director-General Tedros Adhanom Ghebreyesus. "Almost 7,500 cases were reported last week, a 20 percent increase over the previous week, which was also 20 percent more than the week before." According to Tedros, most new infections have been reported among men who have sex with men (MSM). (Carbajal, Becker's Hospital Review, 8/18)
    • After WHO announced on Aug. 12 that it was accepting suggestions to rename monkeypox to reduce stigma and adhere to best practices for naming diseases, the agency has received many submissions to its International Classification of Diseases website, including "humanpox," "lymphpox," "mpox," "Grey pox," and "doloropox." According to WHO, the virus was named after it was initially identified in laboratory monkeys in 1958—before the establishment of best practices for naming diseases. While the virus is currently named monkeypox, its original source is unknown, and other species can carry the disease. "Current best practice is that newly-identified viruses, related disease and virus variants should be given names with the aim to avoid causing offense to any cultural, social, national, regional, professional or ethnic groups, and minimize any negative impact on trade, travel, tourism or animal welfare," WHO said. Jeremy Faust, an emergency medicine physician at Brigham and Women's Hospital, submitted a proposal to call the disease "orthopoxvirus disease 2022" or "OPOXID-22." According to Faust, "OPOXID-22 is easy to pronounce and reflects what we know about this virus. Additionally, it removes 'monkey' from the name, which is likely to not be the animal reservoir for this disease. Additionally, it is specific enough to be distinguishable from other future diseases, both zoonotic or otherwise." While WHO has not established a clear timeline, the agency said that a committee will consider the proposed name changes and vote on a new name. (Carbajal, Becker's Hospital Review, 8/22)
    • A CDC investigation found that frequently used household surfaces in the home of two symptomatic individuals infected with monkeypox were covered in PCR-detected virus. Of the 30 samples taken 20 days after the patients' isolation began, 70% came back positive for non-variola orthopoxvirus on real-time positive PCR tests, according to a researcher team led by Jack Pfeiffer of CDC's Epidemic Intelligence Service and of the Utah Department of Health and Human Services. The positive swabs came from non-porous items (including a toilet seat, light switch, sink handle, banister, and computer mouse), porous objects (including a couch, blankets, and a chaise lounge), and a desk chair, which was considered a "mixed porous" object. Results from the patients' TV remote, bathroom door handle, and thermostat were inconclusive. However, none of the culture results in the lab were positive. "The inability to detect viable virus suggests that virus viability might have decayed over time or through chemical or environmental inactivation," wrote Pfeiffer and his colleagues in CDC's Morbidity and Mortality Weekly Report. "Although both patients were symptomatic and isolated in their home for more than 3 weeks, their cleaning and disinfection practices during this period might have limited the level of contamination within the household." (Hein, MedPage Today, 8/19)

       

    • In a survey released Monday by CDC, around 50% of men who have sex with men (MSM) said they reduced their number of sexual partners and encounters in response to the monkeypox outbreak. Overall, 48% of participants said they reduced their number of sexual partners, 50% said they reduced their number of one-time sexual encounters, and 49% said they reduced the number of sexual encounters they had with partners they met on dating apps or through sexual venues. While public health agencies, including WHO and CDC, have suggested that MSM consider reducing their number of sexual partners amid the ongoing outbreak, many officials have advised MSM to practice safe sexual conduct instead of advising abstinence. (Choi, The Hill, 8/22)

       

    • A growing body of evidence—which includes three studies recently published in peer-reviewed journals and reports fromnationalregionaland global health experts—suggests that global monkeypox transmission may be primarily driven by sexual intercourse. According to this evidence, the skin-to-skin contact that occurs during intercourse likely poses a much smaller risk than the act of sex itself. "A growing body of evidence supports that sexual transmission, particularly through seminal fluids, is occurring with the current MPX outbreak," said Aniruddha Hazra, medical director of the University of Chicago Sexual Wellness Clinic. Understanding the primary risk factors for transmission is key to reducing the risk of infection. Many experts have urged CDC and other public health authorities to update their monkeypox communication strategies to better emphasize the potential risk of intercourse among MSM, who currently make up almost all U.S. cases. However, Rosamund Lewis, WHO's technical lead for monkeypox, told NBC News that it is "unfortunate but true" that "we don't know yet" if monkeypox is primarily transmitted through intercourse. "Completely reading the situation as uniquely due to anal or oral sex is highly likely to be overreach," she added. "The correlation may appear to be strong, but that does not explain the whole picture of disease caused by this virus. So we need to keep an open mind." (Ryan, NBC News, 8/17)

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