The Margin: What are the monkeypox symptoms? Who can get a vaccine? What to know about the virus and how it spreads

As global monkeypox cases spread, and the United States now leads the world in most known cases, there are plenty of questions about how people can protect themselves.

The World Health Organization recently declared monkeypox a global emergency, since the virus that for decades was limited to parts of central and west Africa has now spread to more than 70 countries.

More than 16,000 cases of monkeypox have been reported in 74 countries since about May, according to the Centers for Disease Control and Prevention. The United States has identified more than 3,400 cases of monkeypox across 45 states, Washington, D.C. and Puerto Rico in 2022, and the CDC says the U.S. now leads globally in known monkeypox cases. While health experts are concerned about these cases, officials from WHO and the CDC have also said that “this is not COVID” all over again.

“We need to slow it down, but it does not spread in the air and we have vaccines to protect against it,” said Dr. David Heymann, a leading WHO adviser.

Read more: Monkeypox declared a global emergency by World Health Organization

The U.S. has released the Jynneos monkeypox vaccine, made by Bavarian Nordic
from its national stockpile to help prevent the virus from spreading. And the government has purchased more than 1.1 million more doses, which should soon begin shipping to the U.S.

Here is what else you need to know about monkeypox:

What is monkeypox?

Monkeypox is a rare viral disease that occurs mostly in central and western Africa, and was first identified in lab monkeys in 1958. The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo. The virus originated from wild animals like rodents and non-human primates (such as its namesake, monkeys), according to the CDC website, and it is part of the same virus genus as smallpox.

What are the monkeypox symptoms to look out for?

The symptoms are similar to smallpox, but milder. Most monkeypox patients experience minor flu-like symptoms such as fever, body aches, chills and fatigue, while those with more serious cases could also develop rashes or other skin abrasions, which can include fluid-filled bumps, or pox.

Most people recover within about two to four weeks without needing to be hospitalized. Monkeypox can be fatal for 3% to 6% of cases, however, and it is thought to be more severe in children, according to the World Health Organization.

There is still little information on any asymptomatic infections of monkeypox.

The CDC says risk to the general public is low, but you should still seek medical care immediately if you develop any new, unexplained skin rashes on any part of your body, with or without fever and chills. And if you do develop these kinds of lesions, avoid contact with others. 

You should also call ahead before going to a healthcare facility, if possible. If you can’t phone ahead, then tell a staff member as soon as you arrive that you are concerned you may have monkeypox. And you should delay using public transportation until you have been cleared by a healthcare professional or public health officials.

Finally, tell your doctor if in the month before developing symptoms, you:

had contact with a person that might have had monkeypox.

are a man who has had intimate contact (including sex) with other men.

were in an area where monkeypox has been reported (currently, Europe, North America, Australia) or in an area where monkeypox is more commonly found (the Democratic Republic of the Congo, Republic of the Congo, Nigeria, Central African Republic, Cameroon, Côte d’Ivoire, Gabon, Liberia, Sierra Leone, Sudan).

How is monkeypox spread?

Monkeypox transmission occurs when a person encounters the virus through close contact with another human, an animal, or items that could be contaminated with body fluids carrying the disease.

“Animal-to-human transmission may occur by bite or scratch, bush meat preparation, direct contact with body fluids or lesion material, or indirect contact with lesion material, such as through contaminated bedding,” the CDC website noted.

“Human-to-human transmission is thought to occur primarily through large respiratory droplets. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required,” the CDC adds. “Other human-to-human methods of transmission include direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens.”

Related: Quest Diagnostics launches monkeypox test

While this disease can be spread through various forms of sex, similar to many viral infections like the common cold or the flu, the CDC has stated that monkeypox is not a sexually transmitted disease like HIV or hepatitis. Some U.S. health experts have been speculating over whether monkeypox might be on the verge of becoming an entrenched sexually transmitted infection in the country, however, like gonorrhea, herpes and HIV. That’s because WHO’s top monkeypox expert, Dr. Rosamund Lewis, reported that that 99% of all the monkeypox cases reported outside of Africa were in men, and of those, 98% involved men who have sex with men, the Associated Press reported. Experts suspect the monkeypox outbreaks in Europe and North America were spread from sex at two raves in Belgium and Spain.

But it should be noted that anyone can be infected through close contact with a sick person, their clothing or bedsheets. The CDC also notes some cases were also reported in people who live in the same household as an infected person. And scientists have said it will be difficult to disentangle whether the spread is being driven by sex or merely close contact.

CDC director Walensky said that while some American patients had traveled to areas where monkeypox has been spreading recently, that’s not true for every one, so “we need to presume that there is some community spread.”

What is the CDC’s monkeypox travel warning?

The CDC has three travel advisory levels that it uses when cases of a disease have been reported in dozens of destinations, which include:

• Watch — Level 1: Practice usual precautions• Alert — Level 2: Practice enhanced precautions• Warning — Level 3: Avoid nonessential travel

It has issued a “Level 2” warning for travelers related to monkeypox, suggesting the following precautions:

Avoid close contact with sick people, including those with skin lesions or genital lesions.

Avoid contact with dead or live wild animals, such as small mammals including rodents (rats, squirrels) and non-human primates (monkeys, apes).

Avoid eating or preparing meat from wild game (bush meat) or using products derived from wild animals from Africa (creams, lotions, powders).

Avoid contact with contaminated materials used by sick people (such as clothing, bedding, or materials used in healthcare settings) or that came into contact with infected animals.

Is monkeypox related to smallpox?

The monkeypox virus belongs to a subset of the Poxviridae family of viruses called Orthopoxvirus, and that subset of viruses also includes smallpox, vaccinia and cowpox viruses.

All of the above viruses in the Poxviridae family often can lead to “pox”-like symptoms like rashes, pimples and other lesions on the skin.

See also: Moderna says it will start developing a monkeypox vaccine

Additionally, the WHO says monkeypox is “clinically less severe” than smallpox.

Can monkeypox be cured or treated?

There is currently no specific treatment approved for the monkeypox virus, the CDC says, but antiviral medications developed for smallpox like Tecovirimat (aka TPOXX) may prove beneficial. And there are vaccines that help prevent monkeypox infections.

Where has monkeypox been reported in the U.S.?

U.S. monkeypox cases are usually very rare, according to the CDC. But the U.S. has identified more than 3,400 cases of monkeypox across 45 states, Washington, D.C. and Puerto Rico in 2022, and the CDC says, and America now leads globally in known monkeypox cases.

Last November, the Maryland department of health and the CDC confirmed a case of monkeypox in November from a U.S. resident who had recently returned from Nigeria. That person presented with mild symptom, and was not hospitalized. In July 2021, the CDC and the Texas Department of State Health Services confirmed a case of monkeypox from a U.S. citizen who traveled from Nigeria. 

Who is eligible for a monkeypox vaccine?

Jynneos (also known by the brand names Imvamune or Imvanex) has been licensed in the United States to prevent monkeypox and smallpox. In June, the U.S. had 72,000 Jynneos doses on hand. The government has also purchased more than 1.1 million doses of the vaccine, made by Bavarian Nordic in Denmark. And the country also has 100 million doses of the older smallpox vaccine, which could potentially be used.

But the Jynneos vaccine, given as two doses four weeks apart, was largely being reserved for health-care workers and people who have been exposed to monkeypox, and is not intended to be a mass vaccination effort. Maria Van Kerkhove, the WHO’s emerging diseases and zoonoses lead, and technical lead on COVID-19, said in a Q&A, “We will be making recommendations on who should be prioritized for this” soon.

Related: FDA clears way for more monkeypox vaccine shipments to U.S.

“Right now we are hoping to maximize vaccine distribution to those that we know would benefit from it,” Captain Jennifer McQuiston, deputy director of the CDC’s High Consequence Pathogens and Pathology Division, told Reuters. “So those are people who’ve had contact with known monkeypox patients, healthcare workers, very close personal contacts, and those in particular who might be at high risk for severe disease.”

But some places have expanded eligibility to deal with larger outbreaks. New York City opened a monkeypox vaccine clinic. The NYC health department has also opened eligibility to all gay, bisexual and other men who have sex with men (cisgender or transgender) who are 18 and older who have had multiple or anonymous sex partners in the past 14 days.

Read more: Monkeypox vaccine clinic opens in NYC — here’s who is eligible

Since the monkeypox virus is closely related to the virus that causes smallpox, smallpox vaccines can also protect people from getting monkeypox. The original smallpox vaccine, ACAM2000, was shown to be about 85% effective in preventing monkeypox, although there were some serious side effects. In fact, roughly half of all Americans have some immunity against monkeypox because they were vaccinated against smallpox, although smallpox vaccinations mostly ended in 1972, after the disease was eradicated in the country.

What are the U.S. and President Joe Biden doing about monkeypox?

Earlier in the spring, President Joe Biden said that the monkeypox disease is a “concern in that if it were to spread it would be consequential.” But Biden has not yet publicly commented on any detailed U.S. plan for vaccinations against monkeypox, should they be necessary. But in light of WHO declaring monkeypox a global emergency, the Biden administration is reportedly deliberating whether to declare the nation’s monkeypox outbreak a public health emergency, as well, the Washington Post reported. Biden also plans to name a White House coordinator to oversee the response, according to the Post.

The White House recently announced that it is expanding monkeypox testing to commercial laboratories, to ensure the nation is not undercounting monkeypox cases due to insufficient testing.  And the FDA recently cleared the way for thousands more doses of monkeypox vaccine to ship to the U.S.

This article was originally published in May 2022, and has been updated with the latest data, and the World Health Organization naming monkeypox a global emergency.

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