Monkeypox is taking over headlines, but what is fact versus fiction? Daniel Bausch, MD sat down with Research!America on August 3rd to discuss the most recent global health emergency. Dr. Bausch is the Senior Director of Emerging Threats & Global Health Security at FIND and President of the American Society of Tropical Medicine and Hygiene (ASTMH). In this article, I summarize the main points conveyed by Dr. Bausch.
What is monkeypox?
Monkeypox is a type of Orthopoxvirus (smallpox also belongs to this genus of viruses) which is endemic to sub-Saharan Africa. The virus is maintained in nature by small mammals – this can include monkeys, but the virus is passed to humans mostly through small rodents. The first human case of monkeypox was documented in 1970 in the Democratic Republic of Congo. The virus results in symptoms such as fever, headache, swollen lymph glands, and a rash that starts out looking like chicken pox. The rash can turn into pus-filled lesions, which eventually dry out and scab over.
There are two strains of the monkeypox virus – the first is found in Congo and can be quite severe. The second is found in west Africa and has a lesser fatality rate of 1-3%. This second strain is what has now spread to Europe and beyond. The monkeypox virus is composed of DNA, so it would have lower rates of mutation than RNA viruses, like SARS-CoV-2. Currently, there are around 25,000 confirmed cases of monkeypox around the world, about 70% of which are in Europe. There have been 9 documented deaths so far. The World Health Organization (WHO) recently declared monkeypox to be a public health emergency of international concern.
How does it spread?
Monkeypox is spread from human to human through prolonged direct contact. 98% of cases are currently reported to be in people who had engaged in sexual intercourse with someone positive for monkeypox. However, monkeypox is likely not a sexually transmitted disease in the classic sense, like HIV. For example, having protected sex with a condom wouldn’t necessarily protect someone from spreading monkeypox to their partner. The virus lives mainly in the pustules on the skin, so again, any direct contact with someone with the virus can lead to the spread of monkeypox. Even handling the clothes or bed sheets of an infected person may lead to contraction of the virus because those materials have been in contact with the afflicted person’s skin. Also keep in mind that many cases in Europe, the U.S., etc. are mild (i.e., mild rash), so it could be hard to tell if one’s sexual partner is positive for monkeypox.
What do we do about it?
Currently, the #1 tool to combat the spread of monkeypox is behavior modification. Avoid close contact with anyone who is confirmed to be positive for the virus. Remember that monkeypox is spread through direct physical contact with an infected person, but respiratory transmission through the air is not a concern for monkeypox like it is for COVID-19, for example.
Another important thing you can do about monkeypox is avoid spreading misinformation. To date, monkeypox has mostly been spread between men who have sex with men. But as stated before, monkeypox is NOT currently considered a sexually transmitted disease. Gay men just happen to be the group of people in which the virus is mainly spreading right now. Certain populations, such as those who identify as straight, are NOT protected from the virus.
What are the treatment and prevention options?
The treatment options for monkeypox are out there, but difficult to access. TPOXX is an antiviral drug that could work well against monkeypox (it was approved by the FDA to treat smallpox in 2018), but doctors must request access to it from the CDC or their local health department and submit lab tests and paperwork. The government is working to reduce the barriers to this treatment, but it still takes extra time and effort to prescribe TPOXX to patients.
As far as a vaccine is concerned, Jynneos is indicated for vaccination against smallpox and monkeypox, but there are significant supply issues. Bavarian Nordic has ramped up their manufacturing of Jynneos, but there is likely to be a months-long delay before supply starts to catch up to demand. Scientists are also working to determine how best to use the vaccine. For example, should we only vaccinate people who have already been exposed, or administer it pre-exposure to people who have a higher risk of contracting the virus? Discussion among global health leaders is ongoing to determine the best course of action.
What are the next steps for scientists/global leaders?
Unfortunately, we shouldn’t be surprised that monkeypox has spread to populations beyond Africa, although it is still too early to say if monkeypox will become a disease endemic to the U.S. that sticks around. Our planet is connected – more than ever before – and the idea that there are remote diseases that don’t affect you simply isn’t valid anymore. As Dr. Bausch states in a recent article in The Telegraph, we must expand our efforts to control infectious diseases in the places where they are endemic, not waiting until they reach high-income areas of the world. This means that we need to “level the playing field of public health” so that all countries have efficient disease surveillance systems and so every individual has access to reliable tests, vaccines, and medications when and where they need them.