(CNN) — Monkeypox continues to spread in the United States and around the world: at least 16,000 infections have been documented in more than 40 countries. In fact, the World Health Organization has already declared it a public health emergency of international concern. Meanwhile, the US Centers for Disease Control and Prevention (CDC) report more than 3,000 infectionsjust two months after the first case of this monkeypox outbreak was detected in the country.
Now, how worried should people be about getting monkeypox? Should everyone try to get vaccinated? Which groups are most at risk and what actions should they take? How exactly is monkeypox spread, and how can people try to avoid getting it? What are common symptoms to watch for?
To help us better understand monkeypox and the risk it poses, I spoke with Dr. Leana Wen, a CNN medical analyst, emergency room doctor, and professor of health policy and management at the Milken School of Public Health at George Washington University. Wen is also the author of the book Lifelines: A Doctor’s Journey in the Fight for Public Health.
How is monkeypox spread? Is it just as transmissible as covid-19, another disease that we already know quite well?
Monkeypox does not spread like covid-19. As we now know, covid-19 is highly transmissible and can be spread through microscopic aerosols. That means you could be infected by casually chatting with a person who has the virus or even by someone in the same room or restaurant as you.
Meanwhile, monkeypox is mainly transmitted through prolonged and direct skin-to-skin contact. Although most cases so far have been linked to sexual activity, it is not considered a sexually transmitted infection. Rather, people can spread monkeypox through intimate contact, such as kissing, hugging, cuddling, and having sex.
People with injuries can also spread the virus on sheets, towels, and other household clothing, which can ultimately spread the virus to more people. This is why people with active monkeypox lesions are instructed not to share with other potentially contaminated items such as sheets, towels, drinking glasses, and eating utensils.
What kind of symptoms do patients with monkeypox suffer from?
People who get monkeypox often first develop a fever, headache, muscle aches, and general fatigue. Precisely, symptoms similar to other viral diseases. Many people also have swollen lymph nodes. They then develop a rash that leads to blisters, pimples, or sores. The lesions can be all over the body or just one part. They can be located only in the anal or genital area, on the face, inside the mouth, or anywhere else on the body.
A large study recently published in the journal New England Journal of Medicine evaluated 528 infections at 43 sites in 16 countries. The research found that the most common symptoms are fever, tiredness, muscle aches and swollen lymph nodes. Almost everyone got a blistering rash, although some people had only one sore, while others had several or more. Some only had sores inside their mouths or in the anal or genital area.
Physicians caring for patients with fever and new rashes should have a very low threshold for testing for monkeypox. Especially if the patient is in a high-risk group for the disease. Importantly, the recent study also found that 29% of people diagnosed with monkeypox had a sexually transmitted infection. To me, this highlights that just because a patient is diagnosed with one thing doesn’t mean she can’t have another as well. And patients in high-risk groups who develop new lesions should be tested for monkeypox.
What started monkeypox and how widespread is it in the United States?
Monkeypox is a virus that belongs to the same family as the smallpox virus. It was first discovered in 1958 in monkeys, hence its name, although its animal hosts are usually rodents and other small mammals. The disease first appeared in humans in 1970, in East Africa. It has since been endemic in sub-Saharan African countries, and outbreaks sometimes occur when infected travelers bring the disease back to their countries of origin. Furthermore, there was a large outbreak in the United States during 2003 due to imported rodents.
However, this outbreak is much larger. More than 3,000 people have been infected in the United States so far, with infections reported in nearly every state. The CDC has an up-to-date map of cases and infections here.
Who are the people in the high-risk groups for getting monkeypox?
Until now, monkeypox has predominantly affected homosexuals, bisexuals, and other men who have sex with men. In the international case series of New England Journal of Medicine, 98% of people with monkeypox were homosexual or bisexual, and transmission was related to sexual activity in 95% of cases. The CDC have said that the “vast majority” of cases in the United States are reported in men who have sex with men, with an average age of 36 years.
Currently, those at high risk are men who have sex with men, and who have sex with multiple or anonymous partners. There are also reports in the United States of some women and two children who have been infected with monkeypox, who are believed to be direct contacts of men who have sex with men.
Has anyone died of monkeypox?
Monkeypox usually has a fatality rate from 3% to 6%, according to the World Health Organization. Fortunately, no one has died from monkeypox in the United States yet. But this is a painful disease that can lead to serious illness and death. Particularly vulnerable people include pregnant women, young children, and people who are immunosuppressed.
How concerned should people be about monkeypox?
Because of the way monkeypox is spread, it is not yet a concern for most Americans. However, gay, bisexual, and other men who have sex with men, who share intimate contact with multiple or anonymous people, are at high risk.
These individuals should seek screening immediately if they have a new rash or sore. They must also avoid close physical contact while they get the results. People who want to reduce their risk should avoid going to clubs, raves, sex parties, and other crowded places where there is prolonged skin-to-skin or face-to-face contact with people who may be wearing less clothing.
Should everyone try to get vaccinated against monkeypox?
No. First of all, the monkeypox vaccine is extremely limited at this time. Some 300,000 doses of the two-dose vaccine have been delivered so far. A much lower figure than the 1.5 million people the CDC says are eligible.
Those who should definitely get vaccinated are those with a known exposure to someone with monkeypox. Yes Is administered within four days of exposure, the vaccine can prevent someone from developing the disease. If given within two weeks, it decreases the chance of progression to a serious condition.
I hope that soon there will be enough vaccine so that people in high-risk groups can access it. But, given the way monkeypox spreads, most Americans probably won’t get it. And a mass vaccination campaign targeting the general population is not likely to be recommended any time soon.
Is monkeypox another endemic virus in the United States?
I really hope not. It is still possible to contain monkeypox through testing and vaccination. I hope that the WHO’s declaration of a global health emergency will prompt more countries, including our own, to do everything they can to try to prevent monkeypox from taking hold and becoming endemic.