Monkeypox FAQ

Despite the fact that WHO has not declared monkeypox to be a Global Health Emergency (yet!! expecting the official designation next week), I believe we all need to be paying attention to the increase in cases worldwide (including the US and my home state of PA¹). At this point in time, we all need to be educated and empowered to slow the spread of monkeypox. As a former lifeguard, I find the beach warning flags very helpful — they provide a warning scale and a clear indication of the warranted level of concern. I believe the “swimming area” flag (pictured below) is most appropriate to the monkeypox situation at this point in time. We should be paying attention to the guidance of public health and medical professionals and not engaging in risky activities (equivalent to swimming in areas without a lifeguard). You can still go to the beach but should be swimming where/when lifeguards are present.
READ: you need the guidance and should not be navigating monkeypox alone.

Photo credit

We all need to recognize the ways to prevent exposure to and spread of the disease, as well as the symptoms and treatments.

Currently, there are more than 7000 confirmed cases of monkeypox worldwide, including more than 600 in the US (in 35 states).

Note: more than 40 new monkeypox cases were diagnosed on July 6. Hence: the increase in the number of cases from 560 to over 600.

B.C. (before COVID) I often introduced students in my Epidemiology class to monkeypox by talking about the 2003 outbreak in the US that was linked to exotic pets who spread the disease to pet owners. There were a total of 71 cases in this outbreak. And it was a really big deal; 71 cases in the United States.

Six-hundred (+) cases are cause for concern. Here are answers to a set of FAQs (frequently asked questions) —

What is monkeypox?
Monkeypox is a viral (caused by a virus) zoonotic (spreads from animals to humans) disease. It is part of the orthopoxvirus family, which also includes smallpox and cowpox. Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. The disease was named monkeypox because it was first identified in monkeys. The first human cases of monkeypox were diagnosed in 1970.

The natural reservoir (the organisms or the specific environment in which an infectious pathogen naturally lives and reproduces) of the disease is unknown. But we know that rodents and other mammals can carry and transmit the virus to humans through scratches, bites, or improperly cooked animal meat.

What is up with this outbreak? when did it begin? why?
At the beginning of May 2022, a case of monkeypox in a British resident was reported who had traveled to Nigeria in areas where monkeypox is considered to be an endemic disease. The current outbreak has a different pattern of spread compared to prior monkeypox outbreaks outside Africa — it is spreading more easily/quickly from person to person. And it has spread across geographic boundaries faster than other outbreaks.

We do not know definitely why the virus is spreading so quickly and easily around the globe, but we have a few hypotheses, including —

1. Lower levels of global community/herd immunity to orthopoxvirus disease. This is due to the discontinuation of the smallpox vaccine in the 1970s.

2. Deforestation, climate change, and changes in human populations lead to an increased likelihood of disease spillover.

3. Parties — gatherings of lots of humans in close environments where skin-to-skin contact can occur (read: human behavior can lead to human-to-human transmission).

It is important to note that the cause of the current outbreak (which is a pandemic) could be the result of all three of the causes listed above.

What are the symptoms of monkeypox?
Monkeypox typically presents with flu-like symptoms — fever, headache, muscle aches, swollen lymph nodes, and chills. And there is also the rash or sores.

Photo source.

How is monkeypox spread?
Monkeypox is spread through close, in-person, or physical contact. Human-to-human transmission can occur through respiratory droplets or aerosols from prolonged face-to-face contact, contact with bodily fluids (including the fluid from the monkeypox lesions), or indirect contact with contaminated items (like bedding or clothing) with fluids or sores/scabs. Monkeypox can spread from the time symptoms begin until the sores have healed and a fresh layer of skin forms over the rash. This can take 3-4 weeks.

It is important to note that the infectious period begins when symptoms first present. The disease is not spread before symptoms arise (read: no asymptomatic spread). And an individual can be vaccinated during the incubation period (the time between exposure and the first sign of disease) to slow the disease progression, prevent illness, and break the chain of transmission.

Who is at risk to contract monkeypox?
Anyone can develop monkeypox.

Is there a monkeypox vaccine?
Yes. Two vaccines licensed by the U.S. Food and Drug Administration (FDA) are available for preventing monkeypox infection – JYNNEOS (also known as Imvamune or Imvanex) and ACAM2000.

People can be vaccinated after they are exposed to monkeypox to help prevent illness from the monkeypox virus. It is important to identify contacts of confirmed or probable monkeypox cases to offer vaccines for post-exposure prophylaxis (PEP) and to monitor for any early signs of illness. CDC recommends that the vaccine be given within 4 days from the date of exposure for the best chance to prevent the onset of the disease. This practice of vaccinating individuals post-exposure as well as their close contacts is called “ring vaccination.”

What do you do if you have been in contact with someone who has monkeypox?
If you have been exposed to an individual with monkeypox, contact your physician right away and avoid close contact with others — this means no sex or intimate contact — until you get approval from your physician. Be prepared to be vaccinated.

What do you do if you develop a rash or sores?
If you develop a rash or sores of unknown origin, contact your physician right away and avoid close contact with others — this means no sex or intimate contact — until you get approval from your physician. Be prepared to be vaccinated.

What do you do if you are diagnosed with monkeypox?
If you are diagnosed with monkeypox, contact your physician right away and avoid close contact with others — this means no sex or intimate contact — until you get approval from your physician. Be prepared to be vaccinated.

In conclusion — monkeypox is a serious disease that can take 3-4 weeks to resolve. The disease can be severe. On average 3-6% of individuals diagnosed with monkeypox will die from the disease. But the disease is preventable — through avoidance of sick individuals and vaccinating individuals within four days of exposure.

If you have additional questions about monkeypox — ask them here.

1. A case of monkeypox was identified in Pittsburgh just yesterday. To me, this highlights that the risk of exposure is getting closer/increasing and that this is not just a problem “over there.” Rather monkeypox is an issue in my backyard.