The Biden administration has declared the monkeypox outbreak in the US to be a public health emergency.
“We’re prepared to take our response to the next level in addressing this virus, and we urge every American to take this virus seriously and to take responsibility to help us tackle this virus,” US Department of Health and Human Services Secretary Xavier Becerra said.
Monkeypox is a poxvirus, related to smallpox and cowpox. It generally causes pimple- or blister-like lesions and flu-like symptoms such as fever, according to the US Centers for Disease Control and Prevention.
The lesions typically concentrate on the arms and legs, but in this outbreak, they’re showing up more frequently on the genital and perianal area.
“Classically, it presents like many other viral illnesses with what’s called a viral prodrome, and symptoms like fevers, chills, swollen lymph nodes, fatigue and muscle aches are common. Within five days of the starting prodrome, patients develop a rash that can look like pimples or blisters,” said Dr. Jason Zucker, an infectious diseases specialist at NewYork-Presbyterian/Columbia University Irving Medical Center.
Monkeypox spreads through close contact, according to the CDC. That includes direct physical contact with lesions as well as “respiratory secretions” through face-to-face interaction and touching objects that have been contaminated or fluid by monkeypox. The virus may also pass to a fetus through the placenta.
Many of the cases in the outbreak appear to be connected to sexual contact, often during sex. The CDC says research is ongoing on whether monkeypox can spread through semen or vaginal fluids, or whether the virus can spread asymptomatically.
Anyone who has had contact with someone with a monkeypox-like rash, or who has had contact with someone who has a probable or confirmed case of monkeypox, is at high risk for infection.
However, a large number of cases in this outbreak have been in men who have sex with men, including gay and bisexual men, and public health officials are focusing their prevention efforts in this group. The virus is not unique to this community, but the nature of its close-contact spread has led to a disproportionate impact.
“The vast majority of those who have been diagnosed to date with human monkeypox virus are self-identifying men who have sex with men,” Zucker said.
“This is likely due to shared sexual networks. So what we’re seeing is, they’re seeing it first and experiencing the majority of cases. Just like other diseases, there’s no reason it can’t spread to other communities via sexual or other close contact,” he said.
According to the CDC, those at higher risk during this outbreak include people who “had skin-to-skin contact with someone in a social network experiencing monkeypox activity,” including men who have sex with men who meet partners online, through an app or at the social event.
People with conditions involving a weakened immune system like HIV and eczema, and children under 8 may also be at higher risk of severe illness if infected, according to the CDC.
If you notice a new rash or other monkeypox symptoms, avoid any close contact with other people until you have seen a doctor and gotten tested.
“When you see a healthcare provider, wear a mask, and remind them that the virus is circulating in the area,” the CDC says.
If you’re diagnosed with monkeypox, the agency recommends isolation at home and away from family members until the rash or lesions are gone.
According to the CDC, there is no approved treatment specific for monkeypox. But because it’s genetically similar to smallpox, doctors can use similar treatments, such as antiviral medications.
The CDC is making doses of tecovirimat, an antiviral medication also known as Tpoxx, available for monkeypox patients at risk of severe disease. This may include those whose infection has advanced into the severe stage and people with weakened immune systems. The National Institute of Allergy and Infectious Diseases has also announced a study of Tpoxx as a monkeypox treatment.
Treatment for monkeypox should also include efforts to manage symptoms and complications, according to the World Health Organization.
Two vaccines are available in the US to prevent monkeypox, but not everyone is eligible to get one.
The US has “ample supply” of the smallpox vaccine ACAM2000, which can also be used to prevent monkeypox. However, it shouldn’t be used in people with certain health conditions, according to the CDC.
“We have 100 million doses of ACAM2000,” National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci said in late June, but its side effects mean that it “in my mind as a public health person, would not be worth giving it widely throughout the general population.”
Another vaccine, Jynneos, is specifically intended for monkeypox, but it’s in short supply. Federal stock is being distributed to municipalities based on the number of cases and the population at risk in a given area.
According to the US Department of Health and Human Services, more than 600,000 doses of Jynneos have been distributed from the Strategic National Stockpile and another 150,000 doses are expected to arrive in September. The CDC has estimated at least 1.5 million people in the US are eligible for monkeypox vaccination.
The federal government has proposed changing how vaccines are physically given, which may mean the current supply could stretch further.
Jynneos is a two-dose vaccine, with a four-week gap between doses. But in light of the shortages, some experts have called for a single-dose regimen until supply improves.
Monkeypox vaccination can be used as pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP) and outbreak response PEP (PEP++), according to the CDC.
PrEP refers to vaccinations given to members of high-risk communities, such as lab or health care workers, before they may come into contact with the virus.
PEP means vaccinating people after a known exposure to prevent disease or help ease symptoms. For prevention, the CDC recommends that the vaccine be given up to four days after exposure. PEP given four to 14 days after exposure may result in milder disease.
PEP++ is the CDC approach for people with unconfirmed exposure to the virus but with risk factors that may make them more likely to get it.
“When coupled with self-isolation and other prevention measures when symptoms first occur, PEP++ may help slow the spread of the disease in areas with large numbers of monkeypox cases,” the CDC says.
Monkeypox vaccine demand is high, but supply shortages and eligibility restrictions mean it can be difficult to find at this point.
Eligibility for the vaccines remains somewhat strict.
People who are known, confirmed contacts of people with monkeypox are eligible to be vaccinated. Also eligible are presumed contacts who had a sex partner in the past 14 days diagnosed with monkeypox, those who had multiple sex partners in the past 14 days in an area where monkeypox is spreading, and those whose jobs may expose them to monkeypox, according to the CDC.
If you think you meet one of these criteria and want to find out about your eligibility, contact your doctor or your local health department.
The CDC recommends avoiding close contact or sharing objects with someone with monkeypox. Frequent hand-washing is also recommended.
For social gatherings including parties, raves, clubs and festivals, the CDC says to stick to events with more clothing, where skin-to-skin contact may be less frequent.
Avoid sex or close physical intimacy if any person involved has monkeypox. The CDC specifically recommends to avoid touching any rash that may be on a partner’s body. To help prevent the spread of monkeypox while sexually active, maintaining 6 feet of distance, keeping clothes on during sex, and using condoms and/or gloves can lower chances of exposure.
“However, condoms alone may not prevent all exposures to monkeypox, since the rash can occur on other parts of the body,” the CDC says.
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