How worried should people be about contracting monkey pox? Should everyone try to get the vaccine? Who are the most at-risk groups and what actions should they take? How exactly is monkey pox spread and how can people be prevented from trying to contract it? What are the common symptoms to look out for?
To help us better understand monkeypox and the risk it poses, I spoke with CNN medical analyst Dr. Leana Wen, an emergency physician and professor of health policy and management in the School of Public Health from the Milken Institute at George Washington University. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”
CNN: How does monkeypox spread? Is it as transmissible as Covid-19, another disease we already know very well?
Dr. Leana Wen: Monkey pox does not spread like Covid-19. As we already know, Covid-19 is highly transmissible and can be spread through microscopic aerosols. This means that you could be infected by someone you are having a casual conversation with or even someone who is in the same conference room or restaurant as you.
Monkey pox is primarily transmitted through direct and prolonged skin-to-skin contact. Most cases so far have been linked to sexual activity, although this is not considered a sexually transmitted infection. Rather, people can spread monkeypox through intimate contact, such as kissing, hugging, cuddling, and having sex.
People who have sores can also spread the virus on sheets, towels, and other linens that can spread the virus to other people. That’s why people with active monkeypox lesions are told not to share potentially contaminated items such as sheets, towels, glasses, and eating utensils with others.
CNN: What kinds of symptoms do monkeypox patients have?
Wen: People who contract monkeypox often begin to develop fever, headache, muscle aches and general fatigue, similar to many other viral illnesses. Many people also have swollen lymph nodes. They then develop a rash that progresses to blisters, pimples or sores. The injuries can be all over the body or only in one part. It can be located only in the anal or genital area, on the face, inside the mouth or any other part of the body.
A large study recently published in the New England Journal of Medicine examined 528 infections at 43 sites in 16 countries. He found that the most common symptoms are fever, tiredness, muscle aches and swollen lymph nodes. Almost all had a blistering rash, although some individuals had only one lesion, while others had several or more. Some people only had sores inside the mouth or in the anal or genital areas.
Clinicians seeing patients with fever and a new rash should have a low threshold for testing for monkeypox, especially if the patient is in a high-risk group for contracting monkeypox. Importantly, the recent study also found that 29% of people diagnosed with monkeypox had a sexually transmitted infection. To me, that means that just because a patient has a diagnosis of one thing doesn’t mean they can’t have another, and that patients in high-risk groups who have new lesions should be a test to rule out monkey pox.
CNN: What started monkeypox and how widespread is it in the United States?
Wen: Monkeypox is a virus in the same family as the smallpox virus. It was first discovered in 1958 in monkeys, hence the name, although its usual animal hosts are rodents and other small mammals. It first appeared in humans in 1970 in East Africa. It has been endemic in sub-Saharan African countries, with outbreaks sometimes occurring when infected travelers return the disease to their countries of origin. There was a large outbreak in the United States in 2003 due to imported rodents.
This outbreak is much bigger. So far, more than 3,000 people have been infected in the United States, with infections seen in nearly every state. The CDC has an updated map of cases and infections here.
CNN: Who are the individuals in the high-risk groups for contracting monkeypox?
Wen: Until now, monkeypox has predominantly affected gay, bisexual, and other men who have sex with men. In the international case series in the New England Journal of Medicine, 98% of people with monkeypox were gay or bisexual, and transmission was related to sexual activity in 95% of cases. The US Centers for Disease Control and Prevention has said the “vast majority” of cases in the US are in men who have sex with men, with an average age of 36. Currently, people at high risk are men who have sex with men. and who have sexual relations with multiple or anonymous partners. There are also reports in the United States of some women and two children contracting monkeypox, believed to be direct contacts of men who have sex with men.
CNN: Has anyone died from monkey pox?
Wen: Monkeypox usually has a mortality rate of 3% to 6%, according to the World Health Organization. Fortunately, no one has yet died from monkeypox in the United States, but this is a painful disease that can lead to serious illness and death. People who are particularly vulnerable include pregnant women, young children and immunocompromised people.
CNN: How worried should people be about monkeypox?
Wen: 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 have intimate contact with multiple or anonymous people, are at high risk.
These people should get tested immediately if they develop a new rash or ulcer and should avoid close physical contact in the meantime. People who want to reduce their risk should avoid crowded clubs, raves, sex parties, and other places where there is prolonged skin-to-skin or face-to-face contact with many people who may be wearing less clothing.
CNN: Should everyone try to get the monkeypox vaccine?
Wen: No. First, the monkeypox vaccine is extremely limited right now. About 300,000 doses of the two-dose vaccine have been given so far, far fewer than the 1.5 million people the CDC says are eligible.
Those who should definitely get vaccinated are those with known exposure to someone with monkeypox. If given within four days of exposure, the vaccine can prevent someone from developing monkeypox. If given within two weeks, it decreases the likelihood of progression to a serious illness.
Soon, I hope there will be enough vaccine so that people in high-risk groups can access it. But given the way monkeypox spreads, most Americans are likely to contract it, and a mass vaccination campaign aimed at the general population is probably not recommended.
CNN: Will monkeypox be another virus that will be endemic in the United States?
Wen: 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 encourage more countries, including our own, to make every effort to try to prevent monkeypox from taking hold and becoming endemic here.