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As Monkeypox Cases Spread, the CDC Hopes to Make Testing More Available

·9-min read
Pox virus, illustration. Pox viruses are oval shaped and have double-strand DNA. There are many types of Pox virus including Chickenpox, Monkeypox and Smallpox. Smallpox was eradicated in the 1970's. Infection occurs because of contact with contaminated animals or people and results in a rash or small bumps on the skin.
Pox virus, illustration. Pox viruses are oval shaped and have double-strand DNA. There are many types of Pox virus including Chickenpox, Monkeypox and Smallpox. Smallpox was eradicated in the 1970's. Infection occurs because of contact with contaminated animals or people and results in a rash or small bumps on the skin.

What started out as just a handful of confirmed cases of monkeypox in the US (mainly in Massachusetts and Florida), has grown to more than 750 monkeypox cases across almost every state, as of July 11 per the CDC. In addition, there have been confirmed cases in Europe, Asia, Australia, Africa, the Middle East, and South America.

And it turns out that monkeypox may have been avoidable all along.

NPR reported on July 12 that the disease has been a developing problem for decades, according to the leading expert on the virus, Dr. Anne Rimoin, UCLA epidemiology professor, who has spent the last two decades in the Democratic Republic of Congo where monkeypox originated.

"This virus has been spreading in marginalized and vulnerable populations [in Africa] for decades, and we've done nothing about it," Dr. Rimoin told NPR. "We have known that monkeypox is a potential problem for decades." She also emphasized the importance of dealing with emerging global disease threats early on: "We cannot make the mistake again of thinking that an infection that's happening somewhere in a remote area of the world isn't going to affect us right at home."

With not enough tests or vaccines available, the mishandling of the outbreak in the U.S. looks eerily similar to the start of the COVID-19 pandemic, according to public health experts. On July 11, the CDC said commercial labs have now started testing for monkeypox, which will increase testing capacity and make it easier for providers and patients to access tests.

In a press conference on Monday, May 23, President Joe Biden reassured Americans that we shouldn't be as worried as we were with the pandemic. "I just don't think it rises to the level of the kind of concern that existed with COVID-19," Biden said. But on June 28, the US announced a federal vaccination campaign. "Clinics nationwide will begin offering vaccinations against monkeypox to anyone who may have been exposed to the virus," reports The New York Times.

The CDC activated its Emergency Operations Center (EOC) or command center "for monitoring and coordinating the emergency response to monkeypox and mobilizing additional CDC personnel and resources." It also issued new guidelines on June 14 regarding "how to identify monkeypox during this outbreak, based on the symptoms doctors have observed so far," per NBC. And the CDC alert for monkeypox has been raised to a level 2, urging travelers to "practice enhanced precautions," that include avoiding close contact with sick people, especially those with skin lesions or genital lesions, and with sick animals, too.

People usually catch monkeypox from animals (a bite or scratch). From there, it's possible to pass on the disease to other people through saliva from coughing or via contact with pus from the rash's lesions or items such as clothing or bedding that's contaminated with the virus. But recent evidence shows a new possible route of transmission: through sexual contact. Although monkeypox is typically not spread through sex, most of the recent cases in the UK involve men who've had sex with other men. And since it can be spread through contact with bodily fluids, Dr Susan Hopkins, UKHSA Chief Medical Adviser, said, "We are particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay."

Another cause for concern is that the cases in each country are not connected, so scientists are monitoring the outbreak to see if there are other methods of transmission that are causing the virus to spread faster. More useful information ahead.

What Is Monkeypox?

If you've never heard of monkeypox before, it's because it's a very rare disease found primarily in remote parts of central and western Africa. Monkeypox cases usually arise when people travel to those areas, but what's different about this outbreak is that these recent cases appear to be spreading among people who didn't travel to Africa.

Monkeypox is a viral disease that falls within the family of pox viruses, which includes smallpox and cowpox. Monkeypox was first discovered in 1958, according to the CDC, among colonies of monkeys that were being kept for research (hence the name), but monkeys aren't major carriers. It's usually found among rodents, like rats or squirrels. Those who trap or kill those kinds of animals that are known carriers are more at risk. The virus hadn't spread to humans originally, but the first recorded human case was in 1970 in a 9-year-old boy living in a remote part of Congo.

What Are the Symptoms of Monkeypox?

According to the CDC, traditional symptoms of monkeypox are similar to smallpox but are milder and include:

  • Fever

  • Headache

  • Muscle aches

  • Swollen lymph nodes

  • Chills

  • Fatigue

  • Rash beginning on the face and hands (one to three days after the fever starts), then spreading to other parts of the body, including the genitals. It initially looks similar to chicken pox or syphilis lesions before forming a scab, which then falls off.

However, recent cases of monkeypox, have differed in symptom arrival and presentation. Traditionally, the early signs of monkeypox included a fever, swollen lymph nodes, headache, and muscle aches followed by a rash resulting in firm lesions, spreading from the face and mouth to the hands and feet, per the CDC.

Recent US cases of monkeypox have also included a rash, but it has often begun in the genital or anal region, and sometimes in the mouth. The lesions have also begun spreading to areas beyond the face, hands or feet.

Additionally, "symptoms including fever, malaise, headache, and lymphadenopathy [swollen lymph nodes] have not always occurred before the rash if they have occurred at all," per the CDC.

What's also new is that recent US patients are reporting pain in and around the anus and rectum, tenesmus (or the feeling that you need to pass a bowel movement even though your bowels are empty), and rectal bleeding. "None of those symptoms were commonly associated with monkeypox before," per NBC.

"Any patient who meets the suspected case definition should be counseled to implement appropriate transmission precautions," advised the CDC in its updated guidelines. Precautions for patients who are suspected and confirmed to have been infected include remaining in isolation for the duration of the infectious period (i.e., until all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed). "Patients who do not require hospitalization but remain potentially infectious to others should isolate at home. This includes abstaining from contact with other persons and pets, and wearing appropriate personal protective equipment (e.g., clothing to cover lesions, face mask) to prevent further spread," per the CDC.

Related: What the SCOTUS Roe v. Wade Decision Means For Birth Control

How Is Monkeypox Spread?

Despite the fact that recent cases of monkeypox have been spread sexually and predominantly among men having sex with other men, "anyone can spread monkeypox through contact with body fluids, monkeypox sores, or shared items (such as clothing and bedding) that have been contaminated with fluids or sores of a person with monkeypox," per the CDC. "Monkeypox virus can also spread between people through respiratory droplets typically in a close setting, such as the same household or a healthcare setting, and pregnant people can spread the virus to their fetus through the placenta."

What Is Monkeypox Treatment?

Monkeypox symptoms last about two to four weeks, and most people will get over it without needing to be hospitalized. Unfortunately, it can be fatal for one in 10 people who get it, with more severe cases found in children.

Is There a Monkeypox Vaccine?

There is no vaccine for monkeypox exclusively. But the smallpox vaccine, under the brand name Jynneos in the US, is also licensed to prevent monkeypox. That being said, after smallpox was eradicated, countries stopped vaccinating children against smallpox. So younger populations who haven't received the smallpox vaccine don't have immunity against monkeypox either.

Do I Need a Monkeypox Vaccine?

Prior to the recent vaccination rollout announcement, immunizations were only offered to those with known exposure. Now the US is planning a vaccination campaign that will offer the Jynneos vaccine to anyone with a known or presumed exposure. This will include anyone "who had close physical contact with someone diagnosed with monkeypox, those who know their sexual partner was diagnosed with monkeypox, and men who have sex with men who have recently had multiple sex partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading," according to a statement from the Department of Health and Human Services.

The Department will provide 296,000 doses of the vaccine, 56,000 of which will be made available immediately. The remaining 240,000 doses will be made available in the coming weeks. HHS expects more than 750,000 additional doses to be made available over the summer and a total of 1.6 million doses to be distributed in US by the end of the year. The vaccine will be administered in two doses and given 28 days apart.

How Concerned Should I Be About Monkeypox?

The CDC advises that "people who may have symptoms of monkeypox, such as unknown rashes or lesions, should contact their healthcare provider for assessment." And anyone with new lesions related to illnesses like chickenpox, herpes, or syphilis, should be checked for monkeypox too, as symptoms are quite similar, per the CDC.

Risk factors for monkeypox include in-person contact with someone who has a similar rash or someone that has received a diagnosis of confirmed or suspected monkeypox, anyone who has contact with individuals in a social network experiencing monkeypox infections, and those who have traveled to countries where monkeypox cases have been reported. Additionally, people experiencing flu-like symptoms and the above risk factors should self-quarantine. "If a rash does not appear within five days, the illness is unlikely to be monkeypox," the CDC said.

While monkeypox is rapidly spreading, it is not yet considered a "Public Health Emergency of International Concern (PHEIC)," as stated by the World Health Organization in a June 25 statement. "No deaths outside of Africa have been reported in connection to the current outbreak," per NBC. The WHO noted that "the overall risk is assessed as moderate at global level," but "at the regional level, the risk is considered to be high in the European Region."

Ultimately, the WHO acknowledged that "controlling the further spread of outbreak requires intense response efforts" and advised "that the event should be closely monitored and reviewed after a few weeks, once more information about the current unknowns becomes available, to determine if significant changes have occurred that may warrant a reconsideration of their advice."

- Additional reporting by Alexis Jones and Melanie Whyte

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