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What you need to know about the monkeypox virus



Few things are more unnerving three years into a pandemic than public health officials talking about unusual outbreaks of yet another virus, but here we are.

Recently, officials have been watching an uptick in cases of the monkeypox virus around the globe. On Wednesday, public health officials in Massachusetts announced there was a confirmed case in the state, making it the first confirmed case of the virus in the United States this year. On Thursday evening, health officials in New York City announced they were investigating a possible case of monkeypox, though it has yet to be confirmed.

While we’re still learning about monkeypox — and specifically whether or not the virus has evolved in a way that challenges our current understanding of it — the basics of the virus are somewhat well understood. Here’s what we know and don’t know about monkeypox.

What is monkeypox?

As the name suggests, monkeypox is in the same family of viruses as smallpox, though typically it is much less transmissible and far less severe than smallpox.

William Schaffner, an infectious disease expert at Vanderbilt University Medical School, tells Inverse the virus is typically found in small mammals in areas with tropical climates.

“Occasionally, it does get into primates, that’s why the name monkeypox,” he says. “And of course, it can also get into people. It can be spread from person to person but not easily, you need very close and usually fairly sustained interpersonal contact, touching, kissing, and such.”

The World Health Organization notes that the longest known transmission chain of monkeypox is “nine generations, meaning the last person to be infected in this chain was nine links away from the original sick person. It can be transmitted through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets, and contaminated objects.”

There are two clades, or types, of monkeypox viruses: the West African Clade and the Central African clade.

The first case in the 2022 outbreaks was fairly standard, the person had traveled to Nigeria, where the virus is commonly found. The others, however, haven’t followed the same pattern: As of now, patients recently confirmed to have monkeypox in the U.S. and Europe don’t have known contacts with people with monkeypox and didn’t recently travel to an area where it’s common. So how they got the virus is still unclear.

In an interview with Stat News, Andrea McCollum, who heads up poxvirus epidemiology in the CDC’s division of high consequence pathogens and pathology, said we may not have a full understanding of how this virus is transmitted generally.

“We don’t have really good contemporary estimates of R-naught. [R-naught is the figure that estimates how many people an infected person, on average, will infect.] We don’t really have any estimates of R-naught for the West African clade. Most of our estimates come from Congo Basin. And most of those estimates are less than 1. But I will remind you that you can have an R-naught of less than one and the agent can still be transmitted person to person.”

What are the symptoms of monkeypox?

By all accounts, contracting monkeypox sounds unpleasant. Symptoms typically appear anywhere from 5 to 21 days after exposure.

The symptoms are initially very similar to a bad flu, Schaffner says.

“When you get sick, fever is prominent, it can go up to 103. You get symptoms that are similar to other viral infections, muscle aches, pains, headache, and swollen lymph glands.”

After a day or two of symptoms appearing, an “unusual” rash will appear, typically on the extremities like the head, arms, legs, and notably the palm of the hands.

“The rash initially is a flat red rash, but then it quickly blisters up,” Schaffner says. “But it’s not a thin blister. It’s a rather thick, rubbery blister, that accumulates pus and gets yellow.”

Unlike bites from a similar-sounding virus, chickenpox, the lesions from monkeypox are more painful than itchy.

Today, the average fatality rate falls between 3 and 6 percent, according to the WHO.

How do you prevent and treat monkeypox?

The smallpox vaccine(s) offers some protection against monkeypox, Schaffner says, though the majority of Americans who have been vaccinated for smallpox were vaccinated so long ago that immunity has waned significantly. Still, he adds, “people who have received a smallpox vaccine may have less severe symptoms if they do contract monkeypox than someone who has not.”

There are no approved antivirals for monkeypox, though the Johns Hopkins Center for Health Security notes, “The antivirals cidofovir and brincidofovir could be used to treat monkeypox, though there is insufficient data on their effectiveness for monkeypox treatment in humans. However, animal studies have demonstrated effectiveness against monkeypox in certain mammalian species.”

Where have recent cases of monkeypox been found?

What’s unusual about these cases is how many of them have been found outside Central and West Africa. Cases have now been reported in the United States, Canada, the UK, Portugal, Sweden, and Italy.

That’s certainly concerning, Schaffner says, but perhaps not as concerning as some on social media have posited where conspiracy theories and general panic abound.

In some cases, the instinct to panic is likely a trauma response to living through three years of a global pandemic.

“We’re all infection and pandemic sensitive, I recognize that,” Schaffner says. “But I think the important thing is public health officials picked this up right away. They’re doing investigations and clinicians are treating the patients. Will there be more cases? Of course. The harder you look as you’re getting into an outbreak, the more you’re going to find.”


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