Monkey pox is on the rise. Here’s what you need to know to stay safe

How worried should monkeypox sufferers be? Should everyone try to get the vaccine? Who are the groups at risk and what should they do? How exactly is monkeypox spread and how can people avoid contracting it? What are the common symptoms to look out for?

To help you better understand monkeypox and its dangers, I interviewed CNN medical analyst Dr. Liana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. He is also the author of Lifelines: A Doctor’s Journey in the Battle for Public Health.

CNN: How does monkeypox spread? Is it contagious like Covid-19, another disease we now know better?

Dr. Liana Wen: Monkey pox is not as contagious as Covid-19. As we know, Covid-19 is highly contagious and can be spread through microscopic aerosols. This means you can catch the virus from someone you’re casually talking to, or someone you’re sharing a conference room or restaurant with.

Monkeypox is primarily transmitted through prolonged, direct, skin-to-skin contact. In most cases, this is not considered a sexually transmitted infection, but is associated with intercourse. Conversely, monkeypox can be transmitted through intimate contact such as kissing, hugging, petting and sexual intercourse.

Infected people can also transfer the virus to sheets, towels, and other bedding, which can spread the virus to others. Because of this, people with active monkeypox are advised not to eat or drink contaminated linen, towels, glasses, etc.

CNN: What are the symptoms of monkeypox?

Wen: People with monkeypox often 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 turns into blisters, pimples, or sores. Ulcers can be anywhere on the body or only in one place. It can just be localized to the anal or genital area, face, inside the mouth or any other part of the body.

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A large study recently published in the New England Journal of Medicine examined 528 infections at 43 sites in 16 countries. It found that the most common symptoms were fever, fatigue, muscle aches and swollen lymph nodes. Almost everyone had a rash with blisters, but some people had only one sore and others had several or more. Some people had sores only inside the mouth or on the anal or genital organs.

Clinicians seeing patients with fever and new rash should have a low threshold for testing for monkeypox, especially if the patient is at high risk for monkeypox. Importantly, a recent study also found that 29% of people infected with monkeypox had genital infections. I think that just because a patient is diagnosed with one thing doesn’t mean they can’t have something else, and that high-risk patients with new lesions should be tested to rule out monkeypox.

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 monkeys in 1958, hence its name, but its usual animal hosts are rodents and other small mammals. It first appeared in humans in East Africa in the 1970s. It is endemic in sub-Saharan Africa and sometimes occurs when infected travelers bring the disease to their home countries. In 2003, there was a large outbreak in the United States caused by imported rodents.

This epidemic is much bigger. So far, more than 3,000 people have been infected in the United States, and infections have been reported in nearly every state. The CDC has an updated map of diseases and infections here.
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CNN: Who are the people most at risk of contracting monkeypox?

Wen: Until now, monkeypox has mostly affected gays, bisexuals and other men who have sex with men. In an international case series in the New England Journal of Medicine, 98% of people infected with monkeypox were gay or bisexual, and in 95% of cases, transmission was associated with sexual activity. The US Centers for Disease Control and Prevention said “most cases” in the United States are in men who have sex with men, with an average age of 36.
Men who are currently having sex with men and who have sex with multiple or anonymous partners are at high risk. There are also reports of some women and two children contracting monkeypox in the United States, all believed to have been in direct contact with men who had sex with men.

CNN: Are there any deaths from monkeypox?

Wen: According to the World Health Organization, monkeypox usually has a fatality rate of 3% to 6%. Fortunately, no one has died from monkeypox in the United States, but it is a disease that can cause serious illness and death. Those who are particularly vulnerable include pregnant women, young children and people with weakened immune systems.

CNN: How concerned should people be about monkeypox?

Wen: Because monkeypox is common, it is not a concern for most Americans. However, gays, bisexuals, and those who have sex with other men, who have intimate relationships with multiple or anonymous partners, are at higher risk.

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These people should avoid immediate testing if they have a new rash or sores and should avoid close physical contact to avoid immediate testing. People who want to reduce their risk should avoid clubs, raves, sex parties, and other places where there is prolonged skin-to-face contact with many scantily clad people.

CNN: Should everyone try to get the monkeypox vaccine?

Wen: A horse. First, the monkeypox vaccine is now very limited. So far, about 300,000 doses of the two-dose vaccine have been delivered, far fewer than the 1.5 million people the CDC estimates are eligible.

People who should definitely get the vaccine are people who have had monkeypox. Anyone can be protected from contracting monkeypox if the vaccine is given within four days of exposure. If given within two weeks, it reduces the likelihood of progression to severe disease.

I hope that soon enough vaccine will be available so that people in high-risk groups can get it. But given the prevalence of monkeypox, most Americans are unlikely to contract it, and a mass vaccination campaign aimed at the general population is not recommended anytime soon.

CNN: Will monkeypox become another endemic virus in the US?

Wen: I really hope so. It is still possible to catch monkeypox through testing and vaccination. I hope that the World Health Organization’s declaration of a global health emergency will encourage more countries, including our own, to do their best to prevent monkeypox from spreading and becoming endemic here.


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