Cases of monkeypox are on the rise. Here’s what you need to know to stay safe

How worried should people be about getting monkeypox? Should everyone try to get vaccinated? Which groups are most at risk and what steps should they take? How exactly is monkeypox spread and how can people avoid trying to catch it? What are the common symptoms to watch out for?

To help us better understand monkeypox and the risk it poses, I spoke with CNN medical analyst Dr. Leana Wen, emergency physician and professor of health policy and management at George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A doctor’s journey in the fight for public health.”

CNN: How is monkeypox spread? Is it as transmissible as Covid-19, another disease that we now know very well?

Dr AS Leana Wen: Monkeypox does not spread like Covid-19. As we now know, Covid-19 is highly transmissible and can be spread through microscopic aerosols. This means you could get infected from someone you are having a casual conversation with or even someone who is in the same conference room or restaurant as you.

Monkeypox is transmitted primarily through prolonged, direct, skin-to-skin contact. So far, most cases have been linked to sexual activity, although this is not considered a sexually transmitted infection. On the contrary, individuals can spread monkeypox through intimate contact, such as kissing, cuddling, cuddling, and sexual intercourse.

This illustration shows monkeypox virus particles, which are composed of a DNA genome surrounded by a protein envelope and a lipid envelope.
People who have lesions can also spread the virus on sheets, towels, and other linens which can transmit the virus to others. This is why people with active monkeypox lesions are advised do not share potentially contaminated items like linens, towels, drinking glasses and cooking utensils with others.

CNN: What kinds of symptoms do monkeypox patients have?

Magnifying glass: People who get monkeypox often begin by developing fever, headaches, muscle aches and general fatigue, like many other viral illnesses. Many people also have swollen lymph nodes. They then develop a rash that evolves into blisters, pimples or sores. The lesions can be all over the body or only in one part. It can be localized only in the anal or genital area, on the face, inside the mouth or on 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. He revealed that the most common symptoms are fever, fatigue, muscle aches and swollen lymph nodes. Almost all had a rash with blisters, 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 area.

Clinicians seeing patients with fever and a new rash should have a low threshold for screening for monkeypox, particularly 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 is diagnosed with one thing doesn’t mean they can’t have another too, and patients in high-risk groups who have new lesions should get tested to rule out monkeypox.

CNN: What triggered monkeypox and how widespread is it in the United States?

Magnifying glass: Monkeypox is a virus from the same family as the smallpox virus. It was first discovered in 1958 in monkeys, hence its name, although its usual animal hosts are rodents and other small mammals. It first appeared in humans in 1970 in East Africa. It is endemic in sub-Saharan African countries, with outbreaks sometimes occurring when infected travelers bring the disease back to their home country. There was a large outbreak in the United States in 2003 due to imported rodents.

This epidemic is much larger. More than 3,000 people have been infected in the United States so far, with infections seen in nearly every state. The CDC has an updated map of cases and infections here.
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CNN: Who are the individuals in the high-risk groups for contracting monkeypox?

Magnifying glass: So far monkeypox has mainly affected gay men, bisexuals and other men who have sex with men. In the New England Journal of Medicine international case series, 98% of people with monkeypox were homosexual or bisexual, and transmission was related to sexual activity in 95% of cases. The US Centers for Disease Control and Prevention said the “vast majority” of cases in the United States were in men who have sex with men, with a median age of 36.
Currently, those at high risk are men who have sex with men and have sex with multiple or anonymous partners. There are also reports in the United States that some women and two children who have contracted monkeypox, all of whom are considered direct contacts of men who have sex with men.

CNN: Has anyone died of monkeypox?

Magnifying glass: 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 it is a painful disease that can and does lead to severe illness and death. Particularly vulnerable people are pregnant women, young children and immunocompromised people.

CNN: How worried should people be about monkeypox?

Magnifying glass: Due to 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.

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These people should get tested immediately if they have a new rash or sore, and they 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?

Magnifying glass: No. First of all, the monkeypox vaccine is extremely limited right now. About 300,000 doses of the two-dose vaccine have been delivered so far, far fewer than the 1.5 million people who the CDC says are eligible.

Those who absolutely should get vaccinated are those who have been exposed 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 reduces the risk of progression to serious disease.

Soon, I hope there will be enough vaccines for people in high-risk groups to have access to them. But given the way monkeypox is spread, most Americans aren’t at risk of contracting it, and a mass vaccination campaign targeting the general population probably won’t be recommended anytime soon.

CNN: Is monkeypox going to be another virus that will be endemic in the United States?

Magnifying glass: I really hope not. It is still possible to contain monkeypox through testing and vaccination. I hope the WHO’s declaration of a global health emergency inspires more countries, including our own, to do everything they can to try to prevent monkeypox from taking hold and becoming endemic here.

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