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An infectious-disease doctor answers all your questions about monkeypox

If you’ve heard monkeypox mentioned in the news recently, but are still struggling to figure out what the disease is or how it might affect you, you’re not alone. In an effort to clarify the relatively new health concern, Vogue spoke to infectious-disease physician and public-health researcher Dharushana Muthulingam, M.D., M.S., about monkeypox’s origins, its most common symptoms, the groups that have the highest risk factor for contracting monkeypox, and more. Find all her answers below.

What is monkeypox?

Monkeypox is a viral infection that causes fever and rash. It is a less severe relative of smallpox. The virus was first identified in 1958 from an outbreak among research monkeys. The first human case was recorded in 1970. Initially, it was only found in specific rural regions near tropical rainforests in central and western Africa. There were two types (or clades) of the infection observed—a Congo Basin clade (more severe and easily spread) and a West African clade (milder).

Since then, the infection increasingly appeared in urban areas and multiple countries. 1997 saw the first recognized (small) outbreak of monkeypox in Democratic Republic of Congo; the first outbreak outside the African continent was in the U.S. in 2003, when 70 people were infected via pet prairie dogs housed with other imported pets. In 2017, the Nigeria Centre for Disease Control identified a much larger outbreak, with a rapid spike from zero cases to hundreds.

Why is monkeypox in the news now?

The CDC and global partners regularly monitor for emerging infections. In May 2022, clusters of monkeypox infections showed up in multiple non-endemic regions—places it was not previously found. Also, the cases could not all be traced to travel from endemic regions. This meant the infection was establishing transmission in new regions. Initially, clusters were identified in the U.K. and Massachusetts; since then, cases have also been reported throughout Europe, western and southeastern Asia, Australia and South America. As of mid-June, there have been over 2,100 confirmed cases globally.

How does monkeypox present?

The infection starts with common symptoms—fever, fatigue, muscle ache, sometimes sore throat and cough. More uniquely, individuals can get swollen lymph nodes in the neck, armpits, or groin. Several days after the fever, most people get a typical rash. Classically that rash is “pox,” or pimples, but may start as flat redness or small blisters. The rash typically shows up on the face, arms, and legs more than the torso, and it can be painful before becoming itchy as it starts to heal and scab. The illness overall can last for two to four weeks.

However, these symptoms can also be from other common conditions such as chicken pox, syphilis, bacterial skin infections, or allergic reaction to medications. If any of these symptoms show up, make sure to visit a clinician to figure out the right diagnosis and plan.

Is monkeypox dangerous?

Fatality is rare. Historically, the mortality rate was high (up to 10%) in the Congo Basin clade. The less severe West African clade has a fatality rate of less than 1%. In the Nigerian outbreak in 2017 (West African clade), mortality was as high as 3%. In the current global outbreak (which appears to be structurally most similar to the West African clade), there has been only one death out of the over 2,100 reported cases so far (much lower than 1%). People with higher risk for severe disease that might require hospitalization are kids under age 8, those who are pregnant or immunosuppressed, and those with a history of eczema and related skin conditions.

How does it spread and what are the risk factors?

Once symptoms develop, infection can spread person to person through touch (direct contact with the rash, scabs, or body fluid), from items that were in contact with infected rash or fluids (like clothing), or respiratory secretions in close proximity (such as with kissing or sex). It can also spread through other animals (mammals), if one is scratched, bitten, or eats the meat of an infected animal. Pregnant people can transmit the infection to their fetus by the placenta. Unlike COVID-19, which spreads via aerosols, monkeypox cannot be spread over a distance; it requires much closer contact. A person stops being contagious once the rash crusts over and the scab falls off (with healed skin underneath).

In the current global outbreak, the majority of cases have shown up among men who have sex with men, especially people who have recently had sex with a new partner or multiple partners. Monkeypox is not exclusively a sexually transmitted infection, but the close contact involved in most sex acts can easily be a risk for transmission. There is no difference in the specifics of heterosexual or homosexual sex acts for risk. The transmission among men who have sex with other men is likely related to highly interconnected social and sexual networks, which have allowed the virus to circulate. The same can become true for other subsets of connected people. Additionally, many of the cases have been identified in sexual health clinics, so it may be that we are under-diagnosing cases in individuals with other risks who are less likely to present for care.

Is there a way to prevent or treat monkeypox?

Because of our experience with smallpox, we have literally had vaccine strategies for this genus of virus for centuries. The current smallpox vaccines have at least 85% efficacy against monkeypox; New York City and the U.K. have been offering vaccines for those with higher risk of exposure. Currently, most people do not need medical treatment. Multiple promising antiviral medications are currently under study for individuals who may develop more severe disease.

What does the monkeypox global outbreak mean for me?

Monkeypox remains rare. Most cases of the infection tend to be mild, self-limiting, and do not require treatment. Currently the CDC reports moderate caution for monkeypox. Monkeypox, unlike COVID-19, cannot spread over distances via aerosol droplets, cannot rapidly evolve different variants, nor does it have as high a mortality rate. There are still many unknowns about the current monkeypox outbreak, which remains significant, but it is a different beast from COVID-19.

If you do anticipate close contact (sex, sharing a household) with people in a region with higher case levels or with men who have sex with other men (especially with new or multiple partners), know there might be a slightly higher risk for transmission in your networks. If you have symptoms that sound like monkeypox (fever, swollen lymph nodes, rash), or have had close physical contact (sex, shared a household) with someone diagnosed with monkeypox or who is showing the typical symptoms, you should self-isolate and call your healthcare provider to get assessed.

Why are there so many infectious diseases now? (We are tired!)

While it is true that a more integrated, population-dense globe means it is easier for significant epidemics to spread, infectious diseases are perennial. We have always lived in a complex ecology of microbes and other life. Investing in public health, scientific research, and global equity is one way we can take care of each other within that ecology.

This article was originally published on Vogue US.

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