The US just declared monkeypox a public health emergency. Following the World Health Organization’s lead last month. It comes after the virus — normally endemic to Africa — began spreading internationally this spring without any direct links to the continent. Which is unusual.
So we called up Dr. William Schaffner, professor of infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee, to help us make sense of it all. Including: whether or not the declaration is a cause for concern, who’s most at risk, who’s eligible for the vaccines, and how to protect yourself.
Dr. William Schaffner - Dr. William Schaffner, professor of infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee
Why did the WHO declare monkeypox a public health emergency?
Because monkeypox had spread considerably since early May when there were fewer than 100 cases reported in the US and abroad. The outbreak has ballooned to over 26,000 confirmed cases across 80 countries as of Aug. 3, according to the CDC. Over 6,000 of those cases have been in the US — the most of any country. The WHO’s declaration means that the org sees the outbreak as an “important phenomenon,” Dr. Schaffner said. It puts the virus on the same list as others, like COVID-19, Zika, and Ebola. It’s a “very strong signal to the countries around the world that this is something you need to pay attention to, put some resources into. [And] you need to get your health care facilities geared up to deal with this.”
Resources including: testing, treatments, and vaccines. And public health messaging that educates health care providers who might see patients with monkeypox and informs the people who might be most at risk of getting sick. And the US gov’s declaration aims to do the same. By freeing up federal funding needed to respond to the outbreak.
How did we get here?
One theory: It began spreading through sexual transmission during raves in Spain and Belgium earlier this year, Dr. David Heymann, a leading WHO official, told the Associated Press in May. Monkeypox isn’t technically an STD. But one way it spreads is through sexual contact. Causing flu-like symptoms (see: fever and chills), swollen lymph nodes, and/or rashes that can develop into fluid-filled lesions around the body. Symptoms typically last up to four weeks. A person is contagious from the time symptoms begin until the lesions become scabs and fall off. With the current outbreak, 99% of cases in the US are in men who reported having sex with men. And the majority of rashes have been seen around the genitals (though they’ve also shown up on hands and faces). Meaning it could look like an STD.
The virus has disproportionately impacted the LGBTQ+ community. Bringing back painful memories of the AIDS epidemic and the stigma that followed. And it hasn’t only impacted men who have sex with men. There have also been cases reported in a few women — including one who recently gave birth while infected, according to CBS. Pregnant women can pass the virus to their babies through the placenta. The baby in this case didn’t get sick but was given an antibody treatment just in case. (Btw, both mom and baby are “doing well.”) Five children have been diagnosed with the infection so far. (If you're a parent worried about your kids getting monkeypox, here's what you should know.)
Should I be worried about getting monkeypox?
It depends. Again, health officials say that monkeypox is not an STD. But it can spread when someone is in close contact with infectious rashes, scabs, or bodily fluids. You can think of these as the “highways of transmission,” Dr. Schaffner said. And they include: kissing, hugging, cuddling, and having sex. As for the “side streets”: Monkeypox can also be transmitted through respiratory droplets from prolonged face-to-face contact or from touching contaminated items (think: bedding and clothes used by someone who’s sick). But these “play a relatively minor role” in the viral spread, Dr. Schaffner said.
Monkeypox is unlikely to spread through like COVID does, Dr. Schaffner said. But it is most likely to spread through direct contact with an infected person’s lesions. Certain groups of people typically vulnerable to infection (see: pregnant and/or immunocompromised people and children) might not necessarily face a higher risk of contracting the infection. But like other infections, they may experience more severe illness or complications if they get sick.
There are still a lot of unknowns about the virus. For example: Dr. Schaffner said it’s still unclear if an infected person can spread the virus through skin-to-skin contact when they don’t have lesions. Or if they can spread the virus in the days before the lesions pop. “The textbooks say no,” he said. “But this virus hasn’t read the textbook.”
How do I avoid getting monkeypox?
“The issue is intimate contact,” Dr. Schaffner said. Sexually, that means limiting the number of sex partners you have, not having anonymous sex (which has made it difficult for contact tracers to identify people who’ve been exposed), and inspecting your partners before sex whenever possible — especially if they’re new, he said.
Along with avoiding skin-to-skin contact with someone who has monkeypox, the CDC also recs not sharing eating utensils or cups with a person who has monkeypox, not touching bedding, towels, or clothing that belongs to someone who’s ill, washing your hands often with soap and water, and using alcohol-based hand sanitizer.
How is monkeypox tested and treated?
There isn’t a specific treatment that’ll get rid of monkeypox. But doctors can try to help make symptoms less severe. By giving pain meds or treating fever. Most cases resolve within a few weeks. Though the rashes and lesions can be “disfiguring,” Dr. Schaffner said. People who experience especially severe rashes — or have a high risk for complications — might be given the antiviral drug for smallpox tecovirimat (FYI: smallpox and monkeypox are related).
Your doctor will be best equipped to guide you if you have monkeypox or if you think you’ve been exposed. Because the most accurate tests for monkeypox right now require swabbing lesions. (Dr. Schaffner said it’s still unclear if swabbing other parts of the body, like the throat, can be equally effective for testing.) Over the last month, the federal gov has expanded testing capacity to include larger commercial labs. But results can still take two to three days.
If you’re sick with monkeypox, the CDC advises isolating at home, staying in a separate room from any people or pets that you live with (because yes, the virus can spread to animals too), and limiting the number of shared items you use.
Who should get the monkeypox vaccine?
There are currently two vaccines that can prevent monkeypox infection: the Jynneos smallpox and monkeypox vaccine and the ACAM2000 smallpox vaccine. Both are stored in the national stockpile. But there has been a short supply of Jynneos — the preferred and most commonly used vaccine — and the gov said last week that it would begin distributing 786,000 more doses.
“Your average doctor will not have it. So you’re going to have to go — after you’ve been diagnosed — to your health department and see if you can get the vaccine,” Dr. Schaffner said. That might be your state or local health department, depending on where you are. Dr. Schaffner said that because of the low supply, “it won’t be evenly distributed across the country. It will still be focused at least in the near-term future in those areas where there’s the most transmission.”
Health officials recommend that only those considered high-risk get vaccinated for the time being. These groups include health care providers whose patients have a confirmed monkeypox infection or might’ve been exposed to it and lab workers doing monkeypox testing. But some states have expanded eligibility to include people who’ve had a possible or known exposure (think: someone who went to an event where another person was sick, someone who had sex with another person while they were infected, or someone who’s had multiple sex partners in an area where monkeypox is spreading).
The vaccine can also work in people who were already exposed. It has the “best chance” of preventing infection when given within four days of exposure, according to the CDC. But can reduce disease symptoms when given up to 14 days after exposure. “This is called post-exposure prophylaxis,” Dr. Schaffner said. “We have to target it to where it will do the most good.”
Some other things to consider:
Jynneos is normally given in two doses. But with supplies limited and research showing one dose can protect against monkeypox, some cities like Washington D.C. and New York City have prioritized giving only first doses to patients in order to meet the demand.
The CDC recs Jynneos over ACAM2000 because of the potential for severe side effects in certain people — particularly those with weakened immune systems — meaning people with heart or eye diseases, HIV, atopic dermatitis, and eczema (plus certain other skin conditions), according to the CDC. Pregnant women and babies who are younger than 1 shouldn’t take it, either.
Both Jynneos and ACAM2000 can cause pain, swelling, and redness around the injection site. But in people without the conditions mentioned above, ACAM2000 can still cause fever, rash, and lymph node swelling.
The monkeypox outbreak has quickly gained traction over the last few months. But health officials are working hard to prevent it from becoming a full-blown pandemic. Partly by targeting prevention and vaccination efforts. But everyone can help prevent the spread mainly by avoiding close contact with someone who was recently diagnosed with or exposed to monkeypox.
Updated on Aug. 4 to reflect the US declaring a health emergency and monkeypox rates.
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