By: Ernest Gurulé
For years, it has been a virus not uncommon but certainly unwelcome in central and western Africa. But in just a matter of months, monkeypox has suddenly sprung up in places where its name has never even been spoken. First, the virus found a whole new set of victims in western Europe—the U.K., Spain and Portugal. Then suddenly, new victims were being recorded in Canada and now the U.S., including Colorado.
In a shrinking world, said Denver Health and Hospital’s Dr. Sarah Rowan, monkeypox landing here should be a surprise to no one. “We live in a very global society, as we saw with COVID-19,” she said referencing the virus that blossomed from a countable number in early 2020 before mushrooming into a pandemic and killing a million Americans and fifteen million others worldwide. “Microbes don’t respect geographic boundaries…we need to think globally in our response.”
But the infectious disease physician also said, we also need to be calm. The world already has a trove of data on monkeypox, a virus that closely resembles smallpox, a scourge in its own right.
Monkeypox is a virus that was first discovered in the late 1950’s among colonies of monkeys used in research. While it is called ‘monkeypox,’ its true origin remains unknown though there are theories possibly linking it to African rodents and primates, including monkeys.
Monkeypox symptoms are similar to other pox-like viruses. Fever, headaches, muscle aches, exhaustion and swollen glands are first indicators. A rash soon follows before the first blisters appear. While certainly not comfortable, it is rarely fatal. Only one percent of its victims in the U.S. or Europe dies but in African it can be ten times as deadly.
As of the first eighteen days of July, the Colorado Department of Health and Environment had confirmed 20 cases of monkeypox. Nationally, the virus has been recorded in 43 states as well as Puerto Rico and the District of Columbia. Using the same timeline, the U.S. has just over 1,800 cases of monkeypox.
Because the virus has similarities in smallpox and chickenpox, researchers have not been caught flat-footed as cases mount. That, however, is not to say they are not concerned. “What concerns me most,” said Dr. Rowan, “is the chance that we see a worsening outbreak due to lack of testing and vaccination. If people know they have been exposed to someone with monkeypox and develop fever or sores,” she said, “get tested right away. Also, don’t have sex.” Those most at risk for contracting monkeypox, said Dr. Rowan, are sexually active gay and bisexual men.
Despite a wealth of data on monkeypox, said Dr. Rowan, it is not clear if the virus is passed on through semen. What is absolutely clear, she said, is that monkeypox can affect anyone. Also, among the high risk populations, just because an unusual spot appears on the skin, do not automatically conclude that it is monkeypox. “We’re definitely getting calls from people who’ve had bug bites,” she said, “but it turns out it’s not monkeypox. Many things might look like monkeypox. Just call your provider.”
The vaccine for monkeypox, called Jynneos, is FDA approved for both monkeypox and smallpox. It is currently available but for how long remains a very important question.
While two shots are the recommended dosage for monkeypox, that could change if the virus spreads faster than expected. If that were to happen, doctors could cut vaccinations down to a single shot. Right now, the U.S. has ordered an estimated seven million doses of the vaccine, but only 372,000 doses are readily available. It is feared that shelves will not be full until sometime next year.
Jynneos, to date, is the only vaccine that has been approved by the FDA, who has sent inspectors for on-site visits. The vaccine is given in two doses, 28 days apart. There is only a single company, Bavarian Nordic, a Danish firm, that is making it and the entire world is asking for a rush on the orders.
But there is a Plan-B in the event that vaccines do not arrive in a timely manner. A vaccine, ACAM2000, which initially was developed to fight smallpox may be an acceptable alternative. The downside to ACAM2000 is that is often comes with severe side effects.
While there are legitimate concerns about monkeypox, experts say it would be wrong to conflate it with COVID-19 and imagine a brushfire-like conflagration of the virus. First, monkeypox, unlike COVID, is not new. It has been known about and studied for more than sixty years. They also say that over the course of that period of time, there have been periodic spikes in outbreaks. Each has been manageable.
Monkeypox is also not completely novel outside of Africa. Infected animals have, from time to time, made it past customs inspectors and to new continents where it has been passed on to house pets and then on to owners.
That, however, is not the case with this latest outbreak. There are no animals involved in this latest wave. It is being passed on very specifically through human to human contact.
