Get the Facts: CDC expert answers critical questions about recent monkeypox outbreak

Get the Facts: CDC expert explains recent monkeypox outbreak

Updated: 2:09 PM EDT Aug 18, 2022

The ongoing monkeypox outbreak, which started in the United Kingdom in May 2022, is getting more serious by the day.Earlier this month, President Joe Biden’s administration declared the outbreak a public health emergency. Since then, cases continue to rise domestically and abroad.We sat down with Dr. Caroline Schrodt, an emergency medicine physician and medical epidemiologist at CDC’s Division of High Consequence Pathogens and Pathology, to ask her some of the pressing questions surrounding the virus and the level of concern at the moment.Get the facts on the outbreak below: What is monkeypox?Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox virus is actually related to the same virus that causes smallpox. However, the symptoms that we are seeing with monkeypox are much more mild compared to smallpox. I wanted to comment as well that the virus that causes monkeypox is not related at all to the virus that causes chickenpox.What are the symptoms?Symptoms of monkeypox during this outbreak have been somewhat different than what was seen before. Monkeypox usually presents with symptoms that are similar to the flu. This includes fever, tiredness, muscle aches, headaches and swollen lymph nodes. And is followed by a rash that can last up to two to four weeks. But during this outbreak. some people develop a rash first before the other symptoms and some people don’t have any other symptoms at all. In terms of numbers, the rash with monkeypox can be anywhere from one single skin lesion to several skin lesions, or it can be too many to count. And the rash can be located only one part of the body, or it can be present on several parts of the body. As for the location, the rash can appear on any skin surface, and so examples can include the face, neck, chest, genitals, anus, palms of the hand or soles of the feet. The lesions can even be inside the body, which would include the mouth, vagina or anus. And in terms of appearance, the rash might look like bumps that are firm or may feel rubbery and sometimes have a central dent. But these same bumps usually change in appearance during the course of illness and so they can also look like small or medium-sized puss-filled pimples before they eventually scan and fall off. And additionally, some people describe the rash as being itchy, whereas other people don’t feel anything. And some people are reporting that it can be extremely painful. The rash can be very small and can be confused with other infections like sexually transmitted infections or chickenpox.How does it spread?In the current monkeypox outbreak, those with monkeypox disease are generally describing close, sustained physical contact with people who have monkeypox. And the Centers for Disease Control and Prevention (CDC) is not receiving reports of monkeypox transmission without close, sustained physical contact. And we know from previous outbreaks that monkeypox spreads through direct contact with infected body fluids or lesions on the body of someone who has monkeypox, or less commonly direct contact with materials that have touched infected body fluids or lesions, like clothing or linens. And I also wanted to say that while many of those affected in the current global outbreak are gay, bisexual or other men who have sex with men, not all cases fall into these categories and anyone can catch monkeypox if they have close contact with someone who has monkeypox, regardless of gender identity or sexual orientation.It is not currently classified as an STI, but why are many people talking about it like it is?I think it might be more accurate to describe monkeypox as sexually transmissible. So in other words, sex is just one of the ways monkeypox can be spread. In the past, monkeypox outbreaks have been linked to direct exposure to infected animals or animal products or limited person-to-person spread. But in the current monkeypox outbreak, the virus is spreading primarily through close personal contact so that could include contact with infectious lesions or respiratory secretions that may take place via close, sustained skin-to-skin contact that occurs during sex. However, I do want to emphasize that any close, sustained skin-to-skin contact with somebody who has monkeypox can spread the virus and it does not exclusively have to be intimate or sexual.What is the level of concern about monkeypox spreading in public spaces?I think it’s important that people are aware of monkeypox and in general what the symptoms of monkeypox are. But right now in this current outbreak we really are only seeing cases among people who are reporting very close, often intimate or sexual contact with someone else who has monkeypox. We do believe the risk for people, for example attending certain events or concerts or using public transportation is very low unless they are reporting that they had very close, direct skin-to-skin contact with somebody else.Is there a vaccine? And who should get vaccinated?The U.S. government has two stockpiled vaccines. One is called JYNNEOS and ACAM2000. Both of these can prevent monkeypox in people who are exposed to the virus. ACAM2000 was developed to protect against smallpox virus, but because monkeypox and smallpox viruses are genetically similar, vaccines developed to protect against smallpox may be used to prevent monkeypox infections. And at this time based on the current case counts and risk factors for monkeypox, CDC does not recommend widespread vaccination, but people who should be considered to receive the vaccine are people identified as a close contact of someone with monkeypox or who have a high likelihood of having had close contact with someone with monkeypox. And at this time, vaccination is typically arranged by local health departments sometimes in coordination with health care providers. Is monkeypox deadly?The type of monkeypox seen in this current outbreak is rarely deadly. And more than 99% of people who get this form of the disease are likely to survive. However, some people have higher risk factors for severe illness and that includes children under age 8, people who have a weakened immune system or are pregnant, and people with history of eczema.Can animals contract monkeypox? Can they spread it?Because monkeypox is a zoonotic disease, that means monkeypox virus can spread from people to animals or from animals to human. We have yet to identify where monkeypox virus is found in nature, but it’s thought that small mammals play a part in Africa of spreading the virus to people and other forest animals. While we’re still learning which species of animals can get monkeypox, we should assume that any mammal can be infected with monkeypox virus. We do not know if reptiles, amphibians or birds can get monkeypox, but it is unlikely since these animals have not been found to be infected with viruses that are in the same family as monkeypox. But because mammals can be at risk for monkeypox virus, we do recommend that anyone with monkeypox should avoid contact with animals, and that includes pets, livestock or domestic animals and wildlife. Any pets that become sick within 21 days after having close contact with someone with monkeypox should be evaluated by a veterinarian. With the over 33,000 cases of monkeypox internationally now, we have heard reports about one domestic animal—somebody’s dog — who was also infected with monkeypox. But so far there have been no such reports in the United States.How accurate is the current case count in the US? Are cases being undercounted?The case count in the United States continues to increase daily, but we know that these numbers here and abroad likely do undercount cases. This is likely because detection depends on many factors, like patients presenting for care and health care providers testing for monkeypox. We do believe there is community spread occurring while public health officials across the world are working around the clock to contain the outbreak. We expect that these numbers will continue to increase.