Less than a month after the first monkeypox death in Texas, a second person who is suspected to have had the virus has died in California. Authorities are investigating whether it's officially the cause of death. California continues to be the state reporting the most cases in the country.
With over 21,000 confirmed cases of monkeypox in the United States, the Biden administration accelerated its vaccine distribution plan, announcing an additional 1.8 million doses of the Jynneos monkeypox vaccine, per CNN on August 18. A few days later, an additional 360,000 vials of the vaccine were allocated to jurisdictions under phase 4 of the National Monkeypox Vaccine Strategy.
The administration also announced the launch of a new program for gay and bisexual men - two populations that have been predominantly impacted by the virus. "HHS is launching a pilot program that will provide up to 50,000 doses from the national stockpile to be made available for pride and other events that will have high attendance of gay and bisexual men," said White House monkeypox response coordinator Bob Fenton in a statement.
The Biden administration declared the monkeypox outbreak a public health emergency on August 4. In a statement, HHS Secretary Xavier Becerra said: "Ending the monkeypox outbreak is a critical priority for the Biden-Harris Administration. We are taking our response to the next level by declaring a public health emergency."
Fenton said the public health emergency declaration would "allow us to explore additional strategies to get vaccines and treatments more quickly out to impacted communities. And it will allow us to get more data from jurisdictions so we can effectively track and attack this outbreak," per Politico. And it seems that's the case with the additional 1.8 million doses being made available.
Still, some public health experts believe the outbreak in the US is being mishandled - and looking eerily similar to the start of the COVID-19 pandemic.
"The CDC, the FDA, and all of it - they haven't learned a single lesson from Covid," AIDS activist and PrEP4All founder Peter Staley told The Guardian. "They haven't spent the time to make sure that they don't repeat those mistakes, because all of them have been repeated." Ahead, find useful information on monkeypox, including symptoms, treatments, and vaccine options.
What Is Monkeypox?
Monkeypox is a very rare disease that had been found primarily in remote parts of Central and West Africa. Monkeypox cases usually arise when people travel to those areas, but what's different about this outbreak is that these recent cases appear to be spreading among people who didn't travel to Africa.
Monkeypox is a viral disease that falls within the family of pox viruses, which includes smallpox and cowpox. Monkeypox was first discovered in 1958, according to the CDC, among colonies of monkeys that were being kept for research (hence the name), but monkeys aren't major carriers. It's usually found among rodents, like rats or squirrels. Those who trap or kill those kinds of animals that are known carriers are more at risk. The virus didn't spread to humans initially; the first recorded human case was in 1970 in a 9-year-old boy living in a remote part of Congo.
What Are the Symptoms of Monkeypox?
According to the CDC, traditional symptoms of monkeypox are similar to smallpox but are milder and include:
- Fever
- Headache
- Muscle aches
- Swollen lymph nodes
- Chills
- Fatigue
- Rash beginning on the face and hands (one to three days after the fever starts), then spreading to other parts of the body, including the genitals. It initially looks similar to chicken pox or syphilis lesions before forming a scab, which then falls off.
However, recent cases of monkeypox have differed in symptom arrival and presentation. Traditionally, the early signs of monkeypox included a fever, swollen lymph nodes, headache, and muscle aches followed by a rash resulting in firm lesions, spreading from the face and mouth to the hands and feet, per the CDC.
Recent US cases of monkeypox have also included a rash, but it has often begun in the genital or anal region, and sometimes in the mouth. The lesions have also begun spreading to areas beyond the face, hands, or feet.
Additionally, "symptoms including fever, malaise, headache, and lymphadenopathy [swollen lymph nodes] have not always occurred before the rash if they have occurred at all," per the CDC.
What's also new is that recent US patients are reporting pain in and around the anus and rectum, tenesmus (or the feeling that you need to pass a bowel movement even though your bowels are empty), and rectal bleeding. "None of those symptoms were commonly associated with monkeypox before," per NBC.
"Any patient who meets the suspected case definition should be counseled to implement appropriate transmission precautions," advised the CDC in its updated guidelines. Precautions for patients who are suspected and confirmed to have been infected include remaining in isolation for the duration of the infectious period (i.e., until all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed). "Patients who do not require hospitalization but remain potentially infectious to others should isolate at home. This includes abstaining from contact with other persons and pets, and wearing appropriate personal protective equipment (e.g., clothing to cover lesions, face mask) to prevent further spread," per the CDC.
How Is Monkeypox Spread?
People usually catch monkeypox from animals through a bite or scratch. From there, it's possible to pass on the disease to other people through saliva from coughing or via contact with pus from the rash's lesions or items such as clothing or bedding that are contaminated with the virus. But recent evidence shows a new possible route of transmission: through sexual contact. Although monkeypox is typically not spread through sex, most of the recent cases in the UK involve men who've had sex with other men. And since it can be spread through contact with bodily fluids, Dr. Susan Hopkins, the United Kingdom Health Security Agency's chief medical adviser, said, "We are particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay."
That said, "Anyone, regardless of sexual orientation, can spread monkeypox through contact with body fluids, monkeypox sores, or shared items (such as clothing and bedding) that have been contaminated with fluids or sores of a person with monkeypox," per the CDC. "Monkeypox virus can also spread between people through respiratory droplets typically in a close setting, such as the same household or a healthcare setting."
Another cause for concern is that the cases in each country are not connected, so scientists are monitoring the outbreak to see if there are other methods of transmission that are causing the virus to spread faster.
What Is Monkeypox Treatment?
The drug tecovirimat, or Tpoxx, is currently the only available drug to treat monkeypox. However, due to bureaucratic barriers (such as requiring a doctor to fill out a 27-page application for each patient), it has become increasingly difficult to receive it as cases continue to rise. The NYT reported that Tpoxx melts away skin lesions within 24 hours, compared to untreated monkeypox with symptoms that last about two to four weeks.
Most people will get over monkeypox without needing to be hospitalized. But unfortunately, it can be fatal for one in 10 people who get it, with more severe cases found in children, according to the CDC.
Is There a Monkeypox Vaccine?
There is no vaccine for monkeypox exclusively. But the smallpox vaccine, under the brand name Jynneos in the US, is licensed to prevent monkeypox, which can also be effective after a person is infected, according to the CDC. That being said, after smallpox was eradicated, countries stopped vaccinating children against smallpox. So younger populations who haven't received the smallpox vaccine don't have immunity against monkeypox either.
Do I Need a Monkeypox Vaccine?
Prior to the recent vaccination rollout announcement, immunizations were only offered to those with known exposure. Now the US is planning a vaccination campaign that will offer the monkeypox vaccine to anyone with a known or presumed exposure. This will include anyone "who had close physical contact with someone diagnosed with monkeypox, those who know their sexual partner was diagnosed with monkeypox, and men who have sex with men who have recently had multiple sex partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading," according to an HHS statement.
The department expects a total of 1.6 million doses to be distributed in the US by the end of the year. The vaccine will be administered in two doses and given 28 days apart.
How Concerned Should I Be About Monkeypox?
Monkeypox is officially considered a public health emergency, per the Biden administration announcement, so there is rising concern about the spread of monkeypox globally. It's important to remember that anyone can get monkeypox through exposure and skin-to-skin contact, not just men who sleep with men.
The CDC advised, "People who may have symptoms of monkeypox, such as unknown rashes or lesions, should contact their healthcare provider for assessment."
Anyone with new lesions related to illnesses like chickenpox, herpes, or syphilis should also be checked for monkeypox, as symptoms are quite similar, per the CDC.
Risk factors for monkeypox include in-person contact with someone who has a similar rash or someone that has received a diagnosis of confirmed or suspected monkeypox, anyone who has contact with individuals in a social network experiencing monkeypox infections, and those who have traveled to countries where monkeypox cases have been reported. Additionally, people experiencing flu-like symptoms and the above risk factors should self-quarantine. "If a rash does not appear within five days, the illness is unlikely to be monkeypox," the CDC said.
- Additional reporting by Alexis Jones, Melanie Whyte, and Sara Youngblood Gregory