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Home » Topics » Infectious Diseases Information Center
Publish Date August 17, 2022
HOW DOES MONKEYPOX SPREAD?
Rebecca S.B. Fischer, PhD, MPH, DTMH
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The US declared Monkeypox a public health emergency on August 4, 2022. Credit:
Getty Images
Monkeypox is caused by a virus that, despite periodic outbreaks, is not thought
to spread easily from person to person and historically has not spurred long
chains of transmission within communities. Now, many researchers are left
scratching their heads as to why monkeypox seems to be propagating so readily
and unconventionally in the current global outbreak.
The monkeypox virus typically spreads through direct contact with respiratory
secretions, such as mucus or saliva, or skin lesions. Skin lesions traditionally
appear soon after infection as a rash – small pimples or round papules on the
face, hands, or genitalia. These lesions may also appear inside the mouth, eyes,
and other parts of the body that produce mucus. They can last for several weeks
and be a source of virus before they are fully healed. Other symptoms usually
include fever, swollen lymph nodes, fatigue, and headache.
I am an epidemiologist who studies emerging infectious diseases that cause
outbreaks, epidemics, and pandemics. Understanding what’s currently known about
how monkeypox is transmitted and ways to protect yourself and others from
infection can help reduce the spread of the virus.
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HOW IS THIS OUTBREAK DIFFERENT FROM PRIOR ONES?
The current monkeypox epidemic is a bit unusual in a few ways.
First, the sheer scope of the current epidemic, with over 25,000 cases worldwide
as of early August and in countries where the virus has never appeared, sets it
apart from previous outbreaks. Monkeypox is endemic to specific areas in central
and western Africa, where cases occur sporadically and outbreaks are usually
contained and quickly burn out. In the current outbreak, the global spread has
been rapid. Young men, mostly aged 18 to 44, account for the majority of cases
and over 97% identify as men who have sex with men (MSM). Some superspreading
events associated with air travel, international gatherings, and
multiple-partner sexual encounters contributed to early transmission of the
virus.
Second, the way symptoms are appearing may facilitate spread among people who
don’t yet know they are infected. Most patients reported mild symptoms without
fever or swollen lymph nodes, symptoms that typically appear before a skin rash
is visible. While most people do develop skin lesions, many reported having only
a single papule that was often obscured inside a mucosal area such as inside the
mouth, throat, or rectum, making it easier to miss.
A number of people reported no symptoms at all. Asymptomatic infections are more
likely to go undiagnosed and unreported than those with symptoms. But it is not
yet known how asymptomatic individuals may be contributing to spread or how many
asymptomatic cases may be undetected so far.
WHO IS AT RISK OF GETTING MONKEYPOX?
For most people, the risk of getting monkeypox is currently low. Anyone who has
prolonged, close contact with an infected person is at risk including partners,
parents, children, or siblings, among others. The most common settings for
transmission are within households or health care settings.
Because of sustained transmission within the community MSM, they are considered
an at-risk group, and targeted recommendations can help allocate resources and
limit transmission. While monkeypox is spreading primarily among MSM, this does
not mean that the virus will remain confined to this group or that it won’t jump
to other social networks. The virus itself has no regard for age, gender,
ethnicity, or sexual orientation.
Anyone who comes into direct contact with the monkeypox virus is at risk of
being infected. New cases are recorded daily, with additional countries and
regions reporting their first cases and already affected countries observing a
continued rise in infections.
As with most infections, other factors such as the amount of viral exposure,
type of contact, and individual immune response, play a role in whether
infection takes hold.
IS MONKEYPOX AN STI?
While sexual encounters are currently the predominant mode of transmission among
reported cases, monkeypox is not a sexually transmitted infection (STI). STIs
are spread primarily through sexual contact, while monkeypox can spread through
any form of prolonged, close contact.
Close contact that transmits the monkeypox virus involves encounters that are
typically more intimate or involved than having a casual conversation or
standing next to someone in an elevator. Transmission requires exchange of
mucosal fluids or direct contact with the virus in sufficient quantity to seed
an infection. This could occur through physical contact during kissing or
cuddling.
Because sexual encounters involve direct skin-to-skin physical contact where
bodily fluids may be exchanged, these close encounters can transmit viruses more
easily. Recently, monkeypox DNA has been detected in feces and various body
fluids including saliva, blood, semen, and urine. But the presence of viral DNA
does not necessarily mean that the virus can infect someone else. Transmission
from these sources is still under investigation.
As the virus moves through populations, public health officials focus on getting
the message out to the most at-risk and hardest hit communities about how to
stay safe. Currently, breaking the transmission chain among sexual contacts is a
priority including but not limited to MSM communities. Targeted messaging is
meant to protect the health of a specific group, not to stigmatize the intended
audience.
Other modes of transmission may play a greater role outside the MSM community.
Household transmission, where individuals may come into close contact with
infected people or contaminated items, is one of the most common types of
exposure. Research is ongoing into the potential airborne and respiratory
droplet spread of monkeypox in the current situation.
Outbreaks are dynamic situations that evolve over time, which is why public
health messages may change as the epidemic progresses. Not every outbreak looks
or behaves the same way – even pathogens seen in previous outbreaks can be
different the next time around. As researchers learn more about how the disease
is transmitted and identify changes in patterns of spread, public health
officials will provide updates about specific forms of contact, behaviors, or
other factors that could increase infection risk. While changing guidelines can
be frustrating or confusing, keeping up to date with the latest recommendations
can help you protect yourself and stay safe.
WHAT DO PATIENTS DO IF EXPOSED TO MONKEYPOX?
Anyone who has been infected can help contain the spread by isolating themselves
from others, including pets. Covering skin lesions, wearing a mask in shared
spaces, and decontaminating shared surfaces or items such as bed linens, dishes,
clothes, or towels, can also reduce spread.
You can also help interrupt the transmission chain by participating in contact
tracing and notifying public health officials of others who may have been
exposed through you, which is a basic tenet and common practice of disease
control.
The Centers for Disease Control and Prevention has further guidance on how to
control monkeypox spread in both household settings and shared living
facilities.
Lastly, getting vaccinated as soon as possible can still protect you from severe
illness even if you’ve already been infected.
Rebecca S.B. Fischer, PhD, MPH, DTMH, is assistant professor of Epidemiology at
Texas A&M University.
This article is republished from The Conversation under a Creative Commons
license.
TOPICS:
Dermatology General Infectious Disease Infectious Disease Monkeypox Vaccination
Viral Infections
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