Monkeypox continues to spread in Washington, with cases roughly doubling every week. By the end of July, 109 cases had been identified statewide.
Currently, the majority of confirmed cases in Washington are through local transmission, rather than travel contact, the state Department of Health said. King County, the state’s most populous region, has about 90% of the cases.
Monkeypox is a viral zoonosis, a disease transmitted to humans from animals, with symptoms similar to smallpox, although less severe.
Endemic to central and western Africa, monkeypox has been spreading rapidly and widely since May through human-to-human transmission – particularly through sexual contact – in countries where it is rare. On July 23, with more than 3,000 cases detected in 47 countries, the World Health Organization declared it a global emergency.
The growing spread of the virus in the community is now the real concern, said UW Medicine infectious disease expert Dr. Shireesha Dhanireddy. She added that better local access to testing could also contribute to the growing number of cases.
In early July, UW Medicine’s virology lab, the state’s largest genomic sequencing lab, became one of the few in the country to establish PCR tests for monkeypox.
How is monkeypox spread? Who is infected?
Monkeypox can affect anyone, regardless of gender or sexual orientation, who has close contact with an infected person.
This may include direct contact, sexual or not, with respiratory secretions, broken skin or bodily fluids of an infected person or contact with objects contaminated with the virus such as dishes, utensils, clothing, bedding or electronic devices.
Consistent with current global trends, cases in Washington have so far been concentrated among men who have sex with men and those with multiple partners. Previous outbreaks have not disproportionately affected men who have sex with men. Healthcare professionals are working to respond to this new trend without discrimination or stigma.
“I saw my first case at the end of May and started treatment then and since Pride weekend I feel like we’ve had a significant increase in cases” , Dhanireddy said.
It is unclear whether monkeypox can be sexually transmitted. The CDC is still investigating whether the virus could be present in semen, vaginal secretions, or feces.
The risk is more prevalent in places where there is close, intimate skin-to-skin contact, regardless of sexual orientation, Dhanireddy said. Full-mouth kissing also increased the risk of exposure.
“Rather than saying it’s all gay, gay, or transgender men, it’s really about thinking about the epidemiological risk in these kinds of sexual contact events and the sheer number of partners, which means a risk of higher exposure,” Dhanireddy said.
People who have had several sexual partners in the last few months are at greater risk of exposure.
“If you’ve had more than 10 partners in the past three months, and if you’ve had gonorrhea or syphilis, indicating you have a high risk of exposure, those are also risk factors,” Dhanireddy said. .
Just as infected animals can transmit the monkeypox virus to humans, it is possible that infected people can transmit the virus to animals through close contact. This includes petting, cuddling, or sleeping in the same bed.
Symptoms and signs
Symptoms usually begin within three weeks of exposure to the virus. Whereas in previous outbreaks of monkeypox a rash developed shortly after the infected person experienced flu-like symptoms, in the current outbreak the rash precedes other symptoms. Swollen lymph nodes are another sign of monkeypox.
The rash may look like pimples or blisters and may be painful or itchy. It can appear on or near the genitals but also on other areas like the hands, feet, chest or face.
As a precaution, the CDC recommends avoiding close, skin-to-skin contact or sharing objects with people who may be infected or have a rash that looks like monkeypox.
Wash your hands often with soap and water or use an alcohol-based hand sanitizer and use EPA-approved cleaning products to wipe down and disinfect surfaces shared with someone who has monkeypox .
For people diagnosed with monkeypox, the CDC recommends isolation and abstaining from sex while they recover. Avoid contact with pets and other animals.
Monkeypox is contagious from the time symptoms appear until the rash has healed, all scabs have fallen off and a new layer of skin has formed, which can take several weeks.
“If you’re not able to self-isolate completely, be sure to cover your lesions and try to sleep separately from roommates,” Dhanireddy said.
Infectious disease experts say the monkeypox virus is unlikely to affect people at airports or on public transport as the coronavirus has.
“It’s really just intimate contact,” Dhanireddy said. “So if someone’s lesions are concealed and they’re on public transport, wearing a mask and performing hand hygiene, the risk is very low.”
To treat lesions, the WHO recommends keeping them dry and uncovered when alone, washing hands before and after touching the rash, rinsing the skin with antiseptic soap and the mouth with salt water. To manage discomfort, the WHO advises taking warm baths with baking soda or Epsom salts and using over-the-counter paracetamol painkillers. Regularly disinfect frequently touched surfaces and keep windows open for good air circulation.
While having sex with condoms on can help, condoms alone probably aren’t enough to prevent monkeypox, the CDC said.
For people who have had close exposure with an infected person, who are asymptomatic and within the two week window, talk to your health care provider as you may be eligible for the vaccine.
Additional CDC guidance for sexually active people potentially exposed to the virus is available here.
Advice on pet care and monkeypox can be found here.
After recovery and isolation are complete, the CDC recommends thorough cleaning and disinfection of all areas of the home in the following order:
- Collect all soiled waste such as bandages, paper towels, food wrappers and other waste in a resealable bag.
- Gather contaminated clothing and linens before cleaning anything else in the room. Do not shake the sheets as this may spread infectious particles. Wash them with standard detergent.
- Using EPA-approved disinfectants, clean hard surfaces and household items. Then move on to upholstery and other upholstery with cleaners suitable for the surface. Steam cleaning may be considered.
- Finally, work on the carpet and flooring and dispose of all contaminated waste.
If cleaning is done by someone other than the person with monkeypox, they should wear full clothing that covers all skin, disposable medical gloves, and a tight-fitting respirator or mask.
Do not dry dust or sweep as this may spread infectious particles, although vacuuming is acceptable with a high efficiency air cleaner. Wet cleaning methods like disinfectant wipes, spray bottles, and mopping are best.
More post-recovery cleaning and disinfection guidelines are available here.