Stop the spread: why the monkeypox outbreak must be contained

The United States aims to distribute nearly 800,000 doses of monkeypox vaccine to state and local health departments this summer to combat the growing monkeypox epidemic. Illinois Governor JB Pritzker recently issued a proclamation declaring monkeypox a public health emergency and the state of Illinois a disaster area due to rising cases.

Illinois and California join New York in declaring a state of emergency for monkeypox. Collectively, these three states account for 46% of confirmed cases in the United States.

But virologists have been warning about monkeypox for decades.

In a 2020 publication in the journal, Virus, Malachy Ifeanyi Okeke of the American University of Nigeria described monkeypox as a serious re-emerging pathogen with global reach. Worse still, it was feared that monkeypox would fill the niche of a smallpox virus. Smallpox virus is the causative agent of smallpox, which has caused an estimated 300 million deaths since 1900 before it was declared eradicated in 1980 following a massive global vaccination campaign.

Current data from the Centers for Disease Control and Prevention has confirmed more than 6,600 cases of monkeypox in the United States in 48 states, the District of Columbia and Puerto Rico. Globally, more than 26,000 cases have been confirmed in 87 countries.

The overwhelming majority of cases – 98% – have been identified in countries that historically have not reported cases of monkeypox. The Indiana Department of Health recently announced that monkeypox has been detected in two children, bringing the total number of pediatric cases in the country to five.

Although he did not classify the ongoing monkeypox virus outbreak as a public health emergency in June, World Health Organization Director-General Tedros Ghebreyesus did so after the second meeting of the International Health Regulations Emergency Committee at the end of July.

In a systematic review published earlier this year in PLOS Neglected Tropical DiseasesRobert Steffen and colleagues noted a more than 10-fold increase in confirmed, probable, and/or possible cases of monkeypox over the past five decades.

There are several theories as to why cases of monkeypox are increasing, including climate change and deforestation. A main hypothesis about this increase in cases of monkeypox is related to the vaccine. People vaccinated against smallpox had about 85% protection against monkeypox. However, routine smallpox vaccination in the general public ended in 1972 in the United States, so there are fewer people today with immune protection.

Scientists have not identified the natural reservoir of the monkeypox virus, but it is thought to be small rodent mammals. The monkeypox virus was first identified in 1958 as the cause of infections in a group of laboratory monkeys, but it was not until 1970 that the first human case was identified in the Democratic Republic of the Congo, and the vast majority of cases have occurred in central and western Africa. Until now, cases identified outside Africa have been associated with travel.

This is not the first outbreak of monkeypox outside of Africa, however. A multi-state outbreak in 2003 was associated with 47 confirmed and probable infections. Public health officials and epidemiologists have traced the origin of the outbreak to prairie dogs that were housed at a pet store in Illinois that also housed animals imported from Ghana. In this outbreak, the lab-confirmed cases were all exposed to a prairie dog.

A woman walks near NYC Monkeypox Clinic
A woman walks near the New York Monkeypox Vaccination Clinic sign on August 2, 2022 in the Bronx.
John Smith/VIEWpress/Getty Images

Monkeypox is here, and it’s not going away. Much of the focus on monkeypox is directed at the LGBTQ+ community.

It’s hard not to see similar parallels to the early days of the HIV epidemic. However, monkeypox is not a “gay disease”. While a disproportionate number of cases are reported in men who have sex with men, monkeypox is a virus that infects anyone, including children. Animals and pets can also be infected with monkeypox.

Monkeypox is transmitted directly through skin-to-skin contact. Transmission can occur by touching the rash or scabs of monkeypox lesions or by mouth-respiratory secretions. It can also spread from shared clothing, towels, and bedding. Cases of internal lesions of the mucous membranes of the mouth and rectum have been reported. These lesions are not always visible, which can allow the virus to be transmitted during intimate activities, such as kissing or anal sex.

Certainly, targeting the communities most at risk with targeted educational messages on prevention and strategies to reduce the risk of contracting a pathogen is a crucial role for public health experts, but it cannot be the only element for combat the growing epidemic of monkeypox.

Public health experts say monkeypox can be contained, but the window is closing fast. To effectively reduce the spread and bring this outbreak under control, it is essential to ensure that healthcare providers consider monkeypox when seeing patients in clinics.

It is imperative that access to laboratory testing is expanded beyond public health and large commercial reference laboratories to reduce testing bottlenecks, as seen at the start of the COVID-19 pandemic. COVID-19. Federal authorities and state health departments must distribute large quantities of vaccines and vaccinate those at risk. This route succeeded in preventing the spread of smallpox in 1947 in New York.

More importantly, there must be a broader examination of pandemic preparedness to avoid repeating some of the early mistakes of COVID-19.

Nicholas Moore, PhD, is an Associate Professor of Medical Laboratory Science, Infectious Diseases, and Pathology at Rush University Medical Center, and Public Voices Fellow of the OpEd Project.

The opinions expressed in this article are those of the author.

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