Monkeypox may not be eradicable at this point’

• Outbreak is ‘another failure of U.S. and global public health policy toward emerging infectious diseases’
• ‘No reason monkeypox cannot spread outside of the men-who-have-sex-with-men community’
• 2% of cases have been reported in women and children

How much should the wider general public be concerned after the World Health Organization (WHO) declared the unprecedented global monkeypox outbreak a public health emergency?

Currently, monkeypox is endemic in the men-who-have-sex-with-men (MSM) community who have been diagnosed with more than 98% of the cases. But the public is still at some risk, say Northwestern Medicine infectious disease experts.

The experts share their perspective below and explain why it’s urgent to begin researching this virus early on.

The experts: 

Dr. Shannon Galvin is an associate professor of medicine in infectious diseases at Northwestern University Feinberg School of Medicine. 

Dr. Robert Murphy is executive director of the Robert. J. Havey, MD, Institute for Global Health and a professor of medicine in infectious diseases at Feinberg.

Ramon Lorenzo-Redondo is an assistant professor of medicine in infectious diseases and bioinformatics director of the Center for Pathogen Genomics and Microbial Evolution (CPGME) at Feinberg. 

Judd Hultquist is an assistant professor of medicine in infectious diseases and director of the Emerging and Re-Emerging Pathogens program at CPGME at Feinberg.

How at risk is the general public for contracting monkeypox?

Galvin: “The overall risk to the general public is low, but real; transmission mainly seems to occur from close personal or sexual contact.”

Murphy: “There is no reason monkeypox cannot spread outside of the MSM community. Two percent of cases have been reported in women and children.”

How fast is it spreading?

Murphy: “The lack of rapid diagnostic capacity, difficulty in obtaining an existing and effective therapy known as tecovirimat (TPOXX), and the slow rollout of an approved vaccine (JYNNEOS), has led to a very rapid spread worldwide. Monkeypox infection may not be eradicable at this point. The question really is can it be contained and managed?”

Have the U.S. and global health community reacted quickly enough?

Murphy: “This is another example of failure of not only the U.S., but global public health policy toward emerging infectious diseases. They are late to the party. Sadly, it's the same old story: unable to quickly diagnose, unable to vaccinate high-risk persons, unable to rapidly treat those at highest risk. The situation is even more frustrating because unlike what happened with COVID-19, there is already existing technology to diagnose, treat and vaccinate to prevent monkeypox.”  

Can these viruses mutate to evade the vaccine the way SARS-CoV-2 has done?

Ramon Lorenzo-Redondo: “These viruses evolve way less than RNA viruses. It is highly unlikely that monkeypox will diversify at the rate SARS-CoV-2 does, therefore, vaccines will remain effective. The main problem right now seems to be effective production, deployment and administration of available vaccines.  

“However, it is important to understand the significant degree of genetic differences observed between the currently circulating monkeypox virus and the previously detected ones. These relatively high numbers of an otherwise rare disease, together with the high growth rate of new cases, indicate a significant, ongoing, undetected transmission, and highlight the need to investigate this potentially dangerous new outbreak. That will require the scientific community to begin molecular surveillance and basic research.”

Northwestern’s CPGME lab, which has been sequencing hundreds of SARS-CoV-2 samples from around the globe, is prepared to begin doing the same with monkeypox, if needed, Lorenzo-Redondo said.

What are the symptoms of monkeypox?

Murphy: “Monkeypox is a systemic disease that can start with symptoms similar to many infections such as aches, fever, headache and fatigue. Then there’s a rash consisting of pus-filled blisters, which can occur anywhere on the body.

“The current outbreak — mostly in the MSM community — may have an atypical presentation. It can include a less typical rash only, frequently occurring on the face, genitals and perianal area. The rash can be painful. Symptoms generally resolve in two to four weeks.

How do you catch monkeypox?

Lorenzo-Redondo: “Monkeypox is very resistant to external conditions and is transmitted to humans through contact with an infected animal or human or contact with material contaminated with the virus. In particular, the virus can spread from person to person through direct contact with the infectious rash, scabs, body fluids, respiratory secretions during prolonged, face-to-face contact, and touching contaminated items. Additionally, rare events of mother-to-child transmission have been reported.”

Hultquist: “To minimize the risk of getting monkeypox, the most important step is to avoid close, skin-to-skin contact with people who have symptoms consistent with the disease or a history of recent exposure. High-risk individuals should also consider getting vaccinated for monkeypox.”

Can monkeypox kill you?

Murphy: “In Africa where it is endemic, 1 to 10% of people can die from monkeypox complications. In the current outbreak, including 14,000 outside of Africa, death is very rare, supposedly only five cases, all reported from Africa, but details are lacking. Most at risk for severe complications are young children, pregnant women and immunocompromised individuals.”   

Is there anything COVID taught us in terms of public health that can inform how we deal with monkeypox to prevent its wider spread through the populations?

Galvin: “Data and recommendations change, that is how emerging epidemics work. Be prepared for the unexpected, and don't be surprised when the information constantly evolves.”