As Monkeypox Cases Spread, the CDC Has Released New Guidance. Here’s What To Know

What started out as just a handful of confirmed cases of monkeypox in a few European countries (Spain, Italy, Portugal, and Sweden), Canada, the UK, and the US (mainly in Massachusetts and Florida), has grown to 72 cases in the U.S. across 18 states within the last month, per NBC News. The recent case developments make this the largest monkeypox outbreak to date in the country.

If you've never heard of monkeypox before, it's because it's a very rare disease found primarily in remote parts of central and western 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. In a press conference on Monday, May 23, President Joe Biden reassured Americans that we shouldn't be as worried as we were with the pandemic. "I just don't think it rises to the level of the kind of concern that existed with COVID-19," Biden said. Should a problem arise, the US has enough smallpox vaccines, which is what's used to prevent monkeypox.

"This [outbreak] is rare and unusual," said Susan Hopkins, MD, chief medical adviser of the UK Health Security Agency (UKHSA), adding that the risk to the general (UK) population remains low.

Even so, the CDC issued new guidelines on June 14 regarding "how to identify monkeypox during this outbreak, based on the symptoms doctors have observed so far," per NBC. The CDC has also raised its monkeypox alert to a level 2, urging travelers to "practice enhanced precautions," that include avoiding close contact with sick people, especially those with skin lesions or genital lesions, and with sick animals, too.

People usually catch monkeypox from animals (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's contaminated with the virus. That being said, the infection rate is low, and in most cases, people who get monkeypox don't pass it on to anyone else. According to the World Health Organization (WHO), "There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population."

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. Hopkins added, "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."

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. More useful information ahead.

What Is Monkeypox?

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 hadn't spread to humans originally, but 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 U.S. 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 U.S. 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 probable and confirmed case-patients 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?

Despite the fact that recent cases of monkeypox have been spread sexually and predominantly among men having sex with other men, "anyone 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."

What Is Monkeypox Treatment?

Monkeypox symptoms last about two to four weeks, and most people will get over it without needing to be hospitalized. Unfortunately, it can be fatal for one in 10 people who get it, with more severe cases found in children.

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 also licensed to prevent monkeypox. 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?

For certain at-risk healthcare workers exposed to monkeypox or those treating people infected with monkeypox, vaccines are now available. But so far, there won't be a vaccine rollout to other people, explained Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health to "CNN." "This isn't something where everybody lines up and gets vaccinated," Dr. Adalja said. Only those with direct exposure will need vaccination. Even if you're unvaccinated and become exposed to monkeypox, the CDC says getting vaccinated after exposure can still offer some protection.

How Concerned Should You Be About Monkeypox?

The CDC advises that "people who may have symptoms of monkeypox, such as unknown rashes or lesions, should contact their healthcare provider for assessment." And anyone with new lesions related to illnesses like chickenpox, herpes, or syphilis, should be checked for monkeypox too, 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.

Ultimately, monkeypox is pretty rare and not easily transmissible between humans. "No deaths have been reported outside Africa in connection to the recent outbreak," per NBC. And the CDC is "closely monitoring worldwide case counts" and believes that the "based on limited information available at this time, overall risk to the U.S. public is currently low."

- Additional reporting by Alexis Jones

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