Column by Richard Sternberg

Monkeypox Outbreak Worldwide

As of today, there been more than 5,200 cases of monkeypox confirmed in the United States. Over 1,300 of those cases have been in New York State, the majority of these in the New York City area. The monkeypox outbreak worldwide continues to increase, and last week the World Health Organization declared it a public health emergency of international concern. There needs to be an internationaly coordinated response to try to control this viral disease.

In order to prevent the disease from spreading further, there needs to be more testing, access to vaccines, and treatments along with other public health efforts. Unfortunately, much of this is not in place, and messaging to the public is not always been clear. The coordination, for what it’s worth, seen in the fight against monkeypox, is nowhere near that as seen in the global fight against COVID. Information about who was at risk and access to care is not always been clear. It is difficult to find testing. Vaccine distribution is irregular. Other treatment options are unclear.

Furthermore, symptoms vary. Some people will have pustules over their body others not. Some may have only limited lesions in the genital area which can be interpreted as other sexually transmitted diseases. Also testing requires fluid filled lesions. There is no blood test for this. Some patients will have traditional fever and aches; others not.

Monkeypox is primarily transmitted by direct contact with the fluid in the pustule either through a break in the skin or across a mucous membrane such as the lining of the mouth or genital or gastrointestinal tract. While health officials say the disease is primarily spread sexually, mostly through intercourse between men, in my opinion this is misleading and an unfair categorization just like the comments in the early days of AIDS forty years ago. Male-to-female and female-to-male should be just as likely to be contagious. Any sexual contact carries the risk of spread. Remember mucous membrane to mucous membrane. On the other hand, it is fair to say that any person with multiple partners regardless of their orientation increases the risk of catching and spreading it.

Prevention is critical and safe sex will be the primary way of doing this. This is a situation when being in a monogamous relationship is especially important.

There are two vaccines which were developed for smallpox that have been kept stockpiled in the United States, but supply and distribution is tightly controlled by the federal government and requires special applications. According to the CDC the criteria for eligibility is:

• People who have been identified by public health officials as a contact of someone with monkeypox

• People who are aware that one of their sexual partners in the past 2 weeks has been diagnosed with monkeypox

• People who had multiple sexual partners in the past 2 weeks in an area with known monkeypox

• People whose jobs may expose them to orthopoxviruses, such as:
— Laboratory workers who perform testing for orthopox viruses
— Laboratory workers who handle cultures or animals with orthopoxviruses
— Some designated healthcare or public health workers

The vaccine which requires two doses four weeks apart, can prevent the disease as long as it is given within four days of exposure and ameliorate the symptoms if given up to two weeks after exposure. It is thought that one dose has some protective value. Appointments should be scheduled through your local or state health department.

There is no home testing for monkeypox. If one has symptoms or known sexual contact with someone with the disease you should contact your health care provider or public health office. The test requires a lesion to swab.

Generally, treatment consists of managing symptoms. Some antivirals are recommended for people with a full body rash or high risk for complications. Monkeypox, like the other viral pox diseases, remains transmissible until all the lesions have crusted over and the scab has dropped with a fresh layer of health skin present.

This should be more manageable than COVID but still requires careful preventative measures.