Monkeypox: What you should know as U.S. declares public health emergency

By Kenneth Wong

PHOENIX – On Aug. 4, U.S. officials declared a public health emergency amid a monkeypox outbreak.

The declaration came months after officials with the Massachusetts Department of Public Health reported the first case of monkeypox in the United States, in May of 2022.

Since then, a number of other states, including Arizona, have reported suspected or confirmed cases of the virus. Other countries around the world have also reported cases of the disease, and deaths have also been reported. No deaths have been reported in the U.S., as of Aug. 4.

Here’s what you should know about the rare disease.

Monkeypox? What is it?

According to officials with the Centers for Disease Control and Prevention, monkeypox is caused by a virus that is in the same genus of viruses that causes smallpox.

Monkeypox, according to the CDC, was first discovered in 1958, following two outbreaks of a pox-like disease in colonies of monkeys that were kept for research.

The first human case of the disease was recorded in a country now known as the Democratic Republic of Congo in 1970, during a period of intensified effort to eliminate smallpox. Since then, the disease has been reported in people in several central and western African countries. Cases have also been reported in the U.S., as well as a number of Asian, Middle Eastern, and European countries.

What are the symptoms of monkeypox?

According to CDC’s website, it takes usually seven to 14 days from the time of infection for a person to start feeling symptoms of the disease, but the incubation period can also range from five to 21 days.

The illness, according to the CDC, begins with:

  • Fever
  • Headache
  • Muscle aches
  • Backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion

CDC officials say within one to three days after the appearance of fever, the person infected will develop a rash, often beginning on the face then spreading to other parts of the body. The rash will eventually dry up and fall off.

According to the World Health Organization, symptoms of monkeypox typically last two to four weeks.

Can people die from monkeypox?

According to WHO, The fatality rate for monkeypox varies between zero and 11% in the general population. The rate is higher among young children.

On Aug. 4, Dr. Frank Lovecchio at Valleywise Health said the fatality rate in West Africa, where this strain of monkeypox comes from, is 1%. 

Deaths have been reported in the current monkeypox epidemic, but none of the deaths occurred in the U.S. 

How does it spread?

CDC officials say monkeypox is spread when a person comes into contact with the virus from an animal, human, or materials contaminated with the virus.

“The virus enters the body through broken skin (even if not visible), respiratory tract, or the mucous membranes (eyes, nose, or mouth),” a portion of the website reads.

CDC’s website states that human-to-human transmission of monkeypox “is thought to occur primarily through large respiratory droplets,” but other human-to-human transmission include “direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens.”

The Associated Press has reported that while the overwhelming majority of cases in the current outbreak in the U.S. and Europe have so far been among men who have sex with men, experts and officials say the virus can be transmitted to anyone.

“The people most at risk are men who have sex with men. Our first 250 cases in the U.S., about 98% were men who have sex with men,” said Dr. Lovecchio. “People mix it up, though. It’s not a sexually transmitted disease It is a contact disease, and some of those early cases we saw were people dancing at parties, and skin was rubbing against skin.”

How did it get to the U.S.?

According to Massachusetts health officials, the state’s monkeypox case involved an adult man who had travelled to Canada. At the time, a number of European countries also reported Monkeypox cases. 

Have we seen monkeypox cases in the U.S. before?

According to the CDC, the first-ever monkeypox case in the U.S. happened in 2003, when 47 confirmed and probable cases were reported from six states: Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin.

“All people infected with monkeypox in this outbreak became ill after having contact with pet prairie dogs. The pets were infected after being housed near imported small mammals from Ghana,” read a portion of the website.

According to officials, investigators later determined that an animal shipment from Ghana to Texas in April 2003 introduced monkeypox into the U.S.

Following the 2003 outbreak, two human monkeypox cases were reported in 2021. In both cases, the person infected came to the U.S. from Nigeria.

CDC officials say monkeypox does not occur naturally in the U.S.

You mentioned a public health emergency being declared…

As we mentioned earlier, the U.S. declared a public health emergency on Aug. 4, as more cases of monkeypox were reported.

Under the declaration, the U.S. Department of Health and Human Services can now draw from emergency funds, hire or reassign staff to deal with the outbreak and take other steps to control the virus.

For example, the announcement should help the federal government to seek more information from state and local health officials about who is becoming infected and who is being vaccinated. That information can be used to better understand how the outbreak is unfolding and how well the vaccine works.

A public health emergency can be extended, similar to what happened during the COVID-19 pandemic, noted Lawrence GOstin, a public health law expert at Georgetown University.

How will the current outbreak affect Arizona?

Dr. Frank Lovecchio at Valleywise Health said he is not overly concerned about monkeypox in Arizona.

Dr. Lovecchio said there is medication to help decrease the symptoms, similar to the antiviral medication used for smallpox and other pox illnesses.

What can I do to help prevent getting monkeypox?

CDC officials have the following advice for people in orderto prevent a monkeypox infection. They include:

  • Avoiding contact with animals that could harbor the virus, including animals that are sick, or animals that have been found dead in areas where monkeypox occurs
  • Avoiding contact with any materials, such as bedding, that has been in contact with a sick animal
  • Isolating those who have been infected from others who could be at risk for infection
  • Practice good hand hygiene after contact with infected animals or humans, such as washing hands with soap and water, or using an alcohol-based hand sanitizer.
  • Use personal protective equipment (PPE) when caring for patients.

Is there a vaccine for monkeypox?

Yes.

According to the CDC, a vaccine called Jynneos, also known by the names Imvamune or Imvanex, has been approved by the Food and Drug Administration for preventing monkeypox.

According to the website of the Military Health System, Jynneos was approved by the FDA in September 2019. In a statement issued by Bavarian Nordic, the vaccine is based on a virus that is incapable of replicating inside a human body, but still able to trigger an immune response.

Vaccine clinics have taken place in parts of the U.S., including in Phoenix, for those considered to be at a high risk of contracting the virus.

Dr. Lovecchio said in Arizona, people are recommended to get the vaccine if they have been exposed to monkeypox.

Are there enough doses for everyone?

It has been noted by the AP that doses of Jynneos are limited. Dr. Lovecchio said there is a supply around the world, but distributing it is another matter.

The doses, given 28 days apart, are currently being given to people soon after they think they were exposed, as a measure to prevent symptoms.

The Maricopa County Department of Public Health has received limited, additional doses of the vaccine and are prioritizing vaccinating high-risk individuals. Those who are interested in receiving the vaccine can check their eligibility at Maricopa.gov/monkeypox.

Are officials doing anything about this?

During a call with reporters, Food and Drug Administration Commissioner Robert Califf said regulators are reviewing an approach that would stretch supplies by allowing health professionals to vaccinate up to five people — instead of one — with each vial of Jynneos.

Under this so-called ‘dose-sparing’ approach, physicians and others would use a shallower injection under the skin, instead of the subcutaneous injection currently recommended in the vaccine’s labeling.

Health officials pointed to a study published in 2015 that found that Jynneos vaccine administered that way was as effective at stimulating the immune system as when the needle plunger deeper into other tissue.

Califf said a decision authorizing that approach could come ‘within days.’ Officials said that decision would require another declaration, to allow the government to alter its guidelines on how to administer the vaccine.