Two hands with monkeypox blisters are held out in the center of a red background
Design by Jennie Vang

A current outbreak of nearly 800 cases of monkeypox have been identified outside its native countries in Central and Western Africa, including over 30 confirmed U.S. cases. But what is monkeypox? What are public health experts saying, and should you be worried? 

What is Monkeypox disease?

The monkeypox disease is caused by the zoonotic monkeypox virus, meaning it can spread from animals to humans and from person to person. Monkeypox has been endemic, or commonly found, in Central and Western Africa since the first case was discovered in 1958. 

Monkeypox symptoms include headache, rash, fever and more, which typically last two to four weeks. The rash usually begins one to three days after the fever and can be accompanied by fluid-filled lesions appearing on the palms, face, feet and genital region. According to the World Health Organization (WHO), while the monkeypox virus usually goes away on its own, it could cause serious complications, and even death, for infants, children and immunocompromised individuals. 

A current concern among healthcare officials is that monkeypox symptoms can be mistaken for more common infections. In an email to The Michigan Daily, Susan Ringler-Cerniglia, Washtenaw County Health Promotion Administrator, confirmed information has been sent to healthcare providers in the area regarding the virus’s presentation.

“Last week we sent information to local health care providers to alert them to how infections may look, recommended testing/sampling, and how to report any potential or confirmed cases to us at the Health Department,” Ringler-Cerniglia wrote. “One concern about the current outbreak is that it may look like other more common infections, such as syphilis or herpes. Also, most health care providers have not seen cases of monkeypox.”

Complications of monkeypox include pneumonia, sepsis, inflammation of the brain, infections of the eye and various other secondary infections. Monkeypox spreads through direct contact with bodily fluids — blood, lesions and respiratory droplets — of other individuals or animals, usually rodents and primates, who carry the live virus. It can also be contracted from the consumption of meat and blood from animals who are sick or dead. 

With humans, as with animals, the virus spreads only when the infected person is symptomatic. However, the virus does not only spread through direct contact with lesions and other bodily fluids; it can also spread from person to person through clothing, bedding and even utensils the infected person had used. 

According to the WHO, a number of the current reported cases have been identified in men who have sex with men. However, the spread of the virus is not limited to this demographic. The WHO hypothesizes that the identification of the disease in this demographic may be due to the “positive health seeking behavior” of this community, since the cases were identified in sexual health clinics. 

Is it related to smallpox?

Monkeypox is an orthopoxvirus related to smallpox and was first discovered in monkeys. There are two forms, or strains, of monkeypox: the Central and Western African forms. All new cases outside of the mother region have been confirmed to be from the West African clade, which appears to be less severe with a lower mortality rate compared to the Central African form.

Smallpox vaccines are known to provide at least partial protection against monkeypox. In an email to The Daily, professor of Global Public Health Dr. Joseph Eisenber wrote that a drug licensed for one purpose being used for another purpose is quite common.

“There are no additional risks when using a vaccine for a related virus,” Eisenberg wrote. “But there is always a risk benefit analysis that is done before recommending its use. And that risk benefit trade off will depend on the target population (occupational exposures vs. general population exposures) and on the risk of the specific virus (e.g., risks of severe disease and death).” 

Children today are less likely to be vaccinated against smallpox than children of previous generations because the disease was declared eradicated in 1980. The CDC only recommends administering vaccines to those with occupational exposure to the virus. Thus, Eisenberg believes a widespread vaccination campaign like what was seen with COVID-19 is unlikely to occur.

“Monkeypox is a zoonotic disease that is not that infectious and not that widespread,” Eisenberg wrote. “In this current outbreak there are hundreds of identified cases worldwide. Most of the cluster of cases have occurred in situations where there has been close contact for longer periods of time.”

However, a newer Imvamune vaccine, also known as MVA-BN or Imvanex, was approved in 2019 for smallpox and monkeypox prevention. According to the Centers for Disease Control and Prevention (CDC), Imvamune is 85% effective in preventing monkeypox infection, but the vaccine is not widely available. 

Should you be worried?

The short answer is: no, but be alert and mindful of the virus’s progression, just as public health officials are doing now. Eisenberg noted officials are still trying to understand why monkeypox is spreading outside geographical regions where the virus is endemic. 

“By studying the case clusters we would like to ascertain the risk factors associated with each cluster,” Eisenberg wrote. “We would also like to track the strain of the virus spreading to see whether it is evolving.”

Overall, monkeypox is more stable than COVID-19, meaning mutations are far less likely. Though risk to the general public remains low at this time, prevention strategies have been put in place by the county to ensure a positive case is taken care of responsibly if it were to appear. According to Ringler-Cerniglia, prevention strategies for the public include avoidance, sanitization and safe sexual practices. 

“More specifically to monkeypox, prevention strategies include avoiding direct contact with people who are sick as well as avoiding sexual contact with anyone with flu-like illness or an unexplained rash,” Ringler-Cerniglia wrote. “Always wash hands or use alcohol-base sanitizer if you have contact with infected people or animals. If you are caring for an infected individual, use protective equipment, if possible (mask or respirator, gown, gloves, etc.). Avoid contact with materials that have been in contact with an infected person or animal.”

Daily News Editor Nadir Al-Saidi can be reached at alsaidin@umich.edu.