Worries about monkeypox, a disease related to the much more deadly smallpox, are growing as cases rise in a number of countries.
Only three cases of confirmed or suspected monkeypox have been identified in the United States, but the disease is getting more and more attention in the media and from political figures — including President Biden — on the heels of a pandemic that has left Americans more vigilant to public health threats.
Most Americans are not currently in as much danger of getting monkeypox as the coronavirus. Monkeypox spreads in a different way than the coronavirus, according to the World Health Organization (WHO).
Monkeypox spreads through close contact with an infected animal or person, generally through lesions, body fluids, contaminated materials and respiratory droplets. Those droplets can only travel up to a few feet and usually require prolonged contact for transmission.
In total, the WHO said on Saturday that it was tracking 92 confirmed cases and 28 possible cases across 12 countries. A leading WHO infectious disease expert said on Monday that the leading theory for the recent outbreaks is two raves in Spain and Belgium.
In the U.S., Massachusetts public health officials last week confirmed a case of monkeypox in a person who had recently traveled to Canada. Over the weekend, New York state health officials confirmed a second case as Broward County in Florida investigates a separate presumed case.
Monkeypox patients usually first present symptoms within one to two weeks following infection but have reported onset as early as five days after exposure, according to the Centers for Disease Control and Prevention (CDC). Some patients may not experience any symptoms for up to 21 days.
Monkeypox patients first experience symptoms like fever, headache, muscle aches, swollen lymph nodes, chills and exhaustion. The swelling of the lymph nodes makes the virus distinctive to other diseases that mimic monkeypox’s other initial symptoms, including smallpox, chickenpox and measles.
Within one to three days after initial symptoms, infected individuals develop a rash that typically spreads from the head to other parts of the body.
The rash nearly always affects the face and appears on patients’ palms and feet soles in three-quarters of cases, according to WHO. The rash is also commonly found inside the mouth and more occasionally presents in the genitals, inside of the eyelids and on the cornea.
The rash begins with a flat base, but the lesions fill with fluid before drying up and falling off. In severe cases, the lesions can combine until large sections of skin slough off.
Those severe cases occur more commonly among children, and individuals with underlying immune deficiencies may also experience worse outcomes, according to the WHO.
Monkeypox complications can include secondary infections, bronchopneumonia, sepsis, encephalitis and cornea infections. The virus has been shown in Africa to cause death in as many as 1 in 10 infected people.
Even as concerns rise, tools already exist to help combat the outbreaks.
The smallpox vaccine is suggested to be at least 85 percent effective in preventing monkeypox, according to the CDC. But although many older individuals received the smallpox vaccination during historical vaccination campaigns, WHO warned that some younger people who were born after the disease’s eradication are not vaccinated.
No proven monkeypox treatment exists for humans, and the disease tends to go away on its own after two to four weeks. But antivirals like Cidofovir and Brincidofovir have shown benefits in laboratory settings and animal studies, the CDC noted.
With those tools in place and a new CDC health advisory asking clinicians to be vigilant for the virus, Biden said on Monday that he didn’t expect mandatory quarantine requirements for confirmed patients, like those implemented in Belgium.
“I just don’t think it rises to the level of the kind of concern that existed with COVID-19, and the smallpox vaccine works for it. But, I think people should be careful,” Biden said.
WHO advises that asymptomatic contacts of monkeypox patients can generally continue their daily routines, but it may “be prudent” for preschool children to avoid daycare and other group settings. All contacts should monitor for symptoms for three weeks, including twice-a-day temperature checks.
The extent of asymptomatic infection is unclear, but contacts should refrain from donating blood and other bodily fluids for three weeks, the international health agency said.