With the recent monkeypox outbreak now declared a global emergency by the World Health Organization, many are beginning to ask questions about how the virus is spread and which situations are seeing highest risks.
A global emergency is WHO’s highest level of alert but the designation does not necessarily mean a disease is particularly transmissible or lethal. Similar declarations were made for the Zika virus in 2016 in Latin America and the ongoing effort to eradicate polio, in addition to the COVID-19 pandemic and the 2014 Ebola outbreak in West Africa.
“We have an outbreak that has spread around the world rapidly through new modes of transmission, about which we understand too little,” WHO Director-General Tedros Adhanom Ghebreyesus said. “I know this has not been an easy or straightforward process and that there are divergent views."
According to the U.S. Centers for Disease Control and Prevention, more than 16,000 cases of monkeypox have been reported in 74 countries since about May. To date, monkeypox deaths have only been reported in Africa, where a more dangerous version of the virus is spreading, mainly in Nigeria and Congo.
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So how does the virus spread and how can someone contract it?
In Africa, monkeypox mainly spreads to people by infected wild animals like rodents in limited outbreaks that typically have not crossed borders. In Europe, North America and elsewhere, however, monkeypox is spreading among people with no links to animals or recent travel to Africa.
WHO’s top monkeypox expert, Dr. Rosamund Lewis, said this week that 99% of all the monkeypox cases beyond Africa were in men and that of those, 98% involved men who have sex with men. Experts suspect the monkeypox outbreaks in Europe and North America were spread via sex at two raves in Belgium and Spain.
Person-to-person transmission is possible through "close physical contact with monkeypox sores, items that have been contaminated with fluids or sores (clothing, bedding, etc.), or through respiratory droplets following prolonged face-to-face contact," according to the Chicago Department of Public Health.
"I want to emphasize that monkey pox is not COVID," Chicago Department of Public Health Commissioner Dr. Allison Arwady said. "We've all been paying attention to COVID for a number of years now. You'll hear some more details, but this really does take, based on everything we know now, close and generally intimate contact."
She added that "most cases where we're seeing this are coming from much more intimate skin to skin contact or kissing."
According to Dr. Sharon Welbel, director of hospital epidemiology and infection control at Cook County Health, the virus does not typically spread simply from "bumping up against somebody."
“The way it typically seems to happen is that there is a lesion and it bursts or its opened up and it gets into a scratch or something one can’t even see but a crack in the skin," she said. "It is not by bumping up against somebody, being in the same room as somebody, sharing a seat with somebody.”
She noted that it "general takes prolonged contact."
Experts have cautioned that there is no current evidence to suggest the virus is airborne.
Dr. Amu Hazra, an infectious disease physician with Howard Brown Health, said that while a majority of cases have been in men who have sex with men, "the virus doesn't care how you identify."
Two children have been diagnosed with monkeypox in the U.S., health officials said Friday. In addition to the two pediatric cases, health officials said they were aware of at least eight women among the more than 2,800 U.S. cases reported so far.
Monkeypox often begins with flu-like symptoms and swelling of the lymph nodes, and progresses to a rash on the face and body.
Virus symptoms range from fever, aches and rashes all over the body.
"Suspected cases may present with early flu-like symptoms and progress to lesions that may begin on one site on the body and spread to other parts," CDPH previously stated.
Dr. Irfan Hafiz, an infectious disease specialist with Northwestern Medicine’s McHenry and Huntley hospitals, said the virus causes symptoms that are similar to several maladies, including chickenpox or smallpox.
“It can, to the layperson, look like chickenpox or warts,” he previously said. “But these (sores) tend to be in exposed areas.”
Health experts also stated the illness can be confused with a sexually transmitted infection like syphilis or herpes, or with varicella zoster virus.
In the U.S., some experts have speculated whether monkeypox might be on the verge of becoming an entrenched sexually transmitted disease in the country, like gonorrhea, herpes and HIV.
“The bottom line is we’ve seen a shift in the epidemiology of monkeypox where there’s now widespread, unexpected transmission,” said Dr. Albert Ko, a professor of public health and epidemiology at Yale University. “There are some genetic mutations in the virus that suggest why that may be happening, but we do need a globally-coordinated response to get it under control."
Vaccine supply is extremely limited in Chicago, as only 5,400 doses are available across the city. More than 15,000 doses are soon expected from the federal government, along with another 2,600 from the state of Illinois.
"We're doing everything we can to prioritize vaccinations for those most at risk, but the truth is, given the very limited national supply... there will be tens of thousands of individuals that are eligible and won't gain access," said Howard Brown Health CEO and President David Ernesto Munar.
Currently, you are eligible for the two-dose vaccine if you have had close physical contact with a confirmed case or if you're a man who has had sex with another man and have done so in a social or sexual venue. Additionally, those who received money in exchange for sex or have had sex with anonymous partners are eligible.
The CDC has recommended the Jynneos vaccine for men who report more than four male sexual partners within the past 14 days.
As of last week, the U.S. had distributed 156,000 doses of the Jynneos vaccine to states and ramped up testing capacity to 70,000 tests per week. Many cities and states are offering vaccine doses to people with known or presumed exposure to the virus, including men who have sex with men and transgender, gender nonconforming or nonbinary residents with multiple sexual partners.