By Dr. Samer Koutoubi, M.D., Ph.D.
Department Chair, Public Health
Monkeypox cases continue to increase in the United States. According to the Centers for Disease Control and Prevention (CDC), the U.S. has over 10,392 confirmed cases of monkeypox as of August 10.
The World Health Organization (WHO) declared monkeypox a “public health emergency of international concern” on July 23. This statement from WHO indicates that an international effort is required to combat this highly contagious disease.
Health and Human Services Secretary Xavier Becerra also declared monkeypox to be a public health emergency, especially as monkeypox cases increase in New York, Illinois, and California. At a recent news briefing, Becerra said, “We’re prepared to take our response to the next level in addressing this virus, and we urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus.”
In addition, the Biden administration has taken steps to help combat monkeypox. According to a statement from the White House, “President Biden named FEMA’s Robert Fenton as the White House National Monkeypox Response Coordinator and Dr. Demetre Daskalakis as the White House National Monkeypox Response Deputy Coordinator. Fenton and Daskalakis will lead the administration’s strategy and operations to combat the current monkeypox outbreak, including equitably increasing the availability of tests, vaccinations and treatments.”
What Are the Symptoms of Monkeypox?
According to the CDC, monkeypox is spread through the air (inhaling airborne droplets from an infected person) or by contact with the liquid sores on infected people or animals. It can also be spread by using clothing, towels, toiletries, or bedding from an infected person.
Monkeypox symptoms typically include:
- Muscle aches, including backache
- Swelling of lymph nodes
- A rash and lesions that appear one to three days after exposure
Who Is Testing and What Type of Monkeypox Tests Are Available?
Labcorp and Quest Diagnostics have received approval to provide clinical testing. According to Labcorp, the monkeypox test is qualitative. The test will provide a “detected,” “not detected,” “equivocal,” or “inconclusive” result for the presence of DNA from non-variola orthopoxvirus species, of which monkeypox is one.
Of these four results, “detected” means a positive result for monkeypox and “not detected” means negative for monkeypox. “Equivocal” means that the result cannot be determined, and the CDC recommends in this situation that a new patient sample should be collected and tested. “Inconclusive” means no virus is detected due to a poorly collected sample, and the CDC says that a new patient sample should be collected and tested in this situation.
The CDC notes that the current monkeypox testing capacity is at least 80,000 tests per week.. The US Laboratory Response Network (LRN) has labs capable of conducting 10,000 tests a week), and commercial laboratories can conduct 70,000 additional tests a week.
For these tests, the preferred specimen type is a swab that has been in contact with a monkeypox lesion on any area of the body. The CDC recommends that a patient provide three specimens for testing, and the CDC is currently researching other types of specimens that can be used for monkeypox tests. Ideally, healthcare providers should conduct diagnostic tests for any patient suspected of having monkeypox.
Related link: How Concerned Should You Be about Contracting Monkeypox?
Concern about Delays in Monkeypox Testing
According to People, some Labcorp and Quest Diagnostics technicians may not be taking blood samples from suspected monkeypox patients, which has caused concern about delays in testing. People also noted that Labcorp executive Dr. Brian Caveney said, “(Monkeypox) is new – nobody knew what it was – some nurses and doctors are scared of it. Some of our phlebotomists have been scared – appropriately – of it.”
David Harvey, executive director of the National Coalition of STD Directors, told People that “This is absolutely inexcusable. It’s a grave dereliction of duty…..We can’t afford a delay in diagnostic testing because commercial labs aren’t doing the right thing.”
Related link: How to Stick with Healthy Habits during Summer Travel
What Vaccines Are Available?
The CDC says that smallpox vaccines can be effective at protecting people from monkeypox, provided that people receive a vaccination prior to exposure. In the near future, about 800,000 doses of vaccine will be available for distribution.
According to the CDC, there are two currently licensed smallpox vaccines in the United States, ACAM2000 and Jynneos. People who are exposed to orthopoxviruses – such as monkeypox – may use these vaccines to proactively protect themselves, a technique known as pre-exposure prophylaxis (PrEP).
But getting the vaccine has its difficulties. According to the Washington Post, “as many as 1 million high-risk men may be unable to get two Jynneos doses for months.”
The Washington Post also quoted J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies. Morrison said in a podcast, “When you look mathematically at what the requirements are … we’re facing some tough sledding here.” Morrison noted that “3.2 million doses would be needed to fully cover the at-risk population of HIV-positive men and others targeted to receive vaccinations by the Centers for Disease Control and Prevention.”
The CDC says that children and adolescents who have been exposed to a suspected or confirmed case of monkeypox may be eligible for post-exposure prophylaxis (PEP) with vaccination, immune globulin, or antiviral medication. The CDC also issued guidelines on how ACAM2000 or Jynneos should be given to patients:
- “ACAM2000 is administered as a live Vaccinia virus preparation that is inoculated into the skin by pricking the skin surface. Following a successful inoculation, a lesion will develop at the site of the vaccination (i.e., a “take”). The virus growing at the site of this inoculation lesion can be spread to other parts of the body or even to other people. Individuals who receive vaccination with ACAM2000 must take precautions to prevent the spread of the vaccine virus and are considered vaccinated within 28 days.
- Jynneos is administered as a live virus that is non-replicating. It is administered as two subcutaneous injections four weeks apart. There is no visible “take” and as a result, no risk for spread to other parts of the body or other people. People who receive Jynneosare not considered vaccinated until 2 weeks after they receive the second dose of the vaccine.”
The CDC recommends that “the vaccine be given within 4 days from the date of exposure in order to prevent onset of the disease. If given between 4–14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease.”
Stopping Smallpox Vaccinations May Have Paved the Way for Monkeypox
According to a Los Angeles Times article, stopping smallpox vaccinations in the 1970s may have paved the way for monkeypox cases to begin appearing. Peter Hotez, the co-director of the Center for Vaccine Development at Texas Children’s Hospital and the dean of the National School of Tropical Medicine at Baylor College of Medicine, said to the LA Times, “Monkeypox is believed to have become more prevalent after we stopped vaccinating populations against smallpox…We pretty much slowed or halted smallpox vaccine programs…and that was actually enabling for monkeypox to emerge among human populations, because immunity was wearing off.”
The LA times also quoted Georges Benjamin, executive director of the American Public Health Association (APHA). Benjamin said that if you were vaccinated against smallpox pre-1980, “you would likely have some degree of protection from monkeypox, but you should still get the Jynneos vaccine if you’re exposed or are otherwise eligible.” Benjamin added, “Unless you were recently vaccinated for smallpox, like the last two to three years, most likely you probably want to go ahead and get vaccinated if you’re exposed.”
Isolation and Prevention Is Recommended to Prevent the Spread of Monkeypox
The CDC recommends that people with monkeypox remain isolated at home or at another location as long as the disease lasts, but that might not be possible in all situations. The CDC further notes that:
- “Direct skin-to-skin contact, including sexual and/or close intimate contact, has been identified as a predominant type of exposure for persons with monkeypox in the United States.
- Most people with monkeypox have been adults and have not required hospitalization.
- Deaths have occurred but are rare and have occurred in individuals with underlying conditions.”