Monkeypox in the U.S.: No Cause for Panic

A RUSH infectious disease expert offers her perspective on the virus

COVID-19
Monkeypox

Even though the first probable case of monkeypox in Chicago has been making headlines, the disease is nothing new — at least not to some parts of the world, says Mary Hayden, MD, chief of infectious diseases at Rush University Medical Center.

“Monkeypox is endemic to several countries in Central and West Africa,” Hayden says. “Cases in other geographic areas are usually related to travel. The virus is now gaining attention in many parts of the West because more cases than usual are being reported here.”

So far, the World Health Organization has not reported any deaths in Western countries from the disease. In Africa, as many as 1 in 10 people who get the virus die, according to the Centers for Disease Control and Prevention.

Here, Hayden explains what monkeypox means for the United States.

Where is monkeypox spreading in the West?

On June 2, local health officials confirmed that a Chicago man who had recently traveled to Europe likely had monkeypox. Before this case was reported in Illinois, confirmed or suspected monkeypox cases also were reported in several other U.S. states, as well as about a dozen countries including Canada, England, France, Israel and Australia. WHO cannot confirm that all of these cases were caused by travel to areas where monkeypox is endemic. “This suggests there may be some community spread,” Hayden says.

The virus is typically transmitted through body fluids that enter cuts or sores on the skin. Less often, it is spread through droplets that are inhaled or that enter the eyes or mouth. It may also be passed through contaminated clothing or bedding, according to the CDC. Infected animals such as monkeys and rodents can also pass the virus to humans.

Could monkeypox be the next COVID-19?

“The short answer is no,” Hayden says. She agrees with public health officials who don’t anticipate a COVID-style outbreak with monkeypox. Here’s why: The virus that causes monkeypox is much harder to spread than the virus that causes COVID-19. Also, the monkeypox virus usually doesn’t spread before symptoms appear. “Unlike many people with asymptomatic COVID-19 who wind up spreading the virus, people with monkeypox usually know when they are sick and contagious so they can avoid others,” Hayden says.

Plus, the United States already has a stockpile of millions of smallpox vaccines that can be used against monkeypox in case transmission levels become worrisome. In that case, public officials would need to determine which people should get the vaccine.

What are the symptoms of monkeypox?

According to Hayden and the CDC, early signs of monkeypox include:

  • Fever
  • Headache
  • Muscle aches
  • Chills
  • Fatigue
  • Swollen lymph nodes
  • A painful rash that appears about three days after the fever appears

Usually, the rash will show up on the face and then spread to other parts of the body. Some recent monkeypox cases have had atypical presentations, including a rash localized to the genital or perianal region, Hayden says. “These rashes might be confused with more common sexually transmitted infections such as herpes or syphilis, although monkeypox is not considered an STI,” she says. “The rash might start out as small, flat spots, then develop into bumps or blisters similar to chickenpox.” For the next several weeks, the sores will eventually crust over and form scabs.

Can anyone get monkeypox?

Yes. Although most recent cases of monkeypox in the West have been among men who have sex with men, anyone can become infected, Hayden says.

“Even though your risk for developing this rare disease is low, you can still take some extra common-sense precautions,” Hayden says. This means practicing good hand hygiene and avoiding close contact with anyone who has an unexplained rash or appears sick.

If someone does have contact with a person with suspected monkeypox, one of the available smallpox vaccines may be given after the fact to help prevent them from developing the disease, Hayden says. This is possible because monkeypox has a relatively long incubation period — up to two or three weeks — between the time of infection and the time symptoms like the fever and rash appear. In addition, several antivirals that work against monkeypox are already approved in the United States, providing other possible treatment options.

Is it OK to travel to places where there’s monkeypox?

Hayden recommends practicing enhanced precautions if you are traveling to places where monkeypox cases have been reported. According to the CDC, you should follow these tips on the road:

  • Avoid close contact with people who have an unexplained rash.
  • Stay away from live or dead rats, squirrels or monkeys.
  • If you are in Africa, avoid eating meat from wild animals.

If you have been to places where monkeypox cases have been rising and develop a fever, rash or other symptoms, talk with your doctor.

“Although the chances of you developing monkeypox right now are extremely low, the CDC is concerned enough about cases to issue an alert,” Hayden says. “It’s very unlikely that we’ll see a massive outbreak here in the United States, but monkeypox is a transmissible disease, so it makes sense to exercise a little caution.”

Learn more about how clinicians at RUSH care for infectious diseases.

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