More than 2,000 cases of monkeypox have been detected in 30 countries where the virus is not normally seen. Over 150 cases have recently been identified in the U.S. The count is growing since this briefing was held, June 24.

The most identifiable symptom of the disease includes a rash that can look like pimples or blisters that appear on the face, inside the mouth, appendages, and genitals. Other symptoms include fever, headache, muscle aches and backaches, and swollen lymph nodes.

No one has died of monkeypox, according to the Centers for Disease Control and Prevention. But how worried should we be? Does monkeypox pose a similar risk to Covid? How fast can the virus spread? And are certain populations more vulnerable than others? Do we have effective therapeutics or vaccines to control the spread?

(Above, l-r): Dr. William Schaffner, Professor of Preventive Medicine in the Department of Health Policy and Professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine, Nashville, Tennessee; Dr. Ben Neuman, Professor of Biology and Chief Virologist of the Global Health Research Complex at Texas A&M University; and Dr. Gregg Gonsalves, Associate Professor of Epidemiology (Microbial Diseases), at the Yale Institute for Global Health; Co-Director, Global Health Justice Partnership. (EMS)

At a briefing held by Ethnic Media Services, June 24, speakers – Dr. William Schaffner, Professor of Preventive Medicine in the Department of Health Policy and Professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine, Nashville, Tennessee; Dr. Ben Neuman, Professor of Biology and Chief Virologist of the Global Health Research Complex at Texas A&M University; and Dr. Gregg Gonsalves, Associate Professor of Epidemiology (Microbial Diseases), at the Yale Institute for Global Health; Co-Director, Global Health Justice Partnership – share their expertise helped us gain new insight into what a virus is and how it spreads.

Dr William Schaffner gave an overview of monkeypox, it’s prevalence in the U.S., symptoms, therapeutics, and possible vaccines.

“Monkeypox is a virus that circulates in Central and West Africa. It’s a member of the larger family which includes that virus which we have eradicated already from the face of the Earth, smallpox, but clinically in its classic form it resembles smallpox in some ways in West Africa, particularly in Nigeria.

“Its reservoir, that is the place where this virus normally lives, is in the animal populations, probably small animals, we’re not entirely sure which ones.

“The virus is called monkeypox because it was first identified in that primate species which goes to the point that it can also obviously infect humans.

“There are two major strains of this virus – the Central African strain, which is more severe; the West African strain, which is fortunately involved here, which produces milder infections.

“At the moment, in the United States, as of two days ago, on June 22, I have from the CDC that there were already 155 cases they’re involving 24 States and the District of Columbia. The states most frequently affected were California, New York, Florida, and Illinois.

“Now the cases range in age from 20 to 76 with an average of 37. No children have been involved. 98 of the cases have occurred in men and that’s a striking epidemiologic feature because it is thought that this virus was spread initially in gay pride events, among gay and bisexual men, that occurred in Europe, particularly the Canary Islands, Berlin, and perhaps also in France, where this virus was transmitted among the enthusiastic participants who then went home and then have initiated smaller outbreaks and chains of transmission in their home countries.

“Here in the United States, the first case was diagnosed on May 17, in Massachusetts. This is a person who had been in Canada and perhaps acquired their infection there. They presented with a rash in on their backsides, in their anal genital region, which subsequently spread to their face and to their trunk.

“This is a virus which is spread through close personal contact, usually skin to skin contact among humans. It can be spread via the respiratory root by what we call droplet transmission, in other words, very close within three feet usually over a prolonged period of time, skin to skin very close respiratory, and the third Way on occasion through contaminated towels and perhaps bedding.

“Note that this is not this is not a virus that spreads widely and readily the way COVID does. It usually spreads through chains of transmission, person to person, as a consequence of this close personal contact.

“After you contact the virus, it can take a week, up to two weeks, of an incubation period. You feel perfectly fine then you may get an initial virus-like illness, headache, not feeling so well, perhaps some fever, some swollen lymph glands, that can last a day or two, and then a rash develops. Classically, this is a rash like smallpox. Classically that occurs dominantly in the arms and on the hands, the face, and head, and the legs, and the feet.

“This virus is doing something different – it often has very few lesions and they may occur only in the genital area or on your backside in and around on your buttocks and your anus. All the lesions are in the same phase. The rash appears and makes a blister. It’s usually a clear blister then over time becomes filled with pus.

“One of the distinctive features of this rash is that if you feel the blister it’s firm and rubbery it is what we call ‘deep seated,’ it does not break readily unlike the very thin blisters of chickenpox, for example. These lesions will slowly get better over time. They may develop a little umbilicated center, that is the blister has a little crater in the center of it as it evolves and scabs and goes away. The fluid in the blisters, and the skin around it, are very contagious and that direct skin to skin contact is how this virus is transmitted. There have been no deaths in the United States due to monkeypox,” said Dr Schaffner.

“There are some therapies that are potentially available. Most people have a rather mild infection, treated as outpatients with symptomatic treatment, and it resolves by itself so that’s very fortunate,” concluded Dr Schaffner.

Dr Ben Neuman spoke about how did monkeypox virus it get to the U.S. from Central and West Africa.

“The earliest case was of a British person who contracted it in Nigeria and then came back to the UK, and then within a week or two, the normal incubation time, there was a small cluster. There have been no reports on whether people in that cluster went to some of these large gatherings which were associated with further onward transmission, but there would be pretty strong stigma against people, particularly if in some countries, so I can understand the need for privacy there.

This is one of many, what we would call, neglected and tropical diseases, things which are very damaging, potentially scary, but generally do not infect many people. We live in a world with far more viruses than people who can study them and so the effort tends to go where the money and the interest goes, and not every virus gets its due until something like this happens,” said Dr Neuman.

“Monkey pox has only been reported in a small number of people but among those, four were pregnant people. In those four patients, two of the babies died very early during pregnancy, one baby was born and appeared to be normal, everything was fine, the fourth baby was not born. It was still born and it was covered with monkey pox, human monkey pox like lesions, all over it. This is very typical for ortho pox viruses that is the group of viruses that includes mouse pox and camel pox and cowpox, and those viruses grow very well in the placenta of a lot of animals and in an infected animal.

“When the mother is infected and the virus is transmitted to the fetus, the mother has a much higher chance of survival, if there is an emergency abortion, at least in animal studies, mice that are infected with viruses like this, seldom if ever, survive all the way to term rather than the fetuses do. Controlling access to who would be able to and when they would be able to have these sorts of potentially life-saving medical services is now a concern.

“If this virus were to spread there’s nothing about this virus that means that it has to spread among men who have sex with men. It is a virus that would have spread just as easily inside a crowded dance club, or at a concert, or any other venue, where you have lots of people together, and they’re having a good time, so it’s a thing to be watched, it’s not something that is immediately scary right now but something that could get out of hand and very much something that should be stopped before it gets out of hand, in my opinion as a virologist.

“In an infected experimental animal, you find high doses of the virus in the liver where no one is going to come in contact with your liver, that’s okay, you would find high doses on the skin and you would find high doses in the nasal passages. It’s the nasal passages that worry me because those would allow us to spread the virus a little bit further, a little bit faster, it is very tempting to compare this to the spread and the changes that happen to COVID during that spread, we don’t know if there are other possible mutations that could make the virus a little more stable or a little more efficient at coming out of cells, or a little more effective at entering cells along the nasal passages, but any changes in that direction would be predicted to make this more transmissible and potentially transmissible to a wider number of people.

“This is only a scientific what if. We should not be alarmed that it has changed the virus that we see now is only about 40 mutations different from the virus that appeared in Nigeria about four years ago. It changes slowly which is typical for a DNA virus, but each time a virus emerges from the wild into people there are some changes and some unknowns, and potentially some surprises. As a very conservative virologist I do not like surprises when it comes to viruses,” concluded Dr Neuman.

Dr. Gregg Gonsalves cleared up some of the misconceptions around monkey pox including the fact that it may just be limited to men having sex with men.