New outbreaks of a rarely seen disease called monkeypox are putting public health experts on edge. Several countries, including the US, have recently reported cases of the viral infection. No deaths have been reported so far and the risk to the general public appears low for now. But it’s possible that something has changed in the virus, or its relationship with humans, that makes it more transmissible.
Countries with Reported Monkeypox Cases
The first US case involved a Massachusetts resident who had recently traveled from Canada, where there have been 13 suspected cases. Late Thursday afternoon, New York City health officials reported a suspected case of monkey pox, currently being treated at Bellevue Hospital.
At least 11 countries including UK, Canada, Spain, Portugal, Italy† Sweden, and the US has documented cases of monkey pox. In the UK, the first reported case is: believed incurred while in Nigeria. Australia reported the first case Thursday, with someone who had recently traveled from the UK. Germany, France and Belgium reported their first cases Friday morning and there are now an estimated 100 reported cases worldwide.
Also this morning, the World Health Organization announced it will hold an emergency meeting on monkey pox, where experts will deliberate on whether or not to declare the outbreaks a public health emergency of international concern (PHEIC). The last such major and ongoing outbreak to receive PHEIC status is the Covid-19 pandemic.
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monkeypox was first documented in Africa in the 1970s and has been observed occasionally on the continent since then. But it’s a zoonotic disease, meaning infections are usually transmitted from animals to humans (despite the name rodents are believed to be the primary vector) rather than between humans. So these multiple outbreaks in different countries, with evidence of local transmission in some, are very different from what we’ve seen before, according to Andrew Pavia, an infectious disease physician at the University of Utah. But there’s no clear answer yet as to why this is happening, he adds.
“In the past, human-to-human spread has occurred, but it was quite limited. We don’t know yet that it spreads more easily from person to person. That’s a possible explanation, but I’m not yet aware of any evidence to support that idea,” Pavia told Gizmodo in an email.
What is monkeypox virus?
Monkeypox is caused by the virus of the same name, a member of the poxvirus family. It is a close cousin of the smallpox virus, the only human germ to have been completely eradicated to date. Like smallpox, a monkeypox infection causes distinct bumpy skin rashes that usually start on the face and spread throughout the body, along with flu-like symptoms.
It takes one to three weeks after exposure for symptoms to start, and people are usually sick for about two weeks. As many as 10% of victims can die from it, although the cases documented in the UK appear to be caused by a lineage of the virus known to be less virulent, with a death rate closer to 1%.
There are available monkey pox tools that we could use if these outbreaks spread to a bigger threat. Smallpox vaccinations should remain protective against monkeypox and can be given post-exposure to prevent disease, so they can be used as part of a “ring vaccination” strategy to prevent short-circuit outbreaks. There are approved antivirals that have also been shown to be effective against smallpox virus infections.
Why is monkeypox spreading now?
It is plausible that the virus somehow evolved to make it inherently more contagious between humans. But some scientists, such as Jo Walker, an infectious disease epidemiologist and modeler at the Yale School of Public Health, have. speculated that this seemingly increased spread could in fact be related to our victory over smallpox decades ago.
Smallpox was declared eradicated in 1980 through the efforts of a worldwide mass vaccination program that created a broad network of population immunity. Poxviruses are known to cause cross-immunity to other related viruses (the attenuated virus in the classic smallpox vaccine isn’t even smallpox). And this buffer of immunity to smallpox may also have hindered the spread of monkeypox in humans. But with the passage of time, our collective protections have diminished over time for a variety of reasons, which may have allowed monkeypox to finally spread on a larger scale, without anything having to change in any major way.
“This ‘decreasing immunity’ is due less to waning immunity at the individual level, and more to people with immunity dying, and people without immunity being born and then remaining non-immune,” Walker told Gizmodo in a Twitter post.
Walker notes that some researchers have: long warned about monkeypox or similar viruses that will one day fill the niche left by smallpox, and some have argued that it is a major factor in why the germ created a return to Nigeria from 2017, after four decades of zero reported cases.
Another possibility Pavia raises is that a mysterious animal played an outrageous role in seeding these outbreaks. In 2003, he points out, there was the largest known but still small outbreak of monkeypox in the US (47 cases in all) traced come into full contact with infected prairie dogs as pets – an unknown vector at the time.
At the same time, there is evidence of human-to-human transmission in at least some of these cases. In the UK and Spain, most cases have been found in young gay and bisexual men, raising the possibility that these infections were sexually transmitted. Other research has suggested that monkeypox can: theoretical survival in the environment in aerosol particles intact enough to be considered airborne.
Getting to the bottom of this monkeypox mystery takes classic medical detective work, Pavia said. Epidemiological research will try to find out what type of contact led to people’s infections and the number of infections that seem to emerge from each index case. In the lab, scientists look for potentially relevant genetic changes in patients’ virus samples, or test whether these infections behave differently in model animals.
“Given what we know today, there’s no reason to panic or for most people to worry, but it’s early days so that could change,” Pavia said.
This article was updated as of May 20 with the latest case counts.
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