- Several dozen cases of monkeypox have been diagnosed across Europe, North America, and Australia.
- The disease has mainly been hitting young men who have sex with men, but that doesn’t mean it’s being sexually transmitted.
- Experts are investigating whether this is truly a more infectious version of monkeypox, or it has just infiltrated very close-knit populations.
Monkeypox is spreading, and it is spreading much faster than it usually does.
This month, more than 140 confirmed and suspected cases have been detected in a dozen countries across Europe, North America, and Oceania. The first was diagnosed in the UK on May 7, and the number of cases that have been confirmed in that country has quickly doubled in the past two days, from nine infections on May 18 to 20 infections on May 20.
Other monkeypox cases have recently been confirmed scattered across the US, Australia, Spain, Italy, Germany, Portugal, and Sweden — the list of countries grows by the day.
One of the troubling things that disease experts have noticed with this outbreak is that the patients don’t all have a clear link to one another. They haven’t all traveled to countries where the disease is endemic, like the Democratic Republic of the Congo, Nigeria, or Cameroon, nor have they all been in contact with people who recently traveled to the parts of west and central Africa where animals like rodents harbor this virus.
But one thing that public health experts have noticed is that most of the infected patients — in fact all but one of the patients whose sex has been revealed so far — are men.
This doesn’t mean we are dealing with a new brand of monkeypox — one that only infects males, or one that is sexually transmitted between men who have sex with men. It’s still early days for disease investigators, who are tracking down exactly how genetically related these monkeypox cases may be, and how they might be spreading from person to person. For now, experts are divided on whether we should give much weight to the fact that most of the monkeypox patients diagnosed outside Africa recently have been men.
Why some health officials are focusing on men who have sex with men
Professor Jimmy Whitworth, an infectious disease expert at the London School of Hygiene and Tropical Medicine, told Insider that “we urgently need to find out” whether this version of monkeypox is spreading in a new way.
Typically, monkeypox spreads from person to person through extremely close contact. The virus can be picked up on surfaces, from bedding, clothes, or respiratory excretions, but it’s especially easy to get it through skin to skin contact.
“You could imagine that a female person living in the same house, sharing utensils and so on with somebody who’s incubating it could get it, but we haven’t seen that so far,” Whitworth said. “That’s what makes us a bit suspicious that maybe this is transmitting sexually, and we need to find that out. Because if so, that’s new — that’s not been seen before.”
One CDC monkeypox expert says the sexuality aspect is a red herring
Epidemiologist Andrea McCollum, with the US Centers for Disease Control and Prevention,
has been dispatched to investigate monkeypox outbreaks for years, in at least four different African countries. She says nothing strikes her as odd about how the disease is spreading — at least not yet.
“Even though there’s a lot of questions right now surrounding specific populations of concern, and how this may be spreading, I think it’s entirely consistent with what we know about the virus,” she told Insider. “We know this virus spreads via very close contact.”
That contact can be with another person’s saliva, blood, or the pox themselves — the rashes people get with monkeypox are incredibly infectious.
“Pus, scabs — all those legions are chock full of a ton of virus,” McCollum said. “At first pass, it sounds like this is a strain of virus that’s closely related to what we knew was circulating in West Africa within the last couple of years.”
Typically, monkeypox rashes tend to break out on the face, palms of the hands, and bottoms of the feet. But Swedish health authorities said on Thursday that “in European cases, the skin problems have often been reported to be localized to the genitals, groin, and the skin around the anal opening.”
‘Monkeypox is not a gay disease’
Public health experts and virologists say that the focus on gay men getting monkeypox now is “sadly reminiscent” of some of the initial reporting about HIV and AIDS 40 years ago.
“Monkeypox is not a gay disease, and neither are any other infectious diseases,” virus expert and physician Dr. Boghuma Kabisen Titanji, public health researcher Keletso Makofane, and another public health expert who goes by Dr. Neurofourier on Twitter wrote on the PLOS blog “Speaking of Medicine and Health” on Thursday.
“It is unfortunate that this still needs to be said, highlighting how little we have learned from previous outbreaks.”
The World Health Organization also chimed in on Friday, pointing out in a statement that anyone who closely interacts with an infectious person can be at risk of catching monkeypox.
“This includes health workers, household members and sexual partners,” the WHO said. “Stigmatizing groups of people because of a disease is never acceptable. It can be a barrier to ending an outbreak as it may prevent people from seeking care, and lead to undetected spread.”
Everyone is vulnerable to monkeypox, because most of us haven’t had a smallpox vaccine
McCollum, with the CDC, says that monkeypox cases have been on the rise in recent years in Africa, and there are a couple reasons why that might be happening.
“Nigeria went 39 years without any cases,” she said. “And then all of a sudden they didn’t just have a few cases, they had a lot — and they continue to.”
One key reason might be due to the unparalleled success of the smallpox vaccine. Because smallpox was eradicated from the Earth in 1980, most people alive today haven’t been vaccinated against the disease. (McCollum, however, is vaccinated against smallpox because of her work, which sometimes includes handling infectious lab specimens.)
Smallpox and monkeypox are closely related viruses, and the vaccines that have been developed for smallpox can provide robust cross-protection against monkeypox. But experts estimate that, these days, more than 70% of people worldwide have no immunity to monkeypox, because they never needed to be vaccinated against smallpox to begin with.
Genetic sequencing being done now should shed better light on whether this is truly a more contagious form of monkeypox or not, and whether it is spreading in some new way.
With fewer than 150 suspected cases in total, both McCollum and Whitworth are cautious about raising the alarm too high among the general public.
“The likelihood is that the number of cases is never going to be that big,” Whitworth said. “It’s not like this is the next pandemic — we don’t think.”