The monkeypox virus is spreading in clusters across the United States. There have now been more than 3,500 confirmed cases, according to the latest count from the CDC. And the World Health Organization on Saturday declared monkeypox a global health emergency.
The U.S. government is ramping up production of test kits and vaccines, with a promised 1.6 million vaccine doses expected in coming months.
And although no confirmed cases of the virus have been found in Vermont, they have sprung up in New Hampshire, Massachusetts, Connecticut, Rhode Island and now Maine — with the country's largest outbreak in New York.
Dr. Tim Lahey, an infectious disease specialist at UVM Medical Center, said it’s only a matter of when the virus is found in the Green Mountain State.
“I think it's just a matter of time. We think that a large number of cases of monkeypox have been missed through the decades, particularly since some people get pretty mild symptoms,” Lahey said.
He said everyone has some level of susceptibility to the virus.
“This is particularly true due to a declining number of people who are vaccinated against smallpox, which is a relative of monkeypox,” Lahey said.
As for the virus’ origins, it’s been active in western and central Africa for decades without much notice from the rest of the world. Despite spreading globally now, monkeypox is still rare.
It’s also rarely fatal. Though it is part of the virus family related to smallpox, monkeypox symptoms are typically much milder.
For some, the steps for containing monkeypox virus may sound familiar: isolate and test.
“For somebody who has fever and a new rash that conceivably could be monkeypox, I think it's important to do two things. One is to try to isolate as best as possible. You don't want to spread this. And call your doctor," Lahey said.
Symptoms and spread
With three distinct phases, monkeypox begins with symptoms similar to flu - headache, malaise and weakness. During this first phase after first contracting the virus, a person is not contagious. This stage can last one to two weeks.
A rash and lesions appear next. And for the next two to four weeks, someone with monkeypox lesions will see them change in appearance before scabbing over and resolving. This stage of rash and lesions is when the virus is highly contagious.
“We think the majority of monkeypox transmission happens through direct contact from person-to-person and often skin-to-skin, maybe shared bedding or towels,” Lahey said.
Lahey said monkeypox is most likely to spread through sex. Still, Lahey cautions that monkeypox isn’t considered a sexually-transmitted virus, because the spread of the virus is not exclusive to sexual activity.
For a global population still reeling from and dealing with the COVID pandemic, Lahey said this current outbreak of monkeypox in the United States is not airborne like COVID, though a small portion of cases may be contracted from airborne transmission.
“This might be that if I'm sitting next to somebody, maybe kissing them, maybe cuddling with them,” Lahey said. “Eventually, given the fact that people travel so much — that sex happens in Vermont, just like it does elsewhere — just waiting for the next case to show up here," he said.
Stigma
The majority of monkeypox cases in the U.S. have been in men who have sex with other men.
“Not because of some special vulnerability among that population, but because it happened to enter into that sexual network, which is smaller than others,” Lahey said.
But women and two children have also contracted monkeypox in the U.S.
Lahey cautions against stigmatizing gay men, echoing the early days of the HIV/AIDS pandemic in the 1980s.
"I think it's important to know — for men who have sex with men to be empowered to protect themselves and to have the information and resources that they deserve. And also, I think we need to be really careful not to recapitulate the mistakes that were made early on, in the HIV pandemic, of stigmatizing — even ostracizing,“ Lahey said.
“Blaming men who have sex with men, that would be just counterproductive all over again. And so I think there's a balancing act where we can empower and inform. And that way, if I'm a man who has sex with men, I can adjust my behavior in ways that are feasible. And I can keep myself safe.”
"The time to get testing and vaccination ready is yesterday." - Dr. Tim Lahey, UVMMC infectious disease physician, talking about the monkeypox virus
Vaccine
Lahey said Vermont's vaccine supply is limited.
“It would be better if we could respond closer to what New York and other locales have done, where not only are the vaccinating people who know they've been exposed, but those who are at high risk of exposure.," he said.
Lahey said there are ongoing conversations about importing more vaccine doses into the state, but says it will take time to boost vaccine and testing capacity. Still, he says there should be a sense of urgency.
"We have people who we care about who are at risk, and they should have the right resources. The time to get testing and vaccination ready is yesterday," Lahey said.
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