SARS-CoV-2 that causes COVID-19 kills over a million in the US, avian influenza H5N1 (aka Bird Flu) is responsible for tens of millions of poultry sacrificed to avoid further agricultural devastation and potential human infection, and now there’s monkeypox.
It would be completely understandable for the public to assume that monkeypox may be the next devastating viral pandemic – but you would be wrong. Not all viruses are created equal and therefore have very different infectious disease potential within the human herd.
Monkeypox, a cousin to the smallpox virus, was first detected in laboratory monkeys in 1958. The virus is thought to transmit from rodents to people — or from infected people. In an average year, a few thousand cases occur in western and central Africa, with a mortality rate up to 10 percent. But cases outside Africa have been limited to a handful that are associated with travel to Africa or with the importation of infected animals.
Of concern is that more than 120 confirmed or suspected cases of monkeypox have been reported in 11 non-African countries recently, including in Europe and North America. Scientists at the Centers for Disease Control and Prevention (CDC) are collaborating with the Massachusetts Department of Public Health to investigate a situation in which a U.S. resident tested positive for monkeypox after returning to the U.S. from Canada.
Animal-to-human transmission may occur by bite or scratch, bush meat preparation, direct contact with body fluids or lesion material, or indirect contact with lesion material, such as through contaminated bedding. Human-to-human transmission is thought to occur primarily through close proximity via large respiratory droplets. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required.
Unlike the rapidly-evolving and mutating SARS-CoV-2 which is an RNA virus, monkeypox is a relatively large DNA virus. Double-stranded DNA viruses are better at detecting and repairing mutations than RNA viruses, which means it’s unlikely that the monkeypox virus will quickly mutate to become adept at human transmission.
Curiously, almost all of the case clusters thus far include gay, bisexual or men who have sex with men (GBMSM) aged 20–50. The most likely explanation for this unexpected pattern of transmission is that the virus was coincidentally introduced into a GBMSM community, and the virus has continued circulating there due to close contact, not necessarily of a sexual nature.
The U.S. maintains a supply of smallpox vaccines that are highly effective against monkeypox, as well as an effective antiviral treatment. In the event of an outbreak, communitywide vaccination campaigns can be quickly implemented to curtail transmission.
The past few years have taught us that we need to be vigilant and move quickly in the face of a potentially dangerous viral infection. And while anything is possible in virology, monkeypox is not likely to be the next dreaded viral pandemic.
David Segarnick Ph.D. is senior vice president, Medical & Scientific Services, Evolution Health Group, Pearl River, N.Y., and assistant professor, pharmacology, physiology and neuroscience, Rutgers Medical Schoo, Newark, N.J. He lives in Upper Black Eddy.
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