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Editorial

It’s Science: Where are we now with monkeypox?

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Monkeypox was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) on July 23. As of early August, there were nearly 32, 000 confirmed cases of monkeypox reported across 82 nonendemic countries, with over 10,000 cases in the United States.

Monkeypox, a close 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.

Human-to-human transmission occurs primarily through direct skin-to-skin contact with infectious lesions, as well as large respiratory droplets requiring face-to-face contact. Monkeypox can be transmitted during sexual activity, but it is not considered to be a sexually transmitted infection because the virus can be acquired without having sex.

The average incubation period from time of exposure to first symptom onset is 7.6 days. People with monkeypox should remain in isolation for the duration of illness, which typically lasts 2 to 4 weeks. Complications of monkeypox include pneumonia, encephalitis, and eye infections, which occur mostly in children younger than 8 years and individuals who are immunocompromised or pregnant.

Mortality due to monkeypox is rare, but several deaths have been reported around the world; none yet in the U.S.

At this time, most U.S. cases have occurred among men who acquired the infection through sexual or other physical contact with other men. The U.S. Centers for Disease Control and Prevention (CDC) reported that approximately 99 percent of U.S. cases are among individuals assigned male sex at birth, with a median age of 35 years. At least 13 cases have been reported among persons assigned female sex at birth, including one pregnant individual, and at least two children have become infected.

The most likely explanation for this pattern of transmission is that the virus was coincidentally introduced into a gay, bisexual, and other men who have sex with men (GBMSM) community, and the virus has continued circulating there due to the relative insular nature of the community and frequency of close contact (not necessarily of a sexual nature).

The disturbing reality of social stigma directed towards the GBMSM community is real and harkens back to the early, dark days of HIV. The difference is that monkeypox can be spread through casual close contact of a non-sexual nature.

TPOXX (tecovirimat), an inhibitor of the orthopoxvirus originally approved to treat smallpox, is available to treat monkeypox in oral capsule or as an intravenous injection. In addition, two vaccines can be used to prevent monkeypox: the Bavarian Nordic JYNNEOS vaccine and ACAM2000.

In the event of an outbreak, community-wide vaccination campaigns can be quickly implemented to curtail transmission. The past few years has taught us that we need to be vigilant and move quickly in the face of a potentially dangerous viral outbreak. The public health lesson learned here is that while monkeypox is not likely to be the next lethal viral pandemic, we need to better fund our public health infrastructure at the federal and state levels so we can more rapidly surveille and respond to novel viral infections that cause significant pain, suffering and like COVID-19, death.

David Segarnick Ph.D., is chief medical officer and executive vice president of MedEvoke, Lebanon, N.J. and assistant professor pharmacology, physiology and neuroscience, Rutgers Medical School, Newark. He lives in Upper Black Eddy.


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