U.S. Declares Monkeypox a Public Health Emergency
A week after the World Health Organization deemed monkeypox to be a global health emergency, the U.S. has followed suit, declaring the virus a national crisis.
With the United States now having by far the most cases of monkeypox worldwide, the Biden administration on Thursday declared the virus to be a public health emergency. The declaration opens the door to more treatments, services, and funds to fight the virus.
“We’re prepared to take our response to the next level in addressing this virus, and we urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus,” said U.S. Department of Health and Human Services Secretary Xavier Becerra a press briefing.
As of August 4, the United States leads the world in monkeypox infections, with at least 6,616 cases in 48 states and the District of Columbia, according to the Centers for Disease Control and Prevention (CDC). In just over a week, reported infections in America have more than doubled. The New York Times said that New York, Washington, and Georgia have the highest rates per capita.
Globally, more than 26,000 cases have been recorded in 87 countries, according to the CDC.
With the outbreak spreading around the world rapidly, the World Health Organization (WHO) on July 23 declared monkeypox “a public health emergency of international concern.” The disease has the potential to cause serious illness, and five deaths have been recorded. The last time the WHO declared such an emergency was for COVID-19, in January 2020.
“WHO’s assessment is that the risk of monkeypox is moderate globally and in all regions, except in the European region where we assess the risk as high,” said Tedros Adhanom Ghebreyesus, PhD, the director general of the WHO, adding that the risk of the virus disrupting international trade or travel for now is low.
Dr. Ghebreyesus stressed that an international coordinated response is needed to stop transmission and protect vulnerable groups.
After the United States, Spain has the largest outbreak, with 4,577 cases, followed by Germany with 2,781, the United Kingdom with 2,759, and France with 2,239.
The U.S. Plan of Action
On Tuesday, President Biden named Robert Fenton, an administrator with the Federal Emergency Management Agency, as the White House’s national monkeypox response coordinator. At this week’s briefing, he highlighted how the government has already scaled up testing services from 6,000 to handling 80,000 tests per week.
With the actual number of people being tested at only 10 percent of the capacity, CDC Director Rochelle Walensky, MD, MPH, encourages anyone who has a suspected rash that could be monkeypox to get tested. Individuals can usually schedule testing through a healthcare provider. Aegis Science, Labcorp, Mayo Clinic Laboratories, Quest Diagnostics, and Sonic Healthcare are among the labs testing for the virus.
Fenton noted that the emergency declaration will allow the government to explore additional strategies to get vaccines and treatments more quickly to impacted communities, and to effectively track and attack the outbreak.
In addition to increased testing, administration has provided 1.1 million doses of monkeypox vaccine to state and jurisdiction partners, and ordered 6.9 million doses, which is more than enough to protect the highest risk population of 1.6 to 1.7 million individuals.
“This is a unique outbreak, and that is spreading faster than previous outbreaks,” Fenton said Thursday press briefing. “We will leave no stone no stone unturned in our efforts to combat this virus.”
Who Is Most at Risk
Based on the latest figures, the median age of those who are infected is 36, with a range of 18 to 76 years of age, and the vast majority of cases have been in people who identify as men who have sex with men (MSM).
Gay and bisexual men who have had sex with multiple partners are at particularly high risk of infection right now, according to the CDC. United Kingdom health services are advising individuals, particularly those who are gay, bisexual, or MSM, to be on the lookout for unusual rashes or lesions on any part of their body, especially their genitalia, and to contact a sexual health service if they have concerns. The symptom list in the United Kingdom was recently expanded to include a single lesion or lesions on the genitals, anus and surrounding area, lesions in the mouth, and symptoms of proctitis (anal or rectal pain or bleeding), especially if the individual has had a new sexual partner recently.
“It’s essential that all countries work closely with communities of men who have sex with men to design and deliver effective information and services, and to adopt measures that protect the health, human rights, and dignity of affected communities,” said Ghebreyesus. “Stigma and discrimination can be as dangerous as any virus.”
Although the WHO has stressed that the general public is highly unlikely to get monkeypox, ABC News reported on August 1 that at least four children have now contracted the illness. Dr. Walensky told the Washington Post that children are most likely to get the virus if they come in close contact with the community who is most at risk.
The WHO warned that the public health risk could become high if the virus spreads to groups at higher risk of severe disease, such as young children and immunosuppressed persons.
“That scenario can be prevented,” said Ghebreyesus. “The WHO urges affected countries to make every effort to identify all cases and contacts to control this outbreak and prevent onward spread.”
An Abnormal Outbreak
The WHO called the situation “unusual,” because this is the first time that monkeypox cases and clusters are being reported in widely different areas that have little or no association with West or Central Africa, where the disease primarily occurs.
“This is a very, very unusual infection in the United States and in the developed world,” said William Schaffner, MD, an infectious disease specialist and a professor of preventive medicine and health policy at the Vanderbilt University School of Medicine in Nashville, Tennessee. “Monkeypox virus lives in Africa, in a variety of different rodents, but occasionally gets into primates, such as monkeys, and hence the name, monkeypox.”
A study published in Nature Medicine found that the latest strain of the monkeypox virus has far more mutations than would be expected — including several that increase transmission.
Learn the Symptoms and Prevent Transmission
As monkeypox (which is in the Orthopox genus of viruses) continues to spread, Walensky encourages all Americans to get educated about this disease, including how to prevent it, its symptoms, and how to get tested.
While rare, monkeypox has the potential to cause serious viral illness, notes the CDC. It typically begins with flu-like symptoms (fever, headaches, muscle ache, chills, exhaustion) along with swelling of the lymph nodes. The illness then progresses to an itchy rash on the face and body — often noticeable on the palms of the hands and soles of the feet. Some patients may develop a localized rash, often around the genitals, before any flu-like symptoms, and some have no flu-like symptoms at all.
“The classic presentation that we’ve seen in the past is that the rash first appears on the head or neck and then progresses in what's called a centrifugal pattern. It leaves the center and it goes to hands, limbs, arms, legs, and soles of the feet,” said Rosamund Lewis, the technical lead for WHO’s monkeypox program in a YouTube webinar. Lesions then progress to the trunk and the genital area.
A lesion starts as a macule (a slight red patch on the skin). It then advances to a papule, which is a raised firm bump. And finally it becomes a vesicle, which is like a blister, with fluid inside.
Monkeypox has not previously been described as a sexually transmitted infection, but it can be passed on by direct contact during sex. Walensky noted that monkeypox cases may look like some sexually transmitted infections and could be mistaken for other diagnoses.
“What we know right now is that monkeypox spreads primarily through close skin-on-skin physical contact — by touching objects like sheets or towels that may have been used by somebody with monkeypox, and through close face-to-face interactions like kissing,” said Walensky in a press briefing.
The virus may also transmit between people through respiratory droplets in a close setting, such as the same household or a healthcare environment. Common household disinfectants can kill the virus.
Ghebreyesus recently stressed that person-to-person transmission is ongoing and is likely underestimated. “In Nigeria, the proportion of women affected is much higher than elsewhere, and it is critical to better understand how the disease is spreading there,” he said in a speech on June 23.
Walensky noted, however, that monkeypox is not thought to linger in the air and is not typically transmitted during short periods of shared airspace. “The virus is not thought to spread through interactions such as having a casual conversation, passing in the grocery store, or touching the same items, such as the doorknob,” she told reporters.
Demand for Vaccinations Increases
The Jynneos vaccine is approved by the U.S. Food and Drug Administration (FDA) for protection against smallpox and monkeypox in individuals 18 years and older who are determined to be at high risk of smallpox or monkeypox infection. The vaccine is administered (PDF) in two doses at least four weeks apart, and full immunity is reached two weeks after the second dose. The CDC says that “no data are available yet on the effectiveness of these vaccines in the current outbreak.” Still, studies in animals have been conclusive enough for the FDA to approve Jynneos to be licensed for prevention of monkeypox.
Health officials have struggled to keep up with the fast-rising demand for the vaccine. In San Francisco, city health officials said that in mid-July their supplies were short by tens of thousands of doses, according to NBC News. On July 25, a vaccine clinic at Zuckerberg San Francisco General Hospital closed because of a shortage of shots. In New York City, demand for the vaccine was so high that the NYC Department of Health and Mental Hygiene website crashed as people tried to make vaccine appointments.
How Effective Is the Vaccine?
Past data from Africa suggests that the Jynneos and smallpox vaccine is at least 85 percent effective in preventing monkeypox, according to the CDC.
Dr. Schaffner adds that the smallpox vaccine has “a degree of effectiveness” against monkeypox, but large-scale studies have not been done. He expects the best way to control the spread will be by identifying those with the illness and isolating them.
Administering the smallpox vaccine on a wide scale would pose many challenges, he adds.
“Smallpox vaccine is not administered by a needle and syringe — it's administered by a multiple puncture method,” said Schaffner. “It requires training in order to do that. We would have to train a whole bunch of people to administer this vaccine appropriately.”
The CDC says that there are no treatments specifically for monkeypox virus infections. However, monkeypox and smallpox viruses are genetically similar, which means that antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat monkeypox virus infections.
It’s Possible to Get the Illness From Animals
Jennifer Horney, PhD, MPH, a professor of epidemiology and a core faculty member with the disaster research center at the University of Delaware in Newark, added that monkeypox is associated with unsafe domestication of wild animals and remains endemic in certain parts of the world. People can get monkeypox when they are bitten or scratched by an animal, prepare wild game, or have contact with an infected animal or possibly animal products. New CDC guidance includes avoiding close contact with sick animals.
“A large, 47-person outbreak of monkeypox impacted the United States in 2003,” said Dr. Horney. “That was traced back to contact with exotic mammals that were being kept as pets.”
Following that outbreak, the United States did not see any cases until last year, when Texas and Maryland each identified an infected person who had recently traveled to Nigeria, per the Massachusetts Department of Health.
People Who Should Be Especially Careful
The Massachusetts Department of Public Health says people may want to consult a physician about the possibility of monkeypox if they:
- Have an unexplained rash
- Have traveled in the past 30 days to a country with recent confirmed or suspected cases of monkeypox
- Have had contact with a person or people with confirmed or suspected monkeypox
- Are a man who has sexual contact with other men
For more about this virus, visit the CDC's dedicated page.