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Monkeypox: OHSU experts answer common questions

U.S. has declared a public health emergency; education is key to prevent spread of still-rare disease
close-up shot of a globed hand holding a vial labeled '100 doses Monkeypox vaccine, only for injection'
After the U.S. declared a public health emergency for the current outbreak of human monkeypox virus, also known as hMPXV, Oregon Health & Science University experts say education and mitigation efforts like vaccinating at-risk people are key to preventing the virus from spreading further.

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The spread of the human monkeypox virus, or hMPXV, this year in Europe and the United States has prompted public health emergency declarations — and understandable concern among Oregonians about the threat.

To help members of the public better understand this rare infectious disease, Oregon Health & Science University experts are answering some common questions:

  • Mark Slifka, Ph.D., a hMPXV and smallpox expert who studied the previous U.S. hMPXV outbreak in 2003.
  • Marcel Curlin, M.D., an infectious disease physician and researcher who specializes in virology and has focused much of his career on HIV. Curlin is also medical director of OHSU Occupational Health, which helps OHSU employees protect themselves from the virus.

Both emphasize that hMPXV remains a rare disease that isn’t easily transmissible and say education and mitigation efforts like vaccinating at-risk people are key to preventing its spread.

“If we’re not effective in education and treatment, this could become an endemic disease associated with close, intimate contact,” says Slifka, professor of microbiology and immunology in the OHSU School of Medicine and a senior scientist in the neuroscience division of OHSU’s Oregon National Primate Research Center. “This has the potential to become more common and difficult to treat.”

“It’s important to keep in mind that monkeypox is much harder to get than the cold, the flu or COVID-19,” says Curlin, an associate professor of medicine (infectious diseases) in the OHSU School of Medicine. “It’s primarily spread through prolonged and close, skin-to-skin contact. Monkeypox is not being broadly transmitted in the general community.”

As of Aug. 8, there are about 80 confirmed cases in Oregon, and a total of about 7,510 cases confirmed in the U.S. Click here for a CDC map of confirmed cases.

Q: What is monkeypox?

A: Human monkeypox virus, also known as hMPXV, is a rare infectious disease caused by the monkeypox virus.


Q: What are the symptoms?

A: Most people with hMPXV will develop rashes, which can lead to sores that often look like pus-filled pimples or blisters. These pimples can burst, leading to painful or itchy open sores that contain live, infectious virus. Other symptoms include fever, headache, muscle aches, swollen lymph nodes, chills, exhaustion, and respiratory symptoms such as a sore throat, congestion or coughing. Symptoms usually start within three weeks of being exposed to the virus.


Q: Is hMPXV deadly?

A: No one in the U.S. and very few people worldwide have died from the current outbreak to date. It can cause more severe disease in children and people with compromised immune systems. In Africa, where the disease is more common and where different strains that cause more severe disease circulate, hMPXV has an estimated mortality rate of somewhere between 1% and 10%.


Q: How does it spread?

A: hMPXV is more difficult to spread than the cold, flu and COVID-19.

hMPXV primarily spreads through prolonged and close, skin-to-skin contact. The live virus can be transferred to another person through discharge from pustules or rashes. In the current outbreak, the highest risk group to date includes men who report having sex with other men, as well as those who have close contact with them, such as their household members.

Scientists are continuing the study whether the virus can spread through airborne droplets, but transmission in the air is believed to be rare.


Q: How do I know if it’s hMPXV or another skin disease?

A: If you’re in a high-risk group or one of your close contacts develops hMPXV and you also develop an unfamiliar rash or experience other hMPXV symptoms, you should contact your primary care physician or a health care provider. hMPXV can be diagnosed by a health professional who collects a sample from a lesion and runs it through a PCR lab test, similar to the lab tests offered for COVID-19.


Q: How long does it take to heal?

A: It generally takes two to four weeks for the hMPXV lesions to heal, at which point a person is no longer infectious. Once people have recovered, the disease has run its course and they can no longer spread it to anyone else.


Q: How can I protect myself and others against hMPXV?

A: Those in high-risk groups should speak with their health care provider about getting vaccinated against hMPXV. People living with HIV/AIDS or other conditions that weaken the immune system are more vulnerable to becoming seriously ill if they get hMPXV, and should proactively speak with their health care provider to ensure their immune systems are sufficiently boosted.

Those who become infected should isolate themselves to prevent spreading it to others. As case levels continue to rise in Oregon and the U.S., those in high-risk groups — such as men who have sex with men — should consider limiting the number of their sexual partners, and should discuss the risk of hMPXV with their partners.

In the home, contaminated bedding or clothing should not be shaken, but instead folded or rolled up, and then washed in a washing machine with detergent.


Q: Which vaccines can prevent it?

A: There are two vaccines that can prevent hMPXV infection. The JYNNEOS vaccine is a two-dose injection that’s approved by Food and Drug Administration for hMPXV. Another vaccine, ACAM2000, is FDA-approved for smallpox. Because hMPXV and smallpox are related, ACAM2000 can also be used for hMPXV. However, ACAM2000 is not recommended for some populations, including people who: are pregnant or breastfeeding; have weakened immune systems; or, have certain skin conditions, such as eczema or atopic dermatitis.


Q: How can I get vaccinated?

A: Vaccine supplies are currently limited and are reserved for people who have the highest risk for getting hMPXV, such as men who have sex with men and sex workers. The Oregon Health Authority is distributing available vaccine to health institutions and community organizations.


Q: How is it treated?

A: Antiviral medications that are approved to treat other conditions may also be used for hMPXV in some circumstances, such as to treat those who either have severe monkeypox or have a high risk to develop severe hMPXV. People who are risk for getting severe hMPXV include children and those with weakened immune systems.

Although vaccination aims to prevent infection to begin with, getting vaccinated shortly after being infected may reduce symptom severity or prevent the development of symptoms.


Q: Are elderly people more susceptible, like they are with COVID-19?

A: No. Although anyone can potentially be infected with hMPXV, most U.S. citizens older than 60 have received the smallpox vaccine, which also protects against hMPXV because the two viruses are related. OHSU researchers have found the smallpox vaccine provides durable immunity up to 75 years after a single childhood vaccination against both smallpox and hMPXV.


Q: Is this the COVID-19 pandemic all over again?

A: No. hMPXV is a known virus that is much harder to spread than the virus that causes COVID-19. There is already an approved vaccine to prevent hMPXV. The severity of hMPXV illness can be reduced through vaccination even three or four days after a known exposure, and there are antiviral medications that can be used to treat hMPXV.


Q: Is hMPXV a sexually transmitted disease?

A: hMPXV is primarily transmitted through prolonged and close skin-to-skin contact, which doesn’t have to involve sex. While people of any sexual orientation can get monkeypox, so far, the majority of known cases from the current outbreak outside of Africa have been among men who have sex with men. Spread to date has largely been limited to social networks that include men who have sex with men, and has not extended to the larger community.

People who live with those who are infected can also get hMPXV. That’s why it’s important for anyone who thinks they may have the virus to get tested, treated and isolate themselves according to their health care providers’ recommendations.

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