Health officials are concerned that failure to bring the spread of monkeypox under control raises the specter that it could possibly become an “entrenched STD” as feared and commonly transmissible as gonorrhea, herpes, or HIV.
These concerns have been raised here in the U.S. just as the WHO has declared the monkeypox outbreak a “global health emergency.” The rare designation means the WHO now views the outbreak as a significant enough threat to global health that a coordinated international response is needed.
Meanwhile, in the U.S., there are those health officials that believe the spread of monkeypox, could represent the dawn of a new sexually transmitted disease,
However, no one is really sure of the direction the disease will take, and there are those who feel that testing and vaccines can still stop the outbreak from taking root.
So far, more than 2,400 US cases have been reported as part of an international outbreak that emerged two months ago.
Health officials are not sure how fast the virus has spread. They have only limited information about people who have been diagnosed, and they don’t know how many infected people might be spreading it unknowingly.
They also don’t know how well vaccines and treatments are working. One reason for that is that federal health officials do not have the authority to collect and connect data on who has been infected and who has been vaccinated.
With such huge question marks, predictions about the degree to which the U.S. outbreak will worsen this summer vary widely, from 13,000 cases to perhaps more than 10 times that number.
Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said the government’s response is growing stronger every day, and vaccine supplies will soon surge.
“I think we still have an opportunity to contain this,” Walensky recently told The Associated Press.
Monkeypox is endemic in parts of Africa, where people have been infected through bites from rodents or small animals. It does not usually spread easily among people.
But this year, more than 15,000 cases have been reported in countries that historically don’t see the disease. In the U.S. and Europe, the vast majority of infections have happened in men who have sex with men, though health officials have stressed that anyone can catch the virus.
It spreads mainly through skin-to-skin contact, but it can also be transmitted through linens used by someone with monkeypox. Although it’s been moving through the population like a sexually transmitted disease, officials have been watching for other types of spread that could expand the outbreak.
Symptoms include fever, body aches, chills, fatigue, and the characteristic “pox” or bumps on parts of the body. The illness has been relatively mild in many men, and no one has died in the U.S. But people can be contagious for weeks, and the lesions can be extremely painful.
When monkeypox first emerged here in the U.S., there was good reason to believe that public health officials could control it.
The tell-tale bumps should have made infections easy to identify. And because the virus spreads through close personal contact, officials thought they could reliably trace its spread by interviewing infected people and asking who they had been intimate with.
It didn’t turn out to be that easy.
With monkeypox so rare in the U.S., many infected men — and their doctors — may have attributed their rashes to some other cause. Contact tracing was often stymied by infected men who said they did not know the names of all the people they had sex with. Some reported having multiple sexual interactions with strangers.
It didn’t help that local health departments, already burdened with COVID-19 and scores of other diseases, now had to find the resources to do intensive contact-tracing work on monkeypox, too.
There was another reason to be optimistic: The U.S. government already had a vaccine. The two-dose regimen called Jynneos was licensed in the U.S. in 2019 and recommended last year as a tool against monkeypox.
But now, demand has far exceeded supply, with clinics in some cities rapidly running out of vaccine doses and health officials across the country saying they don’t have enough.
That’s changing, Walensky said. As of this week, the government has distributed more than 191,000 doses, and it has 160,000 more ready to send. As many as 780,000 doses will become available as early as next week.
Once current demand is satisfied, the government will look at expanding vaccination efforts.
The CDC believes that 1.5 million U.S. men are considered at high risk for the infection.
Donal Bisanzio, a researcher at RTI International, believes U.S. health officials will be able to contain the outbreak before it becomes endemic.
But he also said that won’t be the end of it. New bursts of cases will probably emerge as Americans become infected by people in other countries where monkeypox keeps circulating.
Walensky agrees that such a scenario is likely. “If it’s not contained all over the world, we are always at risk of having flare-ups” from travelers, she said.
Indeed, optimism about keeping the disease under control is based largely on it being concentrated in one group of people — men who have sex with men. However, there are health officials that believe jumping to heterosexuals is a likely eventuality.
Spillover into heterosexuals “is just a matter of time,” said Dr. Edward Hook III, emeritus professor of infectious diseases at the University of Alabama at Birmingham.
If monkeypox becomes an endemic sexually transmitted disease, it will be yet another challenge for health departments and doctors already struggling to keep up with existing STDs.