Colorized transmission electron micrograph of monkeypox particles (orange) found within an infected cell (brown and green).
As the viral disease monkeypox continues to spread around the world, the U.S. earlier this month declared the outbreak a national health emergency. For most people, though, the risk of infection remains low.
“This isn’t like COVID – the virus is not highly transmissible through casual contact,” said Rebecca Fischer, assistant professor at the Texas A&M University School of Public Health. “I do not expect we’re going to see classroom spread, workplace spread – that would be a very rare circumstance.”
Fischer is an epidemiologist who studies emerging infectious diseases. Monkeypox is less contagious and much less fatal than COVID-19, Fischer said, but there’s still good reason to be cautious. The virus is mainly transmitted through direct contact with skin lesions that characteristically appear during monkeypox infection, she explains, or even contact with an infected person’s mucus or saliva. The lesions may be visible on the face or hands but can also be hidden within the mucosal areas.
And while the virus is now mostly affecting men who have sex with men, Fischer stresses that monkeypox has no regard for gender, sexual orientation, age or ethnicity. Anyone who comes into direct contact is at risk of infection, and the virus could jump to and spread through other social networks where prolonged physical contact occurs.
Monkeypox is endemic to specific areas in central and western Africa, Fischer said, and the global outbreak can be tracked back to international gatherings that became superspreading events.
“We occasionally have sporadic outbreaks of monkeypox in the United States, but they tend to burn out, and are short-lived and self-limiting,” Fischer said. “I think this is just a reminder that we don’t have the upper hand over all of the infectious diseases out there.”
The people who are at highest risk of being infected are those who come into prolonged, close contact or who have direct skin-to-skin contact with someone else who is infected, Fischer said.
Currently, the primary route of transmission has been through direct contact during sexual encounters. So while monkeypox isn’t a traditional sexually transmitted infection, Fischer said this is a context in which people have prolonged contact, usually with extended skin-to-skin contact, facilitating transmission. People who live in the same household or who share bedding, towels, drinks, or utensils with infected individuals are also at risk.
“I get questions like, ‘If I shake somebody’s hand and they have a pox lesion on their hand, can I get it?’ The answer is yes, because the lesions harbor and transmit virus,” Fischer said. “If somebody were to learn their roommate had this, for example, then they would want to step up their disinfection and be extra careful of those common-touch areas, similar to as we advise for COVID.”
It’s a good idea to limit direct skin contact with widely shared public spaces, like seats in public transportation, benches or other high-touch surfaces if transmission becomes more widespread. She said this is easily accomplished by wearing longer pants and sleeves in lieu of shorts and tank tops. Stepping up hand hygiene throughout the day is also encouraged.
Simply sitting in the same classroom as someone who is infected, though, isn’t going to be a high-risk spreading scenario. Brazos County residents, in particular, are not at risk at the moment, Fischer said, but she encourages students returning to campus for the fall semester to pay attention to messaging from local health officials in case the situation changes.
Infected individuals can help contain the virus by reducing their close contacts and participating in contact tracing. Those who think they may have been exposed should try to access testing and find out how to get the vaccines originally developed for smallpox that also work on monkeypox.
“If the vaccine is rendered within the first four days, even if that person did encounter the virus and got infected, the vaccine is preventing severe disease,” Fischer said.
Some more preventative steps people can take: for now, limit the number of sexual partners and encounters if monkeypox has been identified in the area or in their personal network. This is especially important for sexually active gay and bisexual men, since until now most cases have appeared through high-contact situations in some of these social networks. Limiting prolonged, direct contact that occurs during sex can also reduce the risk of unknown transmission, Fischer said, regardless of sexual orientation or preference.
“If someone in your personal network has monkeypox, avoid direct contact with the person and items they have used,” she said. “Also, be supportive and do not stigmatize. The monkeypox isolation period can last several weeks, and monkeypox can be a painful and miserable experience.”
Texas A&M Student Health Services advises anyone who thinks they have monkeypox to isolate themselves and see a medical provider. Testing can be performed at the campus clinic, and staff have been trained on how to diagnose and treat symptomatic patients.
More guidance on monkeypox can be found on the Student Health Services website.