Bold Explainer: Understanding Guidelines for Monkeypox

a monkeypox virus just hanging out

Coming off the heels of the pandemic, many of us are well primed for the next worldwide infectious outbreak. This is especially after the rollercoaster ride of quarantines and reopenings that occurred with each new variant. It’s therefore little surprise that the emergence of a new infection called Monkeypox is cause for concern. Out of nowhere, this new virus is spreading throughout the U.S. and Europe with thousands of cases already. But there are many myths about Monkeypox being circulated that are simply not true. As a result, it’s worthwhile to take a look at this virus in greater detail and the guidelines for Monkeypox care.

A Little Background About Monkeypox

Despite Monkeypox recently making news headlines, the actual virus was discovered decades ago. In 1958, the first outbreak of Monkeypox occurred in a research lab affecting monkeys. However, despite myths about Monkeypox suggesting the virus originated in monkeys, this isn’t the case. The actual carriers for the virus are various types of rodents. It was thus presumed the monkeys had acquired it from rodent exposure or from humans exposed to infected rodents. The second outbreak then occurred in 2003 in Texas when an animal shipment from Ghana arrived. Infected rodents infected pet prairie dogs, which resulted in 47 people developing Monkeypox. This outbreak was similarly contained, and the virus fizzled away thereafter.

Until recently, almost all the Monkeypox infections have occurred in Africa. In fact, guidelines for Monkeypox identify two main variants of the virus, and both are from Africa. One type, the Central African variant, is more potent. The other one, the West African variant, is less so. The recent Monkeypox infections in the U.S. represent the West African type, making it less concerning. And while no one is clear how the recent outbreaks began, most experts presume international travel may be the primary culprit. This is why most guidelines for Monkeypox today are focused on prevention by limiting human spread.

“I’ve been working on this virus for 20 years. It’s a virus that does not spread as easily as something like SARS-CoV-2. Its most efficient route of transmission is close, prolonged, skin-to-skin contact.” – Anne Rimoin, Professor of Epidemiology, UCLA Fielding School of Public Health

How Monkeypox Spreads

In order to appreciate ways to prevent the spread of Monkeypox, it’s important to understand how the virus behaves. Those so far that appear to be most at risk are men having sex with other men (MSM). This has led to one of the myths about Monkeypox claiming that the virus is a sexually transmitted disease. While it may be transmitted in this fashion, it can also be spread other ways as well. Likewise, MSM are not the only populations at risk. Children under 15 years of age are at risk, and in actuality, anyone may contract the virus through close contact. As such, the guidelines for Monkeypox prevention focus not only on safe sex measures but also contact preventions also.

A collection of test tubes with monkeypox
Guidelines for Monkeypox are here, and the first bit of advice is to not freak out.

In essence, human beings can contract Monkeypox via animal exposures or human exposures. Rodents carrying Monkeypox typically convey the infection to humans via bites and scratches or through direct contact with animal fluids. Person-to-person infection is less common, but it tends to occur with direct contact as well. Skin contact of sores and scabs is one way Monkeypox may be spread. Other ways include exposure to oral secretions or respiratory droplets. It has also been found that bedding, linens, and clothing from infected individuals can cause the virus spread. And while it has not been definitively determined if semen and vaginal fluid trigger virus spread, it is possible. Therefore, current guidelines for Monkeypox warn of all these potential sources of exposure.

“Monkeypox can spread in a variety of ways. It can spread through contaminated objects, respiratory secretions, but really that’s not what we’re seeing as the primary mode of transmission in this outbreak. What we’re seeing is the vast majority of cases are from prolonged skin-to-skin contact, generally in the context of sex.” – Anne Rimoin

What to Expect with Monkeypox

Currently in the US, there are over 7,000 cases of Monkeypox. While this is a concerning number, myths about Monkeypox being the next pandemic are extremely exaggerated. In addition, myths about Monkeypox stating that it is highly fatal are also completely wrong. In actuality, the vast majority of people who get Monkeypox have a self-limited illness for up to four weeks after symptoms appear. These symptoms include fever, chills, flu-like symptoms, and of course, a rash. Of these, the rash can be the most bothersome from a pain perspective. Over a few weeks, lesions go from vesicles, to pustules, to scabbed sores, and each is infectious. But in most cases, these resolve completely even without interventions.

Understanding this, guidelines for Monkeypox care is generally supportive. That means individuals with Monkeypox should stay hydrated, get rest, and take mild pain relivers if needed. In addition, they should also wear a mask during this time and avoid skin contact with others. Other guidelines for Monkeypox infections also include thoroughly washing clothing and bedding, and practice safe sex or abstinence. And for higher risk individuals, vaccines offer hope. Getting a Smallpox vaccine looks to convey significant protection against the virus. It should be noted that Smallpox was eradicated in the 1970s, and vaccination programs were halted in 1980. But because Monkeypox is very similar to Smallpox, vaccination programs are reemerging as part of the new guidelines for Monkeypox.

“Monkeypox is believed to have become more prevalent after we stopped vaccinating populations against smallpox. We pretty much slowed or halted smallpox vaccine programs and that was actually enabling for monkeypox to emerge among human populations, because immunity was wearing off.” – Peter Hotez, Co-director of the Center for Vaccine Development at Texas Children’s Hospital

When to Seek Medical Help

Despite media reports, the actual number of cases of Monkeypox remain low. Likewise, myths about Monkeypox suggesting a high fatality rate continue to be spread. In rare cases, Monkeypox can result in pneumonia, encephalitis, and loss of eyesight if the eyes are involved. But these cases are incredibly small in number. Regardless, guidelines for Monkeypox suggest seeking medical help if such a diagnosis is suspected. Tissue samples from skin sores can be tested for the virus, and blood tests can also be performed. In most cases, all that will be required is supportive care, efforts to prevent spread, and time. Without question, the virus is serious and does result in notable discomfort for those infected. But by following proven guidelines for Monkeypox prevention, the chance of acquiring the virus can be greatly reduced.


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