As number of monkeypox cases rises, infectious diseases expert predicts more to come

July 18, 2022
A magnifying glass focusing on a vesicle rash created by monkeypox. iStock
A magnifying glass focuses on a rash created by monkeypox. iStock

South Carolina now has four known cases of monkeypox. That’s not a lot, but an infectious diseases expert at the Medical University of South Carolina predicts there will be more. “I think most people think we're on the front end of this outbreak. Cases are certainly going up now, as we speak. And so I think we'll just have to see how widespread this outbreak becomes,” said Eric Meissner, M.D., Ph.D.

Monkeypox has been around for decades, but until recently, didn’t get much attention in the U.S. It got its name from outbreaks of what the Centers for Disease Control and Prevention describes as a pox-like disease that showed up in monkeys in the late 1950s. The first recorded human case wasn’t until 1970.

Since then, monkeypox has mainly affected people in Africa. But this year, it started showing up in multiple countries on other continents. The reasons for the outbreak are unclear. But what is clear is that the virus is on the move. As of July 14, there were 1,469 cases in the United States. The states shaded blue in the map below have all had cases.

Map of United States. Most of it is shaded in blue, indicating the spread of monkeypox. 
States shaded in blue have reported monkeypox cases. Source: Centers for Disease Control and Prevention.

As the virus spreads, so do concerns. “I've had patients contact me with questions about it. And it's certainly something that's on our mind as health care providers. Historically, there hasn't been a lot of person-to-person spread of this infection, which is why there's new concern,” Meissner said.

Eric Meissner, M.D., Ph.D. 
Dr. Eric Meissner

In the past, it primarily spread from animals, such as rodents, to humans. “It is now clear that this infection can spread between people by direct contact, and thus we're concerned that there's the potential for this virus to continue to spread and that there are more cases to come.”

Meissner said the current outbreak is concentrated in men who have sex with men. “We’re still trying to understand why. It's not considered a sexually transmitted disease, per se, but can be transmitted through the intimate contact that occurs during sex in addition to other forms of contact that do not involve sex.”

And not all cases involve men who have sex with men. Monkeypox can spread to anyone who comes into contact with the virus’s rash, scabs or body fluids, according to the CDC. It can also spread through respiratory secretions and during intimate physical contact, and by touching material that came into contact with an infectious rash or body fluids.

Monkeypox symptoms can include:

  • Rash that can look like pimples or blisters.
  • Fever.
  • Headache.
  • Muscle aches.
  • Swollen lymph nodes.
  • Chills.
  • Exhaustion.

(source: CDC)

“It’s important for people and health care providers to know that people with this infection don’t always have all of these symptoms, and so it is important to keep an open mind about the possibility of monkeypox if only some of these symptoms are present, particularly if someone has risk factors for exposure.”

Meissner said monkeypox is a relative of smallpox, so smallpox vaccines can help prevent it. The federal government is shipping vaccines from its stockpile across the country. “In terms of eligibility for vaccination, close contact with someone who has been diagnosed with monkeypox would make you potentially eligible for the currently limited supply of vaccine that is available.”

While monkeypox is in the same family as smallpox, its symptoms are typically milder. And Meissner said it doesn’t spread easily, like the coronavirus that causes COVID does, for example.

Public awareness may also help slow the spread of monkeypox. “Health authorities are fully engaged in mitigation measures and education efforts to try to limit the extent of this outbreak. It's not a particularly easy virus to catch. It does require direct contact or prolonged close exposure to someone with it. And so I think there's hope that with these efforts and with heightened awareness in the public, the outbreak can be held in check.”

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