'This is clearly not a containable infection,' infectious diseases expert says as monkeypox spreads

August 18, 2022
The word monkeypox on a blue background.
The first cases of monkeypox in South Carolina were reported in early July.

As the number of diagnosed monkeypox cases in South Carolina tops 70, an infectious diseases expert at MUSC Health predicts many more to come. “This is clearly not a containable infection. People are living their lives and getting diagnosed haphazardly, and we’re likely missing many milder and less symptomatic infections right and left. And there probably have already been hundreds, if not thousands, of cases in South Carolina,” said Scott Curry, M.D.

The first cases of monkeypox in the state were confirmed just last month. Curry said the disease is likely to become endemic, meaning it will stick around. There are a few factors he pointed to. 

First, according to Curry, “There are – even in 2022 – stigmas and care access issues for men who have sex with men in South Carolina.” 

Second, there hasn’t been enough vaccine to go around, although that situation is being eased some by using smaller but still effective doses. 

Third, it can be tough to qualify to get tested in some parts of South Carolina. For now, testing is only available through public health labs and five commercial labs. MUSC Health will start doing its own testing once regulations allow for it. 

Curry said in the meantime, local officials at the Department of Health and Environmental Control are making the testing situation as easy as they can for him and his colleagues. “Dr. Richardson has very generously said, ‘If an MUSC doctor thinks that a case needs to be sent to the DHEC lab, it gets sent.’” Katy Richardson, M.D., leads the Lowcountry region for DHEC. 

“However, that generous arrangement will be unworkable if we exceed the limited capacity of our state lab,” Curry said.

Scott Curry, M.D. 
Dr. Scott Curry

Right now, most of the people who are being diagnosed with monkeypox are men who have sex with men. “It’s very clear that if you’re a sexually active gay man, you should try to get a vaccine. You’re the absolute highest-risk group,” Curry said.

“If you have skin-to-skin contact with a known case of monkeypox, DHEC will also get you access to these vaccines because they can work even after exposure. Monkeypox ranges from a mild illness to a three to four-week ordeal where you can’t sit down, swallow food, or both. So there’s no reason not to vaccinate those clearly highest-risk individuals.” 

People can find out if they’re eligible for the vaccine by calling the South Carolina Department of Health Environmental Control’s CareLine at (855) 472-3432. DHEC is not recommending the vaccine, called Jynneos, for the general public.

So how are people getting monkeypox? Curry said the virus spreads through contact with bodily fluids, including semen, and through skin-to-skin contact with an infected person. “We need to be honest that it’s probably both sexually and nonsexually transmitted, right?”

That means that while men who have sex with men make up about 95% of all diagnosed cases, they aren’t the only ones affected. “Kids don’t have sex, at least not ones of the age that they’re starting to come down with monkeypox. And animals don’t have sex with people, and now dogs are starting to get it. So yeah, this is clearly spread via many routes, but it clearly takes very sustained non-casual contact.” 

He said the virus may eventually spread more widely outside of men who have sex with men. “That’s one potential. It may just become a cause of a pustular rash illness in all the population. It may also just continue to confine itself mostly to men who have sex with men, like syphilis and HIV do, but still occasionally break out into other populations. Or it may cause an intermediate situation where it predominates in one population with occasional breakouts into others.”

Curry said that physicians at MUSC Health have taken care of five monkeypox patients. Four out of five were men who have sex with men.

“Everyone should worry about monkeypox – but only a little bit. Sexually active gay men with more than one partner should worry about it just as much as about HIV and sexually transmitted infections. Heterosexually identified people and people that are not in contact with known cases should worry maybe the least for now, but only if they get a pox-like illness or they’re feverish, and they get a terrible sore throat and some blistery lesions.”

Curry said MUSC Health, one of only three health systems in the state with infectious diseases experts, is well-equipped to treat people with monkeypox. “Thanks to our CDC and DHEC partners, we are prepositioned with the antiviral treatment. So like if somebody does have severe infection and needs to be treated with tecovirimat (TPOXX), that therapy is actually available to us. We have it in our pharmacy.”

But he encouraged people at low risk of getting monkeypox to keep things in perspective. “If you’re feeling well and just walking around the state of South Carolina, then no, you should not be consumed with worry about monkeypox.”

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