NASHVILLE, TN – There have been 3500 cases of the disease in more than 50 countries so far. None of the 155 cases in the U.S. have been fatal, according to the CDC. But people in 24 states have been infected. The virus is a member of a larger class of diseases like smallpox and chickenpox.

The monkeypox virus occurs naturally in Central and West Africa and there are two strains. The less deadly one travelled to Europe, probably from Nigeria, and then to Germany, Great Britain, Massachusetts, and other places. What makes this outbreak unusual is the number of countries that haven’t previously reported the disease.

“This is one of many neglected and tropical diseases—things which are very damaging, potentially scary, but generally do no infect many people,” said Dr. Ben Neuman, Chief Virologist of the Global Health Research Complex at Texas A&M University.

Dr. Ben Neuman is Professor of Biology and Chief Virologist of the Global Health Research Complex at Texas A&M University.

“It changes slowly, typical for a DNA virus. But each time that a virus jumps from the wild into people there are some changes, some unknowns, and some surprises,” Neuman said.

Monkeypox got its name because researchers first identified it in a primate. It is believed to be common in small animals. One theory is that somebody bought an exotic pet in West Africa that carried the virus; they brought it home and it infected a similar species like a gopher or prairie dog and then jumped to humans.

The more common theory is that travellers returning from Nigeria attended Gay Pride events in Europe and brought the disease with them.

The World Health Organization (WHO) said the outbreak does not constitute “global health emergency”. The WHO emergency committee, convened last Thursday, said the outbreak should be “closely monitored and reviewed after a few weeks.”

A leading HIV researcher says almost all the people who are getting infected are men who are having sex with multiple male partners.

“You could see it jumping into sex workers. The longer we wait the more chance we have of a crossover event,” said Dr. Gregg Gonsalves. He is Associate Professor of Epidemiology at the Yale Institute for Global Health.

Dr. Gregg Gonsalves is Associate Professor of Epidemiology at the Yale Institute for Global Health; Co-Director, Global Health Justice Partnership.

Gonsalves said the outbreak could persist unless we quickly deal with it. “There’s always a chance to jump over into another population,” he said.

There are two monkeypox vaccines. The U.S. has the largest stockpile of vaccines and precursor material. However the factory where most monkeypox vaccines are produced is being renovated. Gonsalves said there was a run on the vaccine in New York last week and it isn’t necessarily available to the 50-plus countries experiencing outbreaks now.

How do you know you have it?

“This is a virus that spreads through close personal contact usually skin to skin contact,” said Dr. William Schaffner, Professor of Preventive Medicine at the Vanderbilt University School of Medicine.

Schaffner said it can spread through a “respiratory route…droplets within 3 feet over a long period of time”. He said the virus can spread through contaminated towels and bedding. “This is not a virus that spreads widely and readily the way COVID does,” he said.

“After you contract the virus it can take a week up to two weeks of an incubation period. You feel perfectly fine. Then you may get a virus-like illness—headache, not feeling well, perhaps some fever, perhaps swollen lymph glands for a day or two. Then a rash develops,” Schaffner said.

Dr. William Schaffner is Professor of Preventive Medicine in the Department of Health Policy and Professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine.

Monkeypox usually has fewer lesions than smallpox and they usually occur in the genital area, and around the buttocks and anus. However, in severe cases, they can appear on the hands, arms, face, and chests of victims.

“The rash appears and makes a blister, usually clear, but then over time it becomes filled with pus. One of the distinct features is that if you feel the blister it is firm and rubbery,” Schaffner said. 

The blister fluid is very contagious and fluid samples are sent to the lab for diagnosis. The lesions will slowly get better over time; they will scab, and go away. 

“Most people have rather mild infections and are treated as outpatients with symptomatic treatment and it resolves by itself,” he said.

Since we first reported this story May 28, the Nashville Public Health Department reported a monkeypox case in Davidson County on July 7. The infected person is in isolation at home and is recovering. The department said it was contact tracing a number of people who had contact with the victim.

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