As the United States begins to return to a semblance of “normal,” as we cautiously return to restaurants and movie theaters, as we tentatively dispense with masks and strict social-distancing, suddenly, another viral disease is grabbing headlines: monkeypox.

What is monkeypox?

The monkeypox virus belongs to the Orthopoxvirus genus of viruses, meaning it’s related to smallpox and cowpox. Monkeypox is a viral zoonosis, meaning that it can be spread from animals to humans. The virus was discovered in 1958 during an outbreak among monkeys from Africa held captive for scientific experimentation in Denmark. The first known human infection occurred in 1970 in the Democratic Republic of Congo.

The symptoms of monkeypox are similar to those of smallpox. It begins with flu-like symptoms, including fever, fatigue, headache, and body aches. The subject soon exhibits rashes and lesions that eventually transform into pus-filled blisters. Monkeypox does not spread easily, typically requiring skin-to-skin contact. Monkeypox is also said to be less severe than smallpox, and usually leads to death in only around 5 percent of cases, usually in areas where adequate medical care is not readily available.

The majority of monkeypox cases since its discovery have occurred in the Democratic Republic of Congo, but it has also been reported in other African countries, including the following: Cameroon, Central African Republic, Ivory Coast, Gabon, Liberia, Nigeria, and Sierra Leone. There have been cases of monkeypox outside of Africa, most of which have been linked to travel from Africa and animals exported from Africa. Despite the disease’s common name, the virus’s reservoir is thought to be rodent populations in central and western Africa.

Why are we talking about monkeypox?

The outbreak of monkeypox was first reported and confirmed on May 13, 2022. As of the final week of May 2022, more than 200 cases of monkeypox have been reported to the World Health Organization (WHO). The reports have been received from more than twenty WHO member states where the disease is not endemic (not generally known to be present and actively transmitted), including the United States, Australia, Israel, and countries across Europe.

WHO personnel have said that an outbreak outside Africa was not expected, and that there are many questions about the outbreak that are still unanswered. However, it appears that the outbreak can be traced to incidents of sexual contact in Spain and Belgium. This represents a notable difference in the way the disease is usually transmitted within central and western Africa. In those regions, the disease is typically spread from infected animals, such as rodents and primates, to humans.

Is there a vaccine for monkeypox?

Yes and no. No vaccine for specific use against monkeypox has ever been developed, but because monkeypox and smallpox belong to the same class of viruses, there is cross-immunity between the two viruses. That is, immunity to smallpox (either from prior infection or vaccine) imparts immunity to monkeypox. There is uncertainty, however, about worldwide smallpox immunity levels among populations across the world. For example, the United States did away with routine smallpox immunization after the disease was thought to be eradicated in 1972, although stockpiles of the vaccine remain available. In other words, unlike vaccines against COVID-19, the vaccine for monkeypox would not have to be discovered, developed, tested, approved, and then manufactured. Vaccines for smallpox and monkeypox could be manufactured, deployed, and administered according to a relatively rapid schedule, much faster than that of COVID-19. The WHO predicts that smallpox immunizations would have up to 85 percent effectiveness against monkeypox.

What is being done about monkeypox?

The WHO and the Centers for Disease Control is currently investigating the outbreak, conducting personal contact tracing, surveillance, and working to link the new infections to areas where the disease is endemic. Doses of smallpox vaccine are also being administered to those who are known to have had contact with infected persons. Vaccination is known to be effective several days after contact.

Will the monkeypox outbreak reach epidemic levels like COVID-19 did?

It seems very unlikely. Monkeypox does not spread easily as COVID-19, and there is a vaccine available. Monkeypox is also not a novel (previously unknown) virus, and so more is known about preventing its spread and treating cases. And although experts agree that more cases of monkeypox will likely emerge, worldwide efforts to investigate and monitor the outbreak to prevent pandemic levels of infection are already well underway.

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