Experts do not agree on the possible course of the disease, with some fearing it will spread so widely that it is on the verge of becoming a common sexually transmitted disease – such as gonorrhea, herpes and HIV.
But no one is really sure, and some say tests and vaccines can still stop the outbreak at its roots.
So far, more than 2,400 cases have been reported in the United States as part of an international outbreak that emerged two months ago.
Health officials aren’t sure how quickly the virus will spread. They only have limited information about people who have been diagnosed, and they don’t know how many infected people might unknowingly spread it.
Nor do they know how well vaccines and treatments work. One drawback: Federal health officials do not have the authority to collect and correlate data about who has been infected and who has been vaccinated.
With these huge question marks, projections about the scale of the outbreak in the United States this summer vary widely, from 13,000 to perhaps more than 10 times that number.
Dr. Rochelle Wallinsky, director of the Centers for Disease Control and Prevention, said the government’s response is getting stronger every day and vaccine supplies will soon increase.
“I think we still have a chance to contain this,” Walinsky told The Associated Press.
Monkeypox is an endemic disease in parts of Africa, where people became infected through bites from rodents or small animals. It does not usually spread easily between people.
But this year, more than 15,000 cases have been reported in countries that have not historically experienced the disease. In the United States and Europe, the vast majority of infections have occurred in men who have sex with men, although health officials have confirmed that anyone can contract the virus.
It spreads primarily through skin-to-skin contact, but it can also be transmitted through linens used by someone with monkeypox. Although it is transmitted between the population like sexually transmitted diseases, officials have been monitoring other types of spread that could expand the spread of the disease.
Symptoms include fever, body aches, chills, fatigue, and bumps in parts of the body. The disease was relatively mild in many men, and no one died in the United States, but people can be contagious for weeks, and the lesions can be very painful.
When monkeypox appeared, there was reason to believe that public health officials could control it.
The warning bumps should make it easy to identify the infection. Because the virus spreads through close personal contact, officials thought they could reliably trace its spread by interviewing infected people and asking who they were intimate with.
It wasn’t that easy.
Because monkeypox is so rare in the United States, many affected men—and their doctors—may have the rash due to another cause.
Contact tracing was often hindered by infected men who said they did not know the names of all the people they had sex with. Some have reported having multiple sexual interactions with strangers.
It didn’t help that local health departments, already burdened with COVID-19 and dozens of other diseases, now had to find the resources to do extensive contact tracing work on monkeypox, too.
In fact, some local health officials have given up on expecting too much contact tracing.
There was another reason for optimism: The US government already had a vaccine. The two-dose regimen called Jynneos was licensed in the United States in 2019 and was recommended last year as a tool against monkeypox.
When the outbreak was first identified in May, US officials only had about 2,000 doses available. The government distributed it but limited it to people identified through public health investigations as having recently been exposed to the virus.
Late last month, as more doses became available, the CDC began recommending the shots be offered to those who are aware on their own that they could have been infected.
Demand has outpaced supply, with clinics in some cities quickly running out of vaccine doses, and health officials across the country saying they don’t have enough.
That’s changing, Walinsky said. As of this week, the government has distributed more than 191,000 doses, and has another 160,000 doses ready for dispatch. Up to 780,000 doses will be available as early as next week.
Once the current demand is met, the government will consider expanding vaccination efforts.
The CDC believes that 1.5 million American men are considered to be at high risk of infection.
The test has also been expanded. Walinsky said more than 70,000 people could be tested each week, far more than current demand. She added that the government had also embarked on a campaign to educate doctors and gay and bisexual men about the disease.
Donal Pisanzio, a researcher with RTI International, believes that US health officials will be able to contain the outbreak before it becomes a pandemic.
But he also said that wouldn’t be the end of it. It is likely that new batches of cases will emerge when Americans are infected by people in other countries where monkeypox continues to spread.
Walinsky agrees that such a scenario is possible. “If it is not contained around the world, we are always at risk of explosions” from travelers, she said.
There is reason for initial optimism because the outbreak so far has been concentrated in one group of people — men who have sex with men, said Shawn Kiernan, of the Fairfax County Health Department in Virginia.
Kiernan, the department’s chief of infectious diseases, said the spread of the virus in heterosexual people would be a “tipping point” that might occur before it is widely recognized.
Dr. Edward Hawke III, professor emeritus of infectious diseases at the University of Alabama at Birmingham, said the spread of heterosexual sex is only a matter of time.
If monkeypox becomes an endemic sexually transmitted disease, it will be another challenge for health departments and clinicians who are already struggling to keep up with existing STIs.
Such work has long been underfunded and understaffed, and much of it has simply been suspended during the pandemic. Kiernan said HIV and syphilis are priority, but work on common infections like chlamydia and gonorrhea gets to “counting cases and that’s it.”
Over the years, the incidence of gonorrhea, chlamydia and syphilis has risen.
“In general, clinicians do a poor job of taking sexual history, inquiring about their patients and recognizing them as sexual beings,” Hawke said.
Writer Jenny Harr of the Associated Press in San Francisco contributed to this report.
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