The state health department said the majority of confirmed cases in Washington right now are through local transmission, not contact travel. King County, the state’s most populous area, has about 90% of cases.
Monkeypox is a zoonotic viral disease, transmitted to humans from animals, with symptoms similar to smallpox, although less severe.
Monkeypox, endemic to Central and West Africa, has spread rapidly and widely since May through human-to-human transmission – especially sexual contact – in countries where it is uncommon. On July 23, with more than 3,000 cases detected in 47 countries, the World Health Organization declared it a global emergency.
The increasing spread of the virus in the community is now a real concern, said Dr. Sherisha Dhanerdi, an infectious disease expert at UW Medicine. She added that increased local access to testing may also contribute to the increase in the number of cases.
In early July, UW Medicine’s Virology Laboratory, the state’s largest genome sequencing lab, became one of the few in the country to set up a PCR test for monkeypox.
How does monkeypox spread? Who gets hurt?
Monkeypox can affect anyone — regardless of gender or sexual orientation — who has been in close contact with an infected person.
This may include direct contact, sexual or non-sexual, with respiratory secretions, skin lesions, or body fluids of an infected person or contact with virus-contaminated objects such as dishes, utensils, clothing, bedding, or electronics.
According to current global trends, cases in Washington have so far been concentrated among men who have sex with men, and those with multiple partners. Previous outbreaks did not disproportionately affect MSM. Healthcare professionals are working to tackle this new trend without discrimination or stigmatization.
“I saw my first case in late May and started treatment after that, and since the Pride weekend, I feel we have seen a significant growth in the number of cases,” Dhanireddy said.
It is not clear whether monkeypox can be sexually transmitted. The CDC is still investigating the possibility of the virus being present in semen, vaginal fluids, or stool.
Dhanireddy said the risk is more prevalent in places where there is close, intimate skin-to-skin contact, regardless of sexual orientation. Open mouth kissing also increased the risk of exposure.
“Rather than saying it’s all gay, gay or transgender men, he’s really thinking about the epidemiological risks in those kinds of sexual contact events, and just the sheer number of partners means the increased risk of exposure,” Danireddy said.
People who have had multiple sexual partners in the past few months are at greater risk of exposure.
“If you have had more than 10 partners in the past three months, and if you have had gonorrhea or syphilis, which indicates that you are at high risk of exposure, those are also risk factors,” Dhanireddy said.
Just as infected animals can transmit monkeypox virus to humans, it is possible for infected people to spread the virus to animals through close contact. This includes petting, cuddling, or sleeping on the same bed.
Symptoms and signs
Symptoms usually begin within three weeks of exposure to the virus. Whereas in previous monkeypox outbreaks, a rash appeared soon after the infected person developed flu-like symptoms, in the current outbreak, the rash precedes other symptoms. Swollen lymph nodes are another sign of monkeypox.
The rash can look like blisters or pimples and may be painful or itchy. It may appear on or near the genitals but also on other areas such as the hands, feet, chest or face.
As a precaution, the Centers for Disease Control and Prevention (CDC) recommends avoiding close contact with the skin or sharing objects with people who may be infected or have a rash that resembles monkeypox.
Wash your hands often with soap and water or use an alcohol-based hand sanitizer, and use EPA-approved cleaning products to wipe and disinfect surfaces shared with someone who has monkeypox.
For people diagnosed with monkeypox, the Centers for Disease Control and Prevention recommends isolation and abstinence from sex while they recover. Avoid contact with pets and other animals.
Monkeypox is contagious from the time symptoms begin until the rash has healed, all the crusts shed and forming a new layer of skin which can take several weeks.
“If you are not able to completely isolate, make sure you cover the pests, and try to sleep separately from your housemates,” Dhanireddy said.
Infectious disease experts say the monkeypox virus is less likely to affect people at airports or on public transportation than the coronavirus.
“It’s really just a close, intimate connection,” Dhanireddy said. “So if someone’s wounds are covered, they’re on public transportation, they wear a mask and they practice hand hygiene, the risk is very low.”
To care for the lesions, the World Health Organization recommends keeping them dry and uncovered when alone, cleaning your hands before and after touching the rash, and rinsing the skin with antiseptic soap and the mouth with salt water. To manage discomfort, the World Health Organization advises taking warm baths with baking soda or Epsom salts and using over-the-counter painkillers paracetamol. Routinely disinfect frequently touched surfaces, and keep windows open for good air circulation.
While having sex with a condom may help, condoms alone probably aren’t enough to prevent monkeypox, the CDC said.
For people who have been in close contact with an infected person, have no symptoms, and within the two-week window, talk to your healthcare provider as you may be eligible for the vaccine.
Here’s more guidance from the Centers for Disease Control and Prevention (CDC) for sexually active people who may be exposed to the virus.
Guidelines for caring for pets and monkeypox are available here.
Once recovery and isolation are complete, the CDC recommends a thorough cleaning and disinfection of all spaces inside the home in the following order:
- Collect all soiled waste in a sealable bag such as bandages, paper towels, food packaging, and other rubbish.
- Collect contaminated clothes and linens before cleaning anything else in the room. Do not shake the linens as this may spread infectious particles. Wash them with normal detergent.
- Using EPA-approved disinfectants, clean hard surfaces and household items. Then move on to upholstered furniture and other furnishings with surface-appropriate cleaners. Steam cleaning may be considered.
- Finally, work on the carpets and floors and dispose of all contaminated waste.
If cleaning is done by someone other than the person with monkeypox, they should wear full clothing that covers all of the skin, disposable medical gloves and an appropriate respirator or mask.
Do not dust or vacuum as this may spread infectious particles, although vacuuming is acceptable with a high-efficiency air filter. Wet cleaning methods such as disinfecting wipes, sprays, and wiping are best.
More instructions on cleaning and disinfecting the home after recovery are available here.