It all started in Wisconsin. A three-year-old child was bitten by a prairie dog purchased from a local pet store. Shortly after, the child developed a high fever and a strange rash and had to be hospitalized. The child’s parents also developed the rash, but were otherwise asymptomatic. The Milwaukee Health Department tested the child and the prairie dog and confirmed that the cause of the child’s symptoms was the monkeypox virus, first discovered in crab-eating macaque monkeys in 1958. After a month, 71 people throughout the Midwestern United States had contracted monkeypox.
You may think I’m talking about the current outbreak of monkeypox that has slowly become a major news story over the past few months, but I’m not: the outbreak described above happened nearly twenty years ago, in May of 2003. (There’s nothing new under the sun.) The 2003 outbreak was the first time monkeypox had appeared in the United States and the first time an outbreak had occurred outside of West and Central Africa. Its spread was limited, however, and no one died as a result. There were also no instances of human-to-human transmission. Every infection in the spring and summer of 2003 was traced back to contact with infected prairie dogs that had been shipped to the U.S. from Ghana, Africa.
As of the beginning of August 2022, over 20,000 new cases of monkeypox have been reported worldwide since May and 8 people have died. The World Health Organization (WHO) has declared a global health emergency. The virus has spread to 78 countries on all major continents. Stop me if this sounds familiar. Are we on the precipice of the next great pandemic? What can be done to mitigate the spread?
It’s unclear how exactly all of this started, but advisors for the WHO have suggested the current outbreak originated at two dance parties in Belgium and Spain among gay and bisexual men. It is this community transmission of the virus that distinguishes the outbreak from previous ones. The 2003 outbreak was driven by contact with infected animals, but now monkeypox is spreading primarily from person to person. Outside of West and Central Africa, 98% of cases have occurred in the community of men who have sex with men, suggesting that close sexual contact is the main mechanism of transmission. The CDC explains that “the virus can spread from person-to-person through direct contact with…infectious rash, scabs, or body fluids. It also can be spread by respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex.”
While the spread has been rapid, there is some good news. Unlike COVID-19, monkeypox was well-understood from the beginning of this current outbreak and is typically mild, with most infected people recovering after a few weeks with no treatment. Vaccines against smallpox, a disease caused by a virus related to the monkeypox virus, appear to be effective in preventing infection and lessening severity of symptoms. Antiviral medications such as cidofovir and tecovirimat can also be used to treat the disease. Given these differences, it is unlikely that monkeypox will become the “next COVID”. Still, we need to exercise caution and do our best to prevent more cases.
The first case of monkeypox in the United States this year was in Boston, and Massachusetts currently has over 100 confirmed cases. The Massachusetts Department of Public Health advises that people “[avoid] large gatherings like raves and dance parties where you may have lots of close body contact with others.” They also encourage people to ask sexual partners, “especially new partners whose health status and recent travel history you are not familiar with,” if they have any symptoms of monkeypox. If you have monkeypox or suspect you may have it and you need to leave your home, you should wear a mask and cover any rash or lesions when around others. If you live with or care for someone who has monkeypox, you should wear a mask and disposable gloves if you are going to be in contact with them or with their clothes or bedding. Other basic public health measures can help to mitigate the spread of monkeypox, such as washing your hands after contact with a person who may be infected or with items or surfaces they may have touched.
Through these simple measures, monkeypox can be easily contained. What may be more difficult to contain is the stigmatization gay and bisexual men are currently facing as a result of sensational reporting. It’s true that monkeypox has spread primarily among men who have sex with men, but monkeypox does not discriminate: anyone can get it from anyone else if they have close enough contact. Gay and bisexual men certainly need to take precautions, but so do we all. We must remember the example of HIV/AIDS, which was in the early days of its spread labelled a “gay disease.” The blame and stigma the gay community faced prevented many sick people from coming forward and getting help. It also slowed the response of public health officials. Monkeypox appears nowhere near as serious as AIDS, but those who contract it must be treated with dignity and receive the care they need so that together, we can see the end of another viral outbreak without succumbing to hysteria.
