5 questions about monkeypox with Pittsburgh infectious disease experts

A third confirmed case of the virus associated with monkeypox was reported Friday in Allegheny County, spurring further curiosity about the disease.

The Centers for Disease Control and Prevention is conducting tests to confirm monkeypox, according to the Allegheny County Health Department.

All three cases of orthopoxvirus were confirmed in a 24-hour period and involved men in their 20s and 30s. None of the patients needed to be hospitalized, and all are in isolation at home, the county health department said.

The monkeypox name is a misnomer, as the disease does not come from monkeys, even though it was first isolated from a monkey in Africa. It likely comes from rodents, specifically rodents in Central and West Africa, said Pittsburgh-based infectious disease expert Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

The Tribune-Review posed five questions about monkeypox to Adalja and Allegheny Health Network infectious disease specialist Dr. Matt Moffa.

Question: What exactly is monkeypox?

Answer: “Monkeypox is a viral infection that’s characterized by a fever, a rash and swollen lymph nodes,” Adalja said. “It’s primarily been an infection that is concentrated in a dozen or so countries in Africa. It’s unknown what the animal host is; (however) it’s presumed to be some sort of rodent and it’s caused infections (in humans) since the 1970s. It’s in the same family of viruses as smallpox, but it’s much less dangerous than smallpox. It’s not a very contagious virus in terms of comparing it to a respiratory virus, and it seems — outside of the endemic area — to not be so severe.”

“The reason interest has peaked is we’re finding it in non-endemic regions like Europe and the United States, places that aren’t used to seeing monkeypox,” Moffa said. “So that’s why it’s taken the forefront.”

Q: How does monkeypox spread?

A: “Right now, we’re finding that there seems to be a lot of sexual contact transmission, which seems to be the driver of a lot of the spread,” Moffa said. “You can get it not just from sexual contact, but close skin-to-skin contact with other people or close respiratory droplet contact. But we’re seeing that a lot of it is being driven by sexual encounters.”

“It spreads through close person-to-person contact,” Adalja said. “So when you’re with somebody that is infected, you may be exposed to skin lesions that can spread it. It can also be spread through contact with an infected animal or bed linens that someone with monkeypox lesions might have slept in. Clothing and towels can also spread it from person to person. One of the things about monkeypox is it’s not contagious during its incubation period, which gives you a lot of opportunity to be able to intervene from a public health perspective because people aren’t contagious until they develop symptoms.”

Q: How dangerous is monkeypox? Can it be deadly?

A: “It can be deadly, but it’s pretty rare,” Moffa said. “With this kind of monkeypox, the mortality rate may be around 1%. Some different genetic variants could be even higher, but with this one death is pretty rare. Most people do fine with just supportive care.”

“In prior outbreaks, we’ve seen mortality rates in the single digits,” Adalja said. “But most of those outbreaks had occurred in endemic areas of Africa where there might not have been access to good medical care. What we’ve seen in this outbreak — with cases outside of the endemic area — there have been no deaths.”

Q: How many more cases of monkeypox do you think we’ll see in this area?

A: “There will be more cases because what’s happening is that this outbreak is different than prior monkeypox outbreaks,” Adalja said. “In 2003, there was an outbreak of four dozen cases in the Midwest tied to the importation of African rodents, and that’s an easy outbreak to figure out because everybody in that outbreak had contact with infected animals.

“In this outbreak, what we’re seeing is monkeypox taking advantage of a sexual network, and it’s spreading amongst that network — men who have sex with men — and probably has been doing so for several months. The virus found its way into a social, sexual network and used amplification events like raves in Belgium to get around the world. Anybody can get monkeypox. It just seems that this outbreak has found its way into this network and has been able to spread pretty efficiently. It makes it very hard to do a lot of the basic public health work — contact tracing becomes very hard because some people may not know the people that they might have had sex with.”

Adalja’s comments reflect findings reached by the World Health Organization and the Centers for Disease Control and Prevention. However, David West, president of the Pittsburgh Chapter of Parents, Families, and Friends of Lesbians and Gays, urged a word of caution:

“If indeed the numbers and the data support that (monkeypox) is being spread quite a bit in the gay community, the members of that community need to be warned,” West said. “But the larger way of looking at it, these sorts of statements, even when 100% well-intentioned, they bring up the old prejudices and the old hate and biases. It makes it easier for people who are inclined to look down upon gay men.”

West said he encourages people who show any symptoms to go to a place like Central Outreach Wellness Center on the North Side for testing and treatment.

Q: Should we be concerned about monkeypox the same way we are about covid?

A: “Monkeypox is not a virus with pandemic potential, and monkeypox doesn’t pose a major risk to the general public,” Adalja said.

“You want to have heightened awareness, but covid (is) such a different beast because you have asymptomatic transmission,” Moffa said. “You could be across a restaurant from people minding your own business and get infected from them. That’s not going to happen with monkeypox.”