“I Have a Lot More Optimism That We’ll Be Able to Contain This Monkeypox Outbreak”

As COVID-19 infections spike across the US once again, people are understandably concerned about the newest reports of zoonotic infection. About 300 cases of monkeypox have been reported in at least a dozen countries.

Although monkeypox is not new, the outbreaks are causing some concern due to their scope; monkeypox is typically endemic to central and western Africa, but most of the infected persons had not traveled to these regions.

Internationally recognized physician and scientist Peter Hotez, MD, PhD, sat down with Contagion to discuss these monkeypox infections that have captured the attention of both public health and the general public.

“It’s still a bit of a medical mystery,” Hotez said, “But the unusual feature is the multiplicity of outbreaks.” It remains unknown how and why monkeypox is spiking now, but Hotez said current theories include a centralized index of cases that may have emerged in the Canary Islands, or perhaps Berlin or Belgium.

Cases have now been identified in the US as well. Hotez said he understands there to be confirmed or suspected monkeypox infections “in Massachusetts, 1 in New York, 1 in Florida, and there are 2 now around the Salt Lake City, Utah area.”

“This is still a very uncommon illness,” Hotez emphasized. “The numbers are quite small.” Notably, however, monkeypox has an incubation period of 2 weeks. This means that we will likely see cases rise in the coming weeks, but “that’s not a cause for undue alarm.”

“I doubt that this will grow exponentially,” Hotez said. “And the reason I have that optimism is because there is that long incubation period, and the illness is associated with a characteristic rash, so it’s not as if there are a lot of asymptomatic illnesses.”

Hotez recalled the difficulty of doing contact tracing for COVID-19, when half the infections were asymptomatic and the incubation period was significantly shorter.

Additionally, monkeypox is a relative of smallpox, and thus we have “at least 2 vaccines” stockpiled by the US. We also have antiviral drugs available, and Hotez details the interesting history of how the fear of Russian biological warfare during the Cold War brought these drugs into existence.

“If we need to deploy vaccines or antiviral drugs in order to contain this outbreak, unlike COVID-19, we already have them on hand.”

It is still too early to know the full demographic profile of all those infected, but the US Centers for Disease Control and Prevention (CDC) and European health agencies have noted that outbreak clusters have appeared primarily in men who have sex with men. However, Hotez said, “We do not think at this point that it is a sexually transmitted virus, but rather it’s a virus that’s transmitted by close, face-to-face, personal contact.”

Hotez said it is likely a coincidence that the early individuals indexed for monkeypox were gay and bisexual men, who then may have spread it through their networks. “I think we have to be very careful not to stigmatize groups or individuals about this virus…our profession has made that mistake before.”

Common symptoms of monkeypox are fever, headache, backache, and swollen lymph nodes, which eventually devolve into a characteristic pustular rash. Infection can become serious, but Hotez noted that the monkeypox outbreaks across Europe and North America appear to belong to the west African and Nigerian strain, which is typically associated with lower mortalities.

So far, Hotez said, there have been no mortalities among those infected.

Peter Hotez, MD, PhD, is a professor of Pediatrics and Molecular Virology & Microbiology at Baylor College of Medicine, where he also serves as the co-director of the Texas Children’s Center for Vaccine Development (CVD) and Texas Children’s Hospital Endowed Chair of Tropical Pediatrics.