Monkeypox : Myths, misconceptions and facts | In early July the U.S. The monkeypox outbreak in the back has grown rapidly, with only about 500 cases in the country. Now that number has increased to over 7,000. Federal officials said on Thursday, that the Biden administration declared monkeypox a public health emergency because more aggressive measures are needed to stop the spread of the virus.
As the outbreak has grown, so has the confusion surrounding the virus, how it spreads, and who is currently at higher risk of getting infected.
Can you catch it on a crowded bus or plane? Trying out clothes at the thrift store? from the bathroom counter? Is everyone at the same risk?
Many myths and misconceptions have arisen around these questions. And there’s a lot of conflicting information and guidance.
We’re here to debunk some of those myths—and to explain some recent data about this outbreak, which begins to paint a clear picture of who needs vaccines urgently and who doesn’t.
Question 1: Is it correct to consider monkeypox to be a sexually transmitted disease?
Several lines of evidence indicate that, during this outbreak, the primary way the virus spreads is through close, physical contact during sex – specifically, sexual encounters between people who have had anal sex.
“Right now, about 98% of monkeypox cases are queer and gay people and in our sexual networks. Of course, this includes trans and non-binary people,” says Joseph Osmundson, a biologist at New York University who specializes in queer Identifies and is to help lead the effort to contain the outbreak.
Sexual contact isn’t the only way monkeypox is spread, explains Susan McClellan, an infectious disease physician at the University of Texas Medical Branch in Galveston, Texas. But he agrees with Osmundsson: It’s by far the most likely way into this current outbreak.
“Epidemiological data for outbreaks in Western Europe and the United States make this clear,” she says. “We are not detecting many cases in children and individuals who are not sexually active. We are detecting most cases in individuals with multiple sexual encounters across the network.”
In a study published in the New England Journal of Medicine, researchers from the Queen Mary University of London analyzed records of nearly 500 cases of monkeypox in 16 countries during the outbreak. In 95% of cases, the person most likely caught the virus through sexual contact. And more than 70% of people had sores on or around the genitals or anus. Lesions in those places suggest contact in that area and are spread through sexual encounters.
This week, the World Health Organization presented data with a similar trend. In a study of more than 3,900 people infected with monkeypox, the agency found that about 90% of them contracted the disease through a sexual encounter.
And when you consider how the disease is transmitted, sexual transmission makes sense. Monkeypox causes sores on the skin or mucous membranes—the moist lining inside body cavities like your mouth, nose, and anus. Those wounds are filled with infectious viruses. Viruses can be transmitted when wounds rub against another person’s skin or mucous membranes, especially if the uninfected skin is damaged or broken.
In this way, sexual intercourse is an efficient way to transmit monkeypox, McClellan says: “Because you’re grinding the skin together. And it’s often the skin with the hair follicles, which is also an entry route for the virus.”
Now it is still unknown whether the virus is transmitted directly through semen. But there is mounting evidence showing that the route holds potential. Scientists in Italy and Spain have found the monkeypox virus in the semen of infected people. And in another study, published Tuesday in The Lancet Infectious Diseases, scientists showed that the monkeypox virus from semen can infect human cells.
But – and this is an important point – monkeypox is not only spread during sexual contact. It can also spread through some other routes (more on that in the next part of this story). So it’s not just an STD. It is much more than that, Dr. Jay Verma pointed out on Twitter on Wednesday.
“I heard twice today at public events: ‘We need to tackle the misinformation that #monkeypox is an STI,'” wrote Verma, an epidemiologist at Weill Cornell Medicine. “This is ‘not’ misinformation. Sexual transmission is almost certainly contributing to this outbreak. Misinformation saying that transmission is ‘exclusively’ sexual.”
Question 2: On Twitter and TikTok, and in casual conversations, I’ve heard of people worried about getting monkeypox from shaking hands or touching someone at a concert or on the bus. Or even from an airplane seat. What is the danger of getting monkeypox this way?
>> There has been a lot of confusion here. So yes, it is possible for monkeypox to be transmitted non-sexually. There are instances where people catch the virus by having a face-to-face conversation with someone or by touching a contaminated surface. But data from this outbreak shows that these routes of transmission are extremely rare in public settings, and when they do occur, it most likely happens if you live with an infected person, says Dr. Susan McClellan.
“During this outbreak, there will probably be at least one random case where someone takes it on a bus. But, you know, it’s going to be very rare, probably less likely to be hit by that bus,” She says. “If monkeypox was more easily spread on subways, in buses, we would be seeing it almost exclusively among a very different population than among the population, where transmission is mostly occurring during close, intimate contact.”
The data suggests that the virus does not spread well through these non-sexual routes. For example, in this current outbreak, only 0.2% of those infected have caught the virus from a contaminated surface, the World Health Organization reported this week.
In general, to catch the virus via the non-sexual route, you need either prolonged exposure to the virus or exposure to large amounts of the virus, says Dr. Peter Chin-hong says. It is likely to take hours to become infected by repeatedly touching the virus on surfaces or breathing in the particles.
you’ll have to rub vigorously against another person’s skin or mucous membranes, Chin-hong says. “You have to brush against them, like a scrubbing brush, then to create an abrasive in your skin that can penetrate monkeypox,” he explains. “That would cause a wound on your arm, which we haven’t really seen in this outbreak.”
So you’re not going to catch monkeypox through a contaminated surface or accidental contact with an infected person, Chin-hong says. You won’t get it when trying on a jacket at a thrift store or brushing up against someone with a monkeypox rash on the bus at a festival or sitting in the seat of a plane where the previous occupant was infected.
Even if you are living with a person infected with monkeypox, your risk of catching the disease is surprisingly low, says biologist Joseph Osmundson. Preliminary data, with a small number of cases, found that the odds of spreading monkeypox to a household member, not through sex, was only 0.6%.
“I think the percentage could go down a bit and increase as we get more data,” Osmundson says. “But the household transmission rate for this strain in endemic countries [that is, countries where the virus has entered] is still around 3%. And we are talking about sharing a bathroom with a person who is in your home. Known to be infected.”
By comparison, the chance of SARS-CoV-2 spreading indoors is more than 40%, studies have found. So it shows how less contagious is monkeypox as compared to COVID.
Question 3: Do we have an idea of when a person is contagious and when it is most likely to spread?
>> The Centers for Disease Control and Prevention divides the course of the disease into three possible stages:
Incubation period: This is when someone is infected but is not yet feeling sick. We obviously don’t know if people are contagious at this time. Flu-like symptom stage: Some people start to feel a little sick. They may have a headache. They may have a fever. And a person is probably contagious during this stage, the CDC says.
Rash stage: In the third stage, sores appear on the skin or inside the mouth, nose, eyes, or anus. The CDC says a person is definitely contagious at this stage.
So for now, if you’re showing any monkeypox symptoms — whether it’s a fever or a rash — the guidance is to isolate for two to four weeks and stay away from people and pets in the home.
The CDC writes, “Current data suggest that people can spread monkeypox until all symptoms have cleared up, including complete healing of the rash with the formation of a new layer of skin.” And if you need to leave the house, cover the wound with clothing, bandages, or gloves. And wear a mask as the chances of spreading it through prolonged face-to-face contact are very low.
Question 4: Then what are some proper precautions that people should take to avoid monkeypox?
>> First, do your own personal risk assessment, doctors and scientists say. Find out if you are currently a high-risk person. Right now this virus is spreading mainly among gay and bisexual men and trans people. And most cases are found in people who have sex with multiple partners. So if you are a member of this group, the number 1 thing you can do is to get vaccinated as soon as possible.
And if you can’t get the vaccine (because supplies are limited right now), you can still protect yourself, says biologist Joseph Osmundson.
“If you are part of gay sex networks, you must accept that those sex networks are at really high risk for monkeypox transmission right now,” he says. “While we still have limited access to vaccines, people need to be aware of what high-risk sexual encounters are. And right now, they are having encounters with people you don’t know well. “About 30% of cases are linked to [gay] saunas and other places where people meet,” Osmundson says. See you for sex.”
And he stresses: If you’re not part of gay and lesbian sex networks, your risk is low right now.
“Although we do not yet understand why the virus is not currently spreading in (heterosexual) social and sexual networks,” Osmundson explains. “Still, you should be aware and considerate when visiting places where you do a lot of physical touches.”
And if you have symptoms that match monkeypox, like a fever followed by a rash, visit your doctor and get tested, he says. “You should be able to test now because tests are more widely available than they were back in May and June.” At the time, he says, only men who had sex with men could get the monkeypox test.