I’ve never seen Monkeypox spread like this before 

By  Dr. Mike Hansen

Monkeypox is spreading around the globe in a way that hasn’t been spread before. Scientists at CDC collaborate with the Massachusetts Department of Public Health officials to investigate a situation in which a U.S. resident tested positive for monkeypox on May 18 after returning to the U.S. from Canada. They’re also tracking multiple clusters of monkeypox cases reported this month in several countries that don’t usually report monkeypox, including Europe and North America. This is why it becomes such a concern.

It’s not clear how people in those clusters were exposed to the monkeypox virus, but some of the known causes include people who self-identify as men who have sex with men. 


So let’s jump into what monkeypox is and the most important things you need to know – what causes it, how to prevent it, the symptoms, and its treatment. Monkeypox is an orthopoxvirus, and it was first isolated in the late 1950s from a colony of sick monkeys. The virus itself is the brother of the smallpox virus, but person-to-person spread and mortality are MUCH smaller compared to smallpox.

It is widely believed that the monkeypox virus has infected humans for thousands of years in sub-Saharan Africa but wasn’t identified as a cause of disease in HUMANS until the 1970s in the Democratic Republic of the Congo. Of all the reported 59 cases in the 1970s, 17% of them died.

How did these individuals get it?
They were exposed to small forest animals, like rodents, squirrels, and monkeys.

With the African outbreak from 1996 to 1998, the mortality rate was 5%. The first outbreak of monkeypox in the Western Hemisphere occurred in the United States in 2003. This virus is typically acquired through contact with an infected animal’s bodily fluids or through a bite. Monkeys and humans are incidental hosts. The most likely culprit animal for being the reservoir host…rodents. Including prairie dogs.

That US outbreak in 2003 consisted of 71 cases in the US; they identified and traced the infection back to prairie dogs, which appeared to have acquired the virus from African rodents when the two species were housed at a distribution center in Illinois. It’s also important to note that a complex exposure, such as a bite wound from an infected animal, is more likely to cause severe infection than a non-complex exposure, such as simply touching the prairie dog. Although person-to-person transmission could not be excluded, most human cases had direct exposure to animals.

But unfortunately, Human-to-human transmission can also occur. One way is via large respiratory droplets. But unlike COVID, the virus isn’t good at spreading this way. For example, droplet transmission likely requires prolonged face-to-face contact for 3+ hours. This virus is more likely to spread when close contact with infectious skin lesions, especially during sex.

All in all, most of those cases were identified in men who have sex with men. So what happens if you get the virus? The incubation time, meaning the time of exposure to the time of developing the illness, is about 12 days, but most monkeypox infections are asymptomatic. If you do get symptoms, you’re looking for fevers, chills, muscle aches, and swollen lymph nodes, with the famous painful, non-itchy rash you see in all the pictures.

Typically, about 2 days after the fever starts, the rash appears on the chest and back and spreads outward to the palms and soles of the feet. The lesions are around 0.5 to 1 centimeter in size. They start as spots and then progress over the next few weeks to form vesicles and pustules, and in the end, they scab up and slough off.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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