How do you get monkeypox? An epidemiologist explains what “close contact” means

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Monkeypox is caused by a virus that, despite periodic outbreaks, is not thought to spread easily from person to person and has not historically stimulated long chains of transmission within communities. Now, many researchers are wondering why monkeypox seems to spread so easily and unconventionally in the current global outbreak.

How monkeypox spreads: The monkeypox virus is usually spread through direct contact with respiratory secretions, such as mucus or saliva, or skin lesions. Skin lesions traditionally appear soon after infection as a rash: small pimples or round papules on the face, hands, or genitals. These lesions can also appear inside the mouth, eyes, and other parts of the body that produce mucus. They can last for several weeks and be a source of the virus before they are completely cured. Other symptoms usually include fever, swollen lymph nodes, fatigue, and headache.

I am an epidemiologist who studies emerging infectious diseases that cause outbreaks, epidemics, and pandemics. Understanding what is currently known about how monkeypox is transmitted and ways to protect yourself and others from infection can help reduce the spread of the virus.

Why is this monkeypox outbreak any different?

The United States declared monkeypox a public health emergency on August 4, 2022.

The current epidemic of monkeypox is a bit unusual in some ways.

First, the sheer scope of the current epidemic, with more than 25,000 cases worldwide in early August and in countries where the virus never appeared, makes it different from previous outbreaks. Monkeypox is endemic in specific areas of central and western Africa, where cases occur sporadically and outbreaks are usually contained and quickly subside.

In the current outbreak, the global spread has been rapid. Young men, mostly ages 18 to 44, account for the majority of cases, with more than 97 percent identifying as men who have sex with men. Some superspreading events associated with air travel, international gatherings, and sexual encounters of multiple partners contributed to early transmission of the virus.

Second, the way symptoms appear can make it easier to spread between people who don’t already know they’re infected. Most patients reported mild symptoms without fever or swollen lymph nodes, symptoms that usually appear before a rash is seen. While most people develop skin lesions, many report having a single papule, often hidden within a mucosal area such as the mouth, throat, or rectum, making it easier to miss.

Several people reported no symptoms at all. Asymptomatic infections are more likely to go undiagnosed and unreported than those with symptoms. But it is not yet known how asymptomatic people may be contributing to the spread or how many asymptomatic cases may go undetected so far.

Who is at risk of contracting monkeypox?

Kyle Planck, 26, who has recovered from monkeypox, shows scars from skin rashes in New York on July 19, 2022.YUKI IWAMURA/AFP/Getty Images

For most people, the risk of getting monkeypox is currently low. Anyone who has had close and prolonged contact with an infected person is at risk, including partners, parents, children or siblings, among others. The most common places for transmission are homes or health care facilities.

Due to sustained transmission within the community of men who have sex with men, they are considered an at-risk group and specific recommendations can help allocate resources and limit transmission. Although monkeypox spreads mainly among this group of people, this does not mean that the virus will remain confined to this group or that it will not jump to other social networks. The virus itself does not take into account age, gender, ethnicity, or sexual orientation.

Anyone who comes into direct contact with the monkeypox virus is at risk of becoming infected. New cases are being recorded daily, with additional countries and regions reporting their first cases and already affected countries seeing a continued rise in infections.

As with most infections, other factors, such as the amount of viral exposure, the type of contact, and the individual’s immune response, play a role in establishing the infection.

Is monkeypox an STI?

Although sexual encounters are a mode of transmission among reported cases, monkeypox is not a sexually transmitted infection. STIs are spread primarily through sexual contact, while monkeypox can be spread through any form of prolonged close contact.

The close contact that transmits the monkeypox virus involves encounters that are often more intimate or complicated than having a casual conversation or being next to someone in an elevator. Transmission requires the exchange of mucous fluids or direct contact with the virus in sufficient quantity to seed an infection. This could happen through physical contact during kissing or caressing.

Because sexual encounters involve direct physical skin-to-skin contact where bodily fluids can be exchanged, these close encounters can more easily transmit viruses. Recently, monkeypox DNA has been detected in feces and various body fluids, including saliva, blood, semen, and urine. But the presence of viral DNA does not necessarily mean that the virus can infect another person. Transmission from these sources is still under investigation.

As the virus moves through populations, public health officials are focused on getting the message out to the most exposed and hardest-hit communities about how to stay safe. Currently, breaking the chain of transmission between sexual contacts is a priority, including but not limited to LBGTQ communities. Targeted messages are intended to protect the health of a specific group, not to stigmatize the intended audience.

Other modes of transmission may play a larger role outside of the LBGTQ community. Household transmission, where people can come into close contact with infected people or contaminated items, is one of the most common types of exposure. Research is ongoing into the possible spread of monkeypox by airborne and respiratory droplets in the current situation.

Outbreaks are dynamic situations that evolve over time, so public health messages may change as the epidemic progresses. Not all shoots look or behave the same; even pathogens seen in previous outbreaks may be different the next time. As researchers learn more about how the disease is transmitted and identify changes in spread patterns, public health officials will provide updates on specific forms of contact, behaviors, or other factors that could increase the risk of infection. While changing guidelines can be frustrating or confusing, keeping up with the latest recommendations can help protect you and stay safe.

What do I do if I have been exposed to monkeypox?

Anyone who has been infected can help contain the spread by isolating themselves from others, including pets. Covering skin lesions, wearing a mask in shared spaces, and decontaminating shared surfaces or items such as bedding, dishes, clothing, or towels can also reduce spread.

You can also help interrupt the chain of transmission by participating in contact tracing and notifying public health officials about others who may have been exposed through you, which is a basic principle and common disease control practice. .

The Centers for Disease Control and Prevention has more guidance on how to control the spread of monkeypox in both home settings and shared living facilities.

Lastly, getting vaccinated as soon as possible can protect you from serious illness, even if you’ve already been infected.

This article was originally published on The conversation by Rebecca S. B. Fischer at Texas A&M University. Read the original article here.

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