Experts disagree on the likely course of the disease, with some fearing it is becoming so widespread that it is on the verge of becoming an established STD – like gonorrhea, herpes and HIV. But no one is really sure, and some say testing and vaccines can still prevent the outbreak from taking root. So far, more than 2,400 cases in the US have been reported as part of an international outbreak that emerged two months ago. Health officials are not sure how quickly the virus has spread. They have only limited information on people who have been diagnosed and don’t know how many infected people may be unknowingly spreading it. They also don’t know how well vaccines and treatments work. One hurdle: Federal health officials don’t have the authority to collect and link data about who has been infected and who has been vaccinated. With such huge question marks, estimates of how large the outbreak will be in the US this summer vary widely, from 13,000 to perhaps more than 10 times that number. Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said the government’s response is being strengthened every day and vaccine supplies will soon increase. “I think we still have a chance to narrow this down,” Walensky told The Associated Press. Monkey pox is endemic in areas of Africa where humans are infected by bites from rodents or small animals. It usually does not spread easily between people. However, more than 15,000 cases have been reported this year in countries that historically do not have the disease. In the US and Europe, the vast majority of infections have occurred in men who have sex with men, although health officials have stressed that anyone can contract the virus. It is spread mainly through skin-to-skin contact, but it can also be spread through linens used by someone with monkeypox. Although it circulates in the population as a sexually transmitted disease, officials are watching for other types of spread that could expand the epidemic. Symptoms include fever, body aches, chills, fatigue and lumps in body parts. The disease has been relatively mild in many men and no one has died in the US, but people can be contagious for weeks and the lesions can be extremely painful. When monkeypox appeared, there was reason to believe that public health officials could control it. The telltale bumps should have made infections easy to spot. And because the virus spreads through close personal contact, officials thought they could reliably trace its spread by interviewing infected people and asking who they had been in contact with. It didn’t turn out so easy. With monkeypox so rare in the US, many infected men—and their doctors—may have attributed their rashes to some other cause. Contact tracing was often hampered by infected men who said they did not know the names of all the people they had sex with. Some reported having multiple sexual encounters with strangers. It didn’t help that local health departments, already burdened with COVID-19 and many other diseases, now had to find the resources to do intensive contact tracing work for monkeypox as well. Indeed, some local health officials have stopped expecting much from contact tracing. There was another reason to be optimistic: the US government already had a vaccine. The two-dose regimen called Jynneos was licensed in the US in 2019 and was recommended last year as a tool against monkeypox. When the outbreak was first identified in May, US officials had only about 2,000 doses available. The government distributed them, but limited the downloads to people determined through public health surveys to have been recently exposed to the virus. Late last month, as more doses became available, the CDC began recommending that vaccines be offered to those who realize on their own that they might have been infected. Demand has outstripped supply, with clinics in some cities quickly running out of vaccine doses and health officials across the country saying they don’t have enough. That is changing, Walensky said. As of this week, the government has distributed more than 191,000 doses and has 160,000 more ready to ship. Up to 780,000 doses will be available from next week. Once current demand is met, the government will consider expanding vaccination efforts. The CDC believes that 1.5 million men in the US are considered at high risk for the infection. Testing has also been extended. More than 70,000 people can be tested each week, far more than current demand, Walensky said. The government has also launched a campaign to educate doctors and gay and bisexual men about the disease, he added. Donal Bisanzio, a researcher at RTI International, believes US health officials will be able to contain the outbreak before it becomes endemic. But he also said it won’t be the end. New outbreaks of cases are likely to occur as Americans become infected by people in other countries where monkeypox continues to circulate. Walensky agrees that such a scenario is possible. “If it’s not limited worldwide, we’re always at risk of outbreaks” from travelers, he said. Shawn Kiernan, of the Fairfax County Health Department in Virginia, said there is reason to be cautiously optimistic because so far the outbreak is focused on one group of people – men who have sex with men. The spread of the virus to heterosexuals would be a “tipping point” that may occur before it is widely recognized, said Kiernan, head of the department’s infectious disease division. The spread to heterosexuals is only a matter of time, said Dr. Edward Hook III, professor emeritus of infectious diseases at the University of Alabama at Birmingham. If monkeypox becomes an endemic sexually transmitted disease, it will be another challenge for health departments and doctors who are already struggling to keep up with existing STDs. Such work has long been underfunded and understaffed, and many have simply been put on hold during the pandemic. Kiernan said HIV and syphilis were a priority, but working on common infections such as chlamydia and gonorrhea amounted to “counting cases and going there”. Cases of gonorrhea, chlamydia and syphilis have been increasing for years. “In general,” Hook said, doctors “do a difficult job of taking sexual histories, asking questions, and recognizing that their patients are sexual beings.”
Associated Press writer Janie Har in San Francisco contributed to this report.
The Associated Press Health & Science Section is supported by the Howard Hughes Medical Institute Science Education Division. AP is solely responsible for all content.
