Monkeypox stepped onto the international scene in the aftermath of COVID, causing many to fear another global pandemic was on the horizon. The outbreak was designated a “global health emergency” and placed on the highest level of alert by the World Health Organization.

A cousin of the deadly smallpox virus, this novel disease had been studied for decades in Africa. Yet, it was widely ignored within Western countries — until the outbreak in 2022 caused it to spread across Europe and the U.S. In this regard, the Monkeypox narrative is one of inequitable access to healthcare, discrimination, and death.

The Origin of Monkeypox

Endemic to western and central Africa, the monkeypox virus is not new. Though isolated and identified in 1959 within a group of captive monkeys transported to Denmark from Singapore, the first human case wasn’t cited until 1970 in the Democratic Republic of Congo (DRC). According to a 2022 paper published in the National Library of Medicine, the virus still has its highest prevalence in this region.

Two distinct groups of monkeypox exist. The first is the less deadly West African clade (now officially designated “Clade I”), and the second is the more lethal Central Basin clade (now officially designated “Clade II”), which is further divided into IIa and IIb. 

Ultimately, the 2022 outbreak isn’t the first time that the monkeypox virus has spread outside of Africa. The exotic pet trade and ease of international travel caused sporadic clusters of cases in the U.S. and Europe in the past. In 2003, a notable case in the U.S. was a 3-year-old girl who contracted the virus after her prairie dog bit her finger. That year, all known cases in the U.S. were related to these mammals. It was later discovered that the prairie dogs were housed next to infected Gambian rats by an exotic pet trader in Illinois. 

Early in 2022, the virus started to spread outside of Africa. Initially, most cases were confined to European regions. Its continued spread led the WHO Director-General to label the monkeypox outbreak a “Public Health Emergency of International Concern” in July 2022. The infections were driven by Clade IIb, and data indicates that the 2022 outbreak may ultimately be a new emerging clade of the virus. 

As of Nov. 1, 2022, the total global count included more than 77,500 confirmed cases with approximately 37 percent of those infected within the U.S. And according to data from the Center for Disease Control and Prevention (CDC), the infections spanned 109 locations around the world. 

The confirmed cases peaked in the middle of the summer in 2022, with an average of more than 400. Since that time, the confirmed cases steadily decreased to just 30 cases over the 7-day average across the U.S. by Nov. 2022.

However, people in the U.S. were the lucky ones.

Discrimination and medical access

In 2022, African countries experienced monkeypox at 3x the normal rate. The disease ultimately killed over 130 people since the beginning of 2022, according to a Sept. 23 brief by the African CDC. Unfortunately, this outbreak showed the ugly truth behind the equity of healthcare response within low-income countries. 

Vaccines and other resources have been long available, yet they were rarely deployed in Africa as a response to this endemic disease. Conversely, amidst the 2022 outbreak, the U.S. and other developed countries immediately purchased hundreds — and sometimes thousands —of vaccines to help control the virus within their populations. 

Who’s most at risk?

The impacted demographics are predominantly young men who have sex with men (MSM). Ninety-nine percent of the confirmed cases within the U.S. are related to male-to-male contact, mostly among those with multiple partners. 

On a positive note, the public health system can target the most at-risk communities. Although this can serve to stigmatize a virus, making it harder for vulnerable populations to receive treatment, that doesn’t seem to be the case with the 2022 outbreak. As of Oct. 2022, the CDC and state and local health departments have administered more than 1 million doses in the U.S. Estimates indicate that these numbers are enough to fully protect nearly half a million of the most vulnerable people, and data suggests that vulnerable individuals are primarily the ones seeking vaccines. Ultimately, males make up over 90 percent of the vaccine participants.

Additionally, direct communication seemed to cause a notable change in behaviors. The CDC conducted a survey that shows the MSM population reduced their number of sexual partners by 48 percent to protect themselves and their companions. 

How it spreads

Despite a more concentrated caseload in populations who engage in male-to-male intimacy, the monkeypox virus can infect anyone. It spreads through close contact with a person or animal who is infected, such as direct content with the rash itself or infected fabrics and other objects.

According to the CDC, monkeypox can spread from person to person through:

• Direct contact with rashes, scabs, or body fluids
• Via respiratory droplets after extended close contact (more than four hours) with an infected person
• Clothes, sheets, blankets, or other materials that have been in contact with rashes or body fluids of an infected person
• An infected pregnant person can spread the monkeypox virus to a fetus.

Monkeypox can spread from an animal to a person through:

• Animal bites or scratches
• Game that is cooked for food
• Products made of infected animals
• Direct contact with body fluids or rashes on infected animals

Signs and symptoms of Monkeypox

The incubation period of the virus is seven to 14 days, first replicating at the infection site and then spreading to the lymph nodes. Symptoms, however, can develop up to three weeks after exposure.

Primary symptoms include rash, fever, chills, and aches. 98 percent of infected individuals report a rash on their bodies. Fever is the next most commonly reported symptom, at 66 percent. The infection can be spread until the rash is fully scabbed over with a fresh layer of skin covering the area. Permanent scarring or discoloration of the skin, vision loss, pneumonia, and dehydration are examples of complications that can occur as the disease takes its course. The illness can last up to four weeks.

How to protect yourself

Vaccines are recommended for people with a high risk of exposure to monkeypox. The recommended series is two doses with the second given approximately 28 days after the first dose.  

That said, vaccines are not a 100 percent guarantee of protection. A vaccine study published in Oct. 2022 tracked 90 participants, out of more than 7,000 recipients, who tested positive for the virus after one or two doses. The researchers stated, “Of concern is that at least 2 breakthrough infections were observed in individuals at least 3 weeks after a second dose.” 

Therefore, as always, prevention is the best protection. The CDC recommends remaining isolated for up to 21 days, wearing a surgical mask, and covering rashes until fully healed. Overall, the public health risks are low for the general population.

However, this monkeypox outbreak should be seen as a learning experience that viruses can spread anywhere, at any time. We need to work together as a global community to prevent transmission, infections, and fatalities. 

Notable misconceptions

Misconceptions about the disease abound. Most stem from its name. To begin with, rodents are more likely to carry the monkeypox virus than primates themselves. Humans and monkeys are secondary hosts.

Additionally, the virus should not be labeled ‘African,’ though it is endemic to that location. In fact, it was not even first identified on the continent. A group of scientists called for the renaming of the disease due to its discriminatory and stigmatizing nomenclature in June 2022. The WHO agreed, stating that a new name for the monkeypox virus and its clades will be announced soon. Anyone can submit a proposal for the new name.