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The Biden administration declared a public health emergency to raise awareness of the virus and to free up resources for a robust response.

Monkeypox Has Been Declared a National Health Emergency; Now What? 

Daniel Pastula, associate professor at the CU School of Medicine and Colorado School of Public Health, gives an update on the outbreak. 

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Written by Greg Glasgow on August 8, 2022

The worldwide outbreak of monkeypox that started in May 2022 has now grown to such a degree that on August 4, the Biden administration declared a public health emergency to raise awareness of the virus in the United States and to free up funding and resources for a more robust response. More than 6,600 probable or confirmed cases have now been detected in the U.S., including in Colorado, and there are more than 28,000 confirmed cases worldwide. 

At this point, the spread is limited largely to men who have sex with men (MSM), says Daniel Pastula, MD, MHS, associate professor of neurology and infectious diseases at the University of Colorado School of Medicine and epidemiology at the Colorado School of Public Health, but anyone can get the virus, which is in the same family of viruses as smallpox. 

We talked with Pastula about the latest developments with monkeypox.

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What does it mean that monkeypox has been declared a public health emergency in the U.S.?

It was declared an emergency because it is spreading in multiple states, almost all 50 states now, and there are an exponentially increasing number of cases. We do have a vaccine that can protect against monkeypox and other pox viruses; however, there is a shortage of supply. There is a huge demand among the LGBTQ community and MSM, as they are currently at highest risk in this outbreak. The emergency declaration mobilizes funding and highlights the urgency to get this under control.

Are they targeting the messaging to the LGBTQ community and MSM, or is this something everyone needs to be aware of at this point?

It's both. Everyone should be aware that this is out there right now. However, the Centers for Disease Control and Prevention, state and local public health agencies, and many community organizations are particularly targeting the LGBTQ community and MSM because that is who is being most affected at this moment.

It’s important to stress there's no reason this can't jump into other populations in the future.But I think targeting the populations that are most affected right now is wise so that people can take immediate preventative measures.

Is the virus only spread by physical contact, or is it airborne at all?

Unlike COVID, monkeypox does not appear to be reliably airborne. It is primarily spread by close contact with another infected person, particularly direct skin-to-skin contact. It can also be spread through respiratory secretions and via contact with contaminated objects or materials. So if a towel was in contact with pox lesions and then you shared it with someone else, or if you touch the lesion, and then touch someone else without washing your hands, we think transmission can occur. But we're not seeing that airborne transmission where you're in the same room with someone else and you easily get infected. It’s not like COVID; you really need that close skin-to-skin contact, prolonged face-to-face contact, or sharing of items.

Is there anything you recommend for people as far as protecting themselves from the virus?

For everyone, avoiding close contact with anyone suspected to have the monkeypox virus or a monkeypox-type rash is important. And if someone does have suspected monkeypox, they should isolate themselves, cover their lesions, avoid touching their lesions, wear a mask around others, and talk to their doctor. CDC and the Colorado Department of Public Health & Environment have great websites showing photos of the monkeypox lesions and what people can do to prevent infection.  

Additionally, the highest-risk groups, including some members of the LGBTQ community and MSM, can consider the monkeypox vaccine, depending on their level of exposure. Most state and local health departments are distributing those vaccine doses. But again, there is a shortage currently.  

Finally, just wash your hands regularly and avoid touching your face with unwashed hands. That’s always a good infection prevention strategy.  

What is the treatment for monkeypox if you do get it?

For mild cases, it's symptomatic treatment. It's covering the lesions, making sure they're clean and dry, over-the-counter pain medications, avoiding exposure to others. For those with more severe cases, there are emergency antivirals the CDC gives to states that can then be released. There are other theoretical antivirals and even specific immunoglobulins that can be used, but for mild cases, most people don't need that.

Is monkeypox a disease where if you have it, you know you have it, or can it be more vague?

It can be vague. Classically with monkeypox, you would get a fever and headache and swollen lymph nodes, and then you would develop this classic pustular rash that starts in the face and then descends downward into the extremities. But with this outbreak, we're seeing a lot of cases where people don't have that fever or headache and sickness beforehand. All they're seeing is a limited pustular rash around the genital or anal areas, and it doesn't necessarily spread. 

If anyone, particularly in the LGBTQ community or MSM, notices new skin lesions, particularly fluid-filled bumps around their genitals or anal regions, they should isolate and contact their health care provider right away.

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Daniel Pastula, MD, MHS