Monkeypox in the US: where could it spread next?

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CHICAGO — The United States declared monkeypox a public health emergency last week to help the U.S. response to contain the outbreak.

The virus continues to be widely transmitted among gay and bisexual men, but experts say the disease could spread to other populations, particularly due to vaccine shortages. Monkeypox is spread through contact with pus-filled sores and is rarely fatal.

Here is the current status of monkeypox and some other populations that US experts believe may be at risk:

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WHO’S GETTING MONKEY POXING NOW?

Last month, the World Health Organization declared monkeypox a global public health emergency. So far, 80 countries where the virus is not endemic have reported 26,500 cases of monkeypox, according to a Reuters tally.

According to a technical report from the US Centers for Disease Control and Prevention (CDC), 99.1% of US monkeypox cases in the United States occurred in individuals assigned male sex at birth on July 25. Among the male patients, 99% reported having had sexual contact with other men.

About 38% of cases occurred in white, non-Hispanic males. Another 26% were Black males and 32% Hispanic males.

The pattern of sexual transmission in males is not typical. In Africa, where monkeypox has been around since the 1970s, 60% of cases occur in men and 40% in women.

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One reason could be that the virus appears to be “transmitted very efficiently through anal intercourse and to some extent through oral sex,” said Dr. Celine Gounder, infectious disease epidemiologist and contributing editor at Kaiser Health News.

WHO ELSE IS IN DANGER?

Although the current explosion of cases has occurred in men, experts say there is no biological reason the virus remains largely in the community of men who have sex with men.

“We know for sure that it will spread to family members and other non-male partners,” said Dr. Jay Varma, director of the Cornell Center for Pandemic Prevention and Response. He said the virus could also spread through massage parlors or spas.

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The real question, he said, is whether it spreads as efficiently in these groups as it does in tight sexual networks of men who have sex with men.

Experts point to the way HIV spreads as a possible indicator of where the virus will go next.

“My biggest fear is that as we try to contain this, it will seep along the fractures in our social geography and go to where HIV did, and that’s going to the communities of color in the rural South,” said Dr. Gregg Gonsalves, an associate professor of epidemiology at Yale University and a leading HIV/AIDS activist.

These are places with limited infrastructure for testing, vaccines and treatments.

Gounder is particularly concerned about infections among black women, who account for the largest proportion of new HIV infections in the United States and already suffer from significantly higher rates of maternal complications and deaths.

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WHO ELSE COULD HAVE BEEN DANGER?

Other vulnerable environments include college dormitories, gyms, and sports teams.

Aware of some sports leagues preparing for possible infection, Gounder notes that sports like wrestling involve close skin contact.

Wrestling, soccer, rugby and other sports teams have all had outbreaks of the superbug MRSA, according to the CDC.

“I think we have to think about it and prepare for it,” she said.

Employers may also need to start preparing. Gounder said that some theaters in New York, for example, are considering ways to protect their workers from possible monkeypox infections by exposure to shared costumes.

“We’re just getting started, but I’m heartened to see that some are already considering it.” (Reporting by Julie Steenhuysen; Editing by Caroline Humer and Josie Kao)