Q&A: What should we know about monkeypox, and what makes this outbreak different from COVID?

Amid the continued worldwide repercussions of the COVID-19 pandemic, public health authorities are now monitoring the outbreak of another disease: monkeypox

According to the latest data from the Centers for Disease Control and Prevention, more than 2,500 known cases of monkeypox have been detected in the U.S., and upwards of 16,000 have been detected in dozens of countries around the world. 

This has prompted the World Health Organization to declare monkeypox a global health emergency. 

Unlike when the novel coronavirus first reached the U.S. in 2020, monkeypox has been widely studied for decades, and a vaccine and treatments have been available for years. But like COVID-19, the early monkeypox response in the U.S. has been marred by a lack of testing and access to treatments. 

Dr. Amy MacNeill, a faculty member in Colorado State University’s Department of Microbiology, Immunology and Pathology, has studied poxviruses for years. She weighed in on how worried we should be about monkeypox, the threat of zoonotic spillover, and what differentiates this outbreak from the COVID-19 pandemic. 

Amy MacNeill

Amy MacNeill, an associate professor of Microbiology Immunology and Pathology, explored a possible vaccine for COVID-19 in spring 2020. 

What should we know about monkeypox, and how worried should we be? 

Unlike when COVID-19 first started, this is a virus that scientists already understand quite a lot. It does require close contact to spread – that’s either face-to-face through respiratory droplets, contact with bodily waste or by touching the lesions caused by monkeypox themselves.  

There’s been a lot of interest in this outbreak in the fact that the lesions are around the genital region. That’s not unusual, it’s been involved in past cases, and it’s why bodily waste could spread the disease. What is interesting is that it’s spreading outside of Africa more than it usually does. 

I think the main reason for this is that we have not vaccinated the human population against these poxviruses since the mid-1970s. So, if you haven’t gotten a smallpox vaccine, you’re more susceptible to getting poxviruses, including monkeypox. 

With all this being said, monkeypox is not something I would be worried about personally. I would recommend that people be careful if they’re around an individual who thinks they may be infected, and if you’re worried you’re infected yourself, make sure that you isolate and seek treatment. 

At this point, case counts are relatively low, so your chances of being exposed to the virus are also very low. 

One pesky thing about COVID-19 is that it’s constantly evolving, and new variants are continuing to drive case counts despite the wide availability of vaccines. Should we be worried about monkeypox evolving just as quickly? 

Poxviruses are different from COVID-19. Monkeypox is a DNA virus, not an RNA virus, meaning the genome is much more stable. It can evolve, it just takes longer. It’s also possible for two poxviruses to combine and form a new virus variant, but it’s rare, especially with this one. 

Monkeypox is part of the family of orthopoxviruses that includes variola virus (the cause of smallpox). That’s why the smallpox vaccine has helped protect against it. Cowpox and vaccinia viruses are part of the same family, and those two viruses as well as monkeypox are endemic in different parts of the world. 

Should we consider administering more vaccines for monkeypox? 

I think there might be a point where this is something to consider. One good thing about these types of viruses is there’s a very low fatality rate. Because they’re not particularly deadly, the push to vaccinate people is also fairly low. 

Often with viruses like cowpox and vaccinia – which are related to monkeypox – you get lesions, you feel crummy, but will recover. There are some variants of monkeypox with a slightly higher fatality rate, but they have not spread enough to cause concern. 

Also with these viruses, once you recover, you’re immune for quite some time. 

All of this makes it different from COVID-19, which caused concerns about overloading the medical system, and also came with a tremendous economic impact. 

And, while COVID-19 is spread by air, monkeypox is much harder to transmit and there is less of a concern of asymptomatic spread.  

Your research involves zoonotic cases of poxviruses. What should we know about the risk of spillover of monkeypox between humans and animals? 

One thing that’s interesting about the monkeypox virus is that there are animal reservoirs of the disease all over the world. It’s endemic in Africa, where rodent and squirrel species can harbor the virus and be a source of infection. 

During a U.S. outbreak in 2003, we learned that prairie dogs and a few other species in the U.S. can harbor the virus as well, and some of the work we’re trying to do is figure out whether deer mice can harbor an infection. 

The reason why this is important is if the virus spreads into other potential reservoirs, it could be endemic in the U.S. and other countries around the world. That’s another reason why people who suspect a monkeypox infection should isolate. 

In Africa, we believe that people can get monkeypox from hunting for wild game. It’s often young boys who get the virus since they’re often closer to the animals. 

During the early 2000s outbreak in the U.S., people were getting monkeypox from animals shipped to the U.S. from Africa. These captive animals were sold as pets, and people were getting sick from petting them and kissing them and cleaning their cages. 

We also know that if an animal scratches or bites a person, they can get infected too. 

When it comes to humans spreading monkeypox to animals, our concern is around the potential for spread via bodily fluids, since rodents could come into contact with items like discarded toilet paper and partially eaten food items.