In May, a monkeypox outbreak hit the United States, which is still reeling from the COVID-19 pandemic.
With 21 cases, Lane County has the second highest number of cases out of Oregon’s counties as of Sept. 7.
People with the disease often experience a painful rash and flu-like symptoms. The illness can last up to a month.
The outbreak has sparked concerns over stigmas associated with the disease, similar to those present during the AIDS epidemic.
Some scientists and officials have been calling for the virus to be referred to by an acronym, MPX, and believe the name “monkeypox” is a misnomer that perpetuates racism, stigma and misinformation about the outbreak’s origin.
Although the outbreak has largely affected men who have sex with men, officials warn against thinking of MPX as a disease that only occurs among this population.
“There’s nothing about the virus where it’s looking at someone’s demographics and choosing between people and targeting folks. It has to do with the habits and behaviors of the first case,” Lane County Public Health Public Information Officer Jason Davis said. “So yes, we have seen many of our initial cases with men who have sex with men, but only by virtue of the fact that some of the initial cases were individuals who are men who have sex with men. That’s the only reason. It’s 2022, and we have no reason to believe that this won’t spread to the general population, or if it already has — it probably has. We probably have cases in every sexual preference and in every ethnicity and every demographic category.”
Davis said people cannot dismiss MPX as a problem that only occurs between men who have sex with men.
“We can’t get into this rut that we got into in the 80s and 90s of trying to say a disease is one people’s problem and not a different group of people’s problem. This is a Lane County problem; it is all of our problems. And it’s all of our responsibility to help solve by preventing transmission,” Davis said.
How it spreads
MPX is spread through close skin-to-skin contact with a rash or body fluids from a person infected with the virus, according to Dr. Anna Hejinian, medical director for University Health Services..
“That’s the kind of contact we have through kissing, hugging and cuddling, massaging and sexual activity, not through incidental contact,” Hejinian said.
A second but much less common mode of transmission is handling with bare hands objects recently used by a person with the virus like sheets, clothing, towels or sex toys, she said.
The likelihood that someone can spread MPX before they have developed sores on their skin is low compared to someone that has them, she said. The virus can also spread through respiratory droplets in the air, but it’s highly unlikely and occurs in confined spaces with exposure for over three hours, according to Davis. As a result, much of the messaging and discussions about the virus has focused on skin-to-skin contact transmission.
Some people are conflating MPX with a sexually transmitted infection or disease due to skin-to-skin contact being guaranteed in most sexual situations, Davis said.
“But it’s not the the act of sex that is the isolated incident here that’s transmitting the disease; it’s actually just the skin-to-skin contact,” Davis said. “So I think that’s really important for folks to know, first of all, just for a correct view of the illness. Also to make sure that we’re correctly typing it to not assume that only sexual intercourse is going to transmit this. It’s absolutely not true. You can get it just from that skin-to-skin contact.”
For sexually active individuals or individuals with prolonged exposure to someone else’s skin, the best way to prevent transmission is to limit skin-to-skin contact with other people, Davis said. If someone does have that skin-to-skin contact with someone, they should evaluate themselves and the other person for sores or other symptoms of the disease. This should be done with any form of physical contact someone has, Davis said.
People should evaluate the risk of going to certain events such as parties and consider how much skin-to-skin contact there will be, according to the Centers for Disease Control and Prevention. Events where attendees are fully clothed are less likely to spread MPX. People should regularly wash their hands, especially before eating or after using the bathroom, to avoid the virus.
Anyone who experiences symptoms should self-isolate and call a medical professional, Hejinian said. Students experiencing symptoms should call the University Health Services.
“We would want to see the student and evaluate them, test them if it’s felt like that was needed and coordinate their care from there,” she said.
Hejinian said people must isolate during the entire time they are infectious, which often lasts from the beginning viral symptoms like fever, sore throat and swollen lymph nodes, all the way through until the rash is crusted over and a new fresh layer of skin is developing underneath.
According to the CDC, the illness typically lasts 2-4 weeks.
UHS has already helped some students determine whether they have MPX; none of which have been positive so far, Hejinian said.
“Even one student with a preventable infection would be one too many in my book,” she said. “Also this isn’t COVID-19. It does not spread nearly as efficiently because of its mode of transmission. And so my hope is if we all do our part we can contain it, box it in so to speak, and reduce the outbreak.”
In a statement to the Daily Emerald, UO spokesperson Kay Jarvis said the university is preparing for fall term and university provider and clinical teams are closely monitoring the CDC and other medical resources to stay up to date on developments in the prevention, testing, diagnosis and treatment of MPX.
“The virus does not spread without close contact and the risk to the broader campus community is low,” she said. “In an effort to reduce spread as students and staff return to campus, we will provide guidance on how to protect against the virus and ensure our healthcare providers have appropriate training.”
Vaccination
Vaccines can help prevent the virus. However, there are limited vaccines available right now, so only certain people are eligible. Information about eligibility can be found through the CDC.
“Certain individuals may be candidates for vaccination even without a known viral exposure — this is called PEP+ or expanded PEP,” Hejinian said.
According to the Oregon Health Authority case tracker, this primarily includes men who have sex with men who have had more than one sexual partner in the last 14 days as of early September.
For those with an exposure to MPX, vaccination is still an option.
“It’s most effective if given within four days post-exposure. The vaccination can also be given four to 14 days post-exposure, but this may not prevent infection but may reduce symptoms and risks for complications,” Hejinian said.
People who have been exposed to MPX can reach out to public health officials or their primary care provider to talk about testing and vaccination.
As more vaccines become available in Lane County, people who are not included in the eligible groups can be vaccinated, according to Hejinian.
Founded in 1994 to provide resources to people living with HIV and AIDS, HIV Alliance has been helping people to get information about MPX.
The organization has developed a strong relationship with the LGBTQ community, Executive Director Renee Yandel said. After distributing the COVID-19 vaccine, HIV Alliance’s county partners and OHA reached out to the organization to help distribute vaccines for MPX.
“Initially, it was very much smaller amounts,” Yandel said. “And that has gone up over the last few weeks.”
Many of the initial vaccines came from the Strategic National Stockpile, which holds a supply of vaccines in case of an outbreak in the U.S.
Davis said vaccines from the stockpile are becoming needed more. But it’s difficult to prevent a disease with the vaccines only being distributed at an at-need basis rather than going over that need to prevent more cases, he said.
Yandel said many high-risk people called HIV Alliance, wanting to get vaccinated, but they did not have the specific behaviors and timelines needed to be eligible.
“And that’s confusing to everybody, too, because they want to do their part to get vaccinated to protect themselves and their partners, and then they’re told, ‘no, you didn’t meet this criteria,’” Yandel said.
In the past, public health would often bear much of the burden of responding to a communicable disease outbreak, Yandel said.
“In some ways, it’s easier because part of what the pandemic did was help make partnerships with community based organizations stronger,” Davis said.
Distributing the vaccines has been easier in some ways because the pandemic helped make partnerships with community organizations stronger.
Davis said MPX has created a template for future disease outbreaks and an opportunity for improvement.
“Because we’re talking about equity. We’re talking about sensitivity. We’re talking about things that can alienate whole groups of people unnecessarily,” he said. “So I hope that we take some of the lessons that we’ve already learned from the things that we’re actively learning about MPX, and we see how they affect the outcomes; and we make the adjustments needed, especially when it comes to how we talk about these things and how we label them, just referring back to the fact that this is not a men who have sex with men problem.”
