Infectious disease experts in Madison answer questions about monkeypox

MADISON, Wis. – Six cases of orthopoxvirus — presumed to be monkeypox cases — have been confirmed in Wisconsin as of Friday afternoon, according to the state’s Department of Health Services. Public Health Madison & Dane County has identified two people with monkeypox.

News 3 Now asked medical experts some commonly-raised questions about the rare disease. 

RELATED: PHMDC identifies second monkeypox case in Dane County

Dr. Dan Shirley is the medical director for infection prevention at UW Health. Katelyn Harms is the infection prevention program manager at UnityPoint Health – Meriter.

Their responses have been lightly edited for clarity.

Q: What is monkeypox?

DS: Monkeypox is a virus. It’s been around for a long time, and most disease cases were seen in Africa. There were two types: Central African and West African versions, and the West African one is the one that we’re dealing with throughout the world right now. That’s why we’re dealing with cases in the United States, including Wisconsin.

KH: Monkeypox is an orthopoxvirus. It’s historically found in countries within Africa, most commonly found in infected animals It usually lives in animals, but can pass to humans when people are in close contact with infected animals or by eating infected meat.

Q: What are some of the symptoms of monkeypox?

DS: The disease usually starts with some nonspecific symptoms of infection, like fever, fatigue, muscle aches, headaches. In the classic way, a couple of days later, it’s followed in monkeypox by a rash, usually skin lesions. It might start with red bumps, and they might become blisters, it could become pus-filled, and then eventually kind of slough off. That’s the sort of the classic pattern. One thing, one symptom that’s a little bit specific to monkeypox is that your lymph nodes can get swollen. That’s, you know, historically how we differentiate it from smallpox, which doesn’t exist right now, luckily. 

KH: First symptom onset is usually flu-like symptoms: Fever, chills, headache, muscle aches. That can be followed by the classic rash that develops over one to three days after the onset of fever. Classic lesions could be on the head, feet, palms, or can present in other areas of the body, for example, genital lesions.

Q: How is monkeypox transmitted?

KS: It’s really limited to close contact, meaning humans in direct contact with someone who has open lesions, their infected body fluids, or they have contact with contaminated materials like bedding or clothing. 

DS: The main way it’s transmitted is (through) skin-to-skin contact. It requires prolonged close contact. But in general, if you’re in contact with someone’s open lesions with your bare skin, the risk of transmission is something for sure. It also can be spread by body fluids. That includes saliva and other body fluids. It’s not something that’s passed just by passing by someone or casual contacts, for the most part.

Q: Who is vulnerable?

DS: Right now, the highest risk is people who are known to be in close contact with someone with monkeypox. Like a lot of infections, immunocompromised people are vulnerable, if they get it, to have a severe disease. And as far as getting it, it’s really a matter of what your risk is of having close contact with someone with monkeypox. Some of the initial risk factors for having this kind of really close prolonged contact were sexual contacts, starting in Europe and kind of extending into the United States. However, anybody that’s in close contact with someone with monkeypox could get it. So no one’s more susceptible than another. It’s more about your risk factors for having that close contact.

KH: People who are at greatest risk or those who have been in contact with someone with open lesions or symptoms of monkeypox. Anybody who has been in contact with someone who is sick, had lesions recently, or specifically a sexual partner that had symptoms or open lesions are higher risk individuals right now.

Q: Does monkeypox act similarly to an STI? Specifically, is this an issue in the LGBTQ+ community?

KH: I think there’s a lot of research still being done in that space as we are diagnosing monkeypox in a population of people who identify as men who have sex with men. I think we’re still inconclusive or whether it’s truly sexually transmitted disease or that’s just another opportunity for that close skin-to-skin contact or close contact with open lesions and symptoms. I think it would be inappropriate to say that our gay population is at a specific risk here. Monkeypox is not a gay disease. It is asexual, it is a virus. But for people who have sexual contact with someone who are symptomatic, have open lesions, those are the folks that should consider themselves high risk and maybe reach out for additional resources.

DS: I think it’s not that it’s the activity so much as the population and just the groups of people that are having close intimate contact with people with monkeypox. Obviously, there are body fluids involved, but there’s also really close skin-to-skin contact, which is still thought to be the primary reason that sex is sort of associated with this which obviously usually involves really close skin-to-skin contact.

Q: What is testing like?

DS: Testing is (a) swab on skin lesions. Having skin lesions is the basis for our testing right now. Some of those other symptoms are pretty nonspecific to monkeypox. It’s only when you (have) the skin lesions that we’d be able to test for it in most cases.

RELATED: How fast is testing in Wisconsin? A monkeypox Q&A

Q: What is the vaccine like?

KH: The smallpox vaccine can also be used as a tool to prevent further spread of monkeypox. It’s usually limited to people who have either been diagnosed with monkeypox or in close contact with someone who has. At this time, Public Health is working with clinicians to determine patients who are at high risk and eligible for treatment with that smallpox vaccine.

DS: There’s a new vaccine that is effective in preventing smallpox but also is effective in preventing monkeypox, because these are pretty closely related viruses. There’s a stockpile of this new vaccine that’s been around since 2019 or so.

Q: How is monkeypox treated?

DS: The vast majority of people have pretty mild diseases. And when we say that, you get the skin lesions, you feel bad, but you don’t need to go to the hospital and be admitted. The treatment is there, and similar to the vaccine, it was developed with smallpox in mind. However, the vast majority of people wouldn’t need treatment and it’s really reserved for those severe cases.

KH: Antivirals are occasionally available for people with exhibiting monkeypox symptoms. Luckily, it’s usually a self-limiting disease. The case fatality rate is really low; usually, symptoms resolve within two to four weeks.

Q: There are two cases in Dane County as of Friday. What does this mean for the community locally?

KH: Public health messaging has still pushed that this is a low-risk scenario for the general population. I think it’s important to know that people who do not have monkeypox symptoms cannot spread the virus. Unlike COVID-19, for example, where we are often concerned about that asymptomatic transmission opportunity, that’s not the case here. You’re not going to get monkeypox unless you’re in close contact with someone who is sick. It’s also helpful to remember that a lot of our COVID precautions also help stop the spread of monkeypox. Things like good hand washing, ventilation, staying home when you’re sick and covering your face or preventing that spread of respiratory droplets are all helpful tools for us.

DS: The higher the population, the more monkeypox cases you find, which really mostly means to us that we need to test more people. Dane County does have a significant population, and so we want to certainly get the word out that if you have symptoms that seem like monkeypox, if you have had contact with someone with monkeypox, especially if you’ve traveled to somewhere that already knows they have lots of monkeypox cases, that’s the kind of stuff to talk to your healthcare provider about and consider getting tested if you’re going through these symptoms.

Q: Could we see a wide spread of this virus, similar to COVID?

DS: Even though it sounds scary that skin-to-skin contact could be the transmission, it’s obviously way less of a risk per spread than something that’s in the air you breathe. Even droplets are usually associated with much more transmission than sort of skin-to-skin contact. In relative terms, it’s not very transmissible in a population sort of sense. It’s not something you casually get just because you pass by somebody. And, you know, obviously, we’re in the middle of a COVID pandemic still, and that is a much more transmissible situation. It’s a different discussion, for lots of reasons, but there’ll be questions when a new disease comes in the midst of another very contagious disease. 

KH: I hope I don’t hate my words here, but I’m going to say no, it is unlikely that monkeypox will be our next pandemic. It’s because of that close contact that’s really required for transmission.  COVID, first of all, could have asymptomatic spreads. That’s not the case here with monkeypox. Casually passing by in the grocery store, for example, or sitting next to someone at a restaurant is not going to be how you get monkeypox.

Q: Should the average person in our community be concerned?

KH: For the general population, you’re at low risk. You’re not going to get monkeypox unless you’re around someone who is sick. (It) also gives us (a) good reason to push that message that you are sick, stay home. 

DS: I think the average person in the community shouldn’t be highly concerned; it’s more just being aware that there are cases in our area. But, we’re still trying to find cases. If you have specific risk factors, that’s something where you want to watch closely and let someone know, kind of like COVID precautions and that type of stuff, it’s more just awareness that you know it’s going around. 

Q: If I think I have monkeypox, what should I do?

KH: If you do develop symptoms that you are concerned about, isolate at home, make sure you call your doctor and testing may be available with coordination through Public Health. If you feel that you had a high risk of exposure to someone who is symptomatic, again, call your doctor and treatment in the form of vaccination may be available to those who have been potentially exposed to monkeypox. So why?

Q: If there’s such a low risk, why should I care about monkeypox?

KH: I think coming off of the solid two and a half years of really thorough discussion on COVID, I think the general public is just more well versed in infectious disease discussions now. You know, monkeypox has been endemic for decades, we’ve always known it existed. There have been clusters of cases outside of Africa for many, many years. In fact, there was a cluster of monkeypox cases in Wisconsin, back in 2003 related to exotic pets. These things have happened before, but I think just the public’s awareness of infectious disease and conversations around it are in a different space this time around. 

Q: Is the conversation around monkeypox being overblown out of proportion for the concern in our area? 

KH: I think conversations like this are a good thing. I think it’s helpful to have these conversations and it’s not necessarily being overblown, but giving the community good facts. Because this disease has been endemic for a long period of time, it’s important to remember that people have been affected by this for a long time, and people have died of this illness. It’s important to keep remembering prevention efforts and support prevention efforts, even if it’s not directly affecting us.