Last week, the United States declared monkeypox a public health emergency in an effort to strengthen the US response to contain the outbreak.
The virus is still largely spread among gay and bisexual men, but experts say the disease could spread to other populations, especially because of a lack of vaccines. Monkeypox is transmitted by contact with pus-filled wounds and is rarely fatal.
Here’s the current situation with monkeypox and some other populations that US experts believe may be at risk:
Who has monkeypox now?
Last month, the World Health Organization declared monkeypox a global emergency. According to statistics, so far in 80 countries where the virus is not endemic, 26,500 cases of monkeypox have been registered.
According to a technical report from the Centers for Disease Control and Prevention (CDC), in the United States, 99.1% of monkeypox cases in the United States occur in individuals who were assigned male at birth. Among male patients, 99% reported having had sexual contact with other men.
About 38% of cases occurred among non-Hispanic white men. Another 26% were for black men and 32% for Hispanic men.
The pattern of sexual transmission in men is not typical. In Africa, where monkeypox has been circulating since the 1970s, 60% of cases occur in men and 40% in women.
One reason may be that the virus appears to be “transmitted very efficiently through anal intercourse and to some extent oral sex,” said Dr. Celine Gounder, an infectious disease epidemiologist.
Who else is at risk?
Although the current explosion of cases has occurred among men, experts say there is no biological reason why the virus will remain largely in the community of men who have sex with men.
“We know for sure that this 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 can also spread through massage parlors or spas.
He added that the real question is whether it spreads as effectively in these groups as it does among the close sexual networks of men who have sex with men. Experts point to how HIV spreads as a possible indicator of where the virus will go next.
“My biggest fear is that if we try to contain it, it will seep along the cracks in our social geography and go where HIV has gone, and it will go to communities of color in the rural South,” said Dr. Greg Gonsalves, an associate professor of the Department of Epidemiology at Yale University and a leading activist in the fight against HIV/AIDS.
These are places with limited infrastructure for testing, vaccines and treatment. Gunder is particularly concerned about infections among black women, who account for the largest share of new HIV infections in the United States and who already suffer much higher rates of maternal complications and deaths.
Who else might be at risk?
Other at-risk groups include college dormitories, health clubs, and sports teams. Gunder is aware of some sports leagues preparing for possible infections, noting that sports like wrestling involve close skin-to-skin contact.
According to the CDC, wrestling, football, rugby and other sports teams have had MRSA outbreaks in the past.
“I think it’s something we need to think about and be prepared for,” she said.
Employers may also need to start training. Grunder said some theaters in New York, for example, are considering protecting their workers from possible monkeypox infections through contact with shared costumes.
“We’re still at the beginning of this, but I’m happy to see that some are already thinking about it,” he added.