NEW YORK (AP) – The spread of monkeypox in the United States could represent the dawn of a new sexually transmitted disease, although some health officials say the virus that causes pimple-like bumps could still be contained before it is firmly established.
Experts disagree on the likely route of the disease, with some fearing it could become so widespread that it is on the verge of becoming an ingrained STD – like gonorrhea, herpes and HIV.
But no one is really sure, and some say tests and vaccines can still prevent the epidemic from taking hold.
So far, more than 2,400 cases in the United States have been reported as part of an international epidemic which appeared two months ago.
Health officials do not know how quickly the virus has spread. They only have limited information about who has been diagnosed, and they don’t know how many infected people could be spreading it unknowingly.
They also don’t know how well vaccines and treatments work. One hurdle: Federal health officials lack the authority to collect and connect data on who has been infected and who has been vaccinated.
With such huge question marks, predictions for the size of the US outbreak this summer vary widely, from 13,000 to perhaps more than 10 times that number.
Dr. Rochelle Walensky, director of the Centers for Disease Control and Preventionsaid the government’s response was getting stronger every day and vaccine supplies would soon increase.
“I think we still have an opportunity to contain this,” Walensky told The Associated Press.
Monkeypox is endemic in parts of Africa, where people have been infected by bites from rodents or small animals. It usually does not spread easily among people.
But this year, more than 15,000 cases have been reported in countries that historically do not see the disease. In the United States and Europe, the vast majority of infections have occurred in men who have sex with men, although health officials have stressed that anyone can catch the virus.
It is mainly spread through skin-to-skin contact, but it can also be transmitted through the sheets used by someone with monkeypox. Although it has spread through the population as a sexually transmitted disease, officials are watching for other types of spread that could expand the outbreak.
Symptoms include fever, body aches, chills, fatigue, and lumps on certain parts of the body. The disease was relatively mild in many men, and no one died in the United States. But people can be contagious for weeks and the lesions can be extremely painful.
When monkeypox emerged, there was reason to believe that public health officials could control it.
The telltale bumps should have made it easier to identify the infections. And because the virus spreads through close personal contact, officials thought they could reliably track its spread by interviewing infected people and asking them with whom they had had intimate relationships.
It didn’t turn out that easy.
Because monkeypox is so rare in the United States, many infected men — and their doctors — may have attributed their rashes to another cause.
Contact tracing was often blocked by infected men who said they did not know the names of everyone they had sex with. Some said they had multiple sexual interactions with strangers.
It hasn’t helped local health departments, already overwhelmed by COVID-19 and dozens of other diseases, now had to find the resources to do intensive contact tracing work on monkeypox as well.
Indeed, some local health officials have given up expecting much from contact tracing.
There was another reason for optimism: the US government already had a vaccine. The two-dose regimen called Jynneos was approved in the United States in 2019 and recommended as a tool against monkeypox last year.
When the outbreak was first identified in May, US officials only had about 2,000 doses available. The government distributed them but limited injections to people who were identified by public health investigations as having been recently exposed to the virus.
Late last month, as more doses became available, the CDC began recommending that injections be offered to those who realize on their own that they might have been infected.
Demand has exceeded supply, with clinics in some cities rapidly running out of vaccine doses and health officials across the country saying they don’t have enough.
That’s changing, Walensky said. Since this week, the government has distributed more than 191,000 doses, and it has 160,000 more ready to go. No less than 780,000 doses will be available next week.
Once current demand is met, the government will consider expanding immunization efforts.
The CDC estimates that 1.5 million American men are considered at high risk for infection.
Testing has also expanded. More than 70,000 people can be tested each week, far more than current demand, Walensky said. The government has also launched a campaign to educate doctors and gay and bisexual men about the disease, she added.
Donal Bisanzio, a researcher at RTI International, believes US health authorities will be able to contain the outbreak before it becomes endemic.
But he also said it wouldn’t be the end. New surges of cases will likely emerge as Americans are infected by people in other countries where monkeypox continues to circulate.
Walensky agrees that such a scenario is likely. “If it’s not contained everywhere in the world, we are still at risk of having flare-ups” from travellers, she said.
Shawn Kiernan, from the Fairfax County Health Department in Virginia, said there was reason for tentative optimism because so far the outbreak is concentrated in one group of people – men with sex with men.
The spread of the virus to heterosexual people would be a “tipping point” that could occur before it is widely acknowledged, said Kiernan, chief of the department’s communicable disease section.
The spillover onto heterosexuals is only a matter of time, said Dr. Edward Hook III, professor emeritus of infectious diseases at the University of Alabama at Birmingham.
If monkeypox becomes an endemic sexually transmitted disease, it will be yet another challenge for health services and doctors who are already struggling to keep pace with existing STDs.
This work has long been underfunded and understaffed, and much of it has simply been put on hold during the pandemic. Kiernan said HIV and syphilis were prioritized, but work on common infections like chlamydia and gonorrhea came down to “counting the cases and that’s about it”.
For years, cases of gonorrhea, chlamydia and syphilis have been increasing.
“Overall,” Hook said, doctors “do a lousy job of taking sexual histories, inquiring, and acknowledging that their patients are sexual beings.”
Associated Press writer Janie Har in San Francisco contributed to this report.
The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute Department of Science Education. The AP is solely responsible for all content.