Monkeypox in North Carolina. A UNC doctor answers questions.
Monkeypox was first officially reported in North Carolina on June 23, 2022.
One month later, the World Health Organization (WHO) officially declared the monkeypox outbreak a global public health emergency. In the United States, the Centers for Disease Control and Prevention recently confirmed the first two cases of monkeypox in children.
North Carolina has 34 confirmed monkeypox infections as of July 25, according to the state division of public health, and there are more than 2,500 cases in the U.S., according to recent data from the Centers for Disease Control and Prevention (CDC).
What is monkeypox?
Monkeypox is a rare but potentially serious viral illness, per the CDC, which typically starts with flu-like symptoms and lymph node swelling, progressing to a widespread rash on the face and body.
Dr. Zack Moore, State Epidemiologist and Epidemiology Section Chief, said in a release that doctors should consider the possibility of monkeypox if they spot a rash or skin lesion on a patient.
“Though this is the first confirmed case in North Carolina, we know there are likely other cases in the state,” Moore said in a statement.
This spring, a spokesperson for NC DHHS said public health officials were “closely monitoring the situation and developing guidance for clinicians and other partners.”
“We will also be using some of our existing surveillance systems, including our syndromic surveillance system and our networks of hospital-based epidemiologists, to make sure we can detect any cases that might occur here,” the spokesperson said.
In 2017, monkeypox reemerged in Nigeria after no reported cases in nearly 40 years. Since then, Nigeria has reported over 450 cases, and at least eight known cases have been reported internationally.
The CDC tracks clusters of monkeypox that have been reported in European countries that don’t normally report the disease, according to a CDC press release. It was not clear how people in the clusters were exposed to monkeypox, but the cases include self-identified men who have sex with men.
Monkeypox concerns should not be limited only to men who report having sex with men, the CDC says, as those with close personal contact to people with monkeypox may also be at risk for the disease.
Monkeypox questions answered
Should we be concerned about monkeypox in NC?
Here’s what Dr. Blossom Damania, professor of microbiology and immunology and vice dean of research at UNC School of Medicine, told The News & Observer.
Note: Damania spoke in May, before North Carolina’s case had been identified.
Q: What’s the monkeypox danger for North Carolina and the US?
A: “At the current time, there is no immediate danger to North Carolina. However, it is important for our scientists to keep close track of this virus and watch for any additional outbreaks that occur in the US, as we are observing pockets of transmission in many countries. Monkeypox virus infection is a serious disease. With viruses that spill over from animal reservoirs, as is the case with monkeypox, it is hard to accurately predict what will happen.”
Q: What are UNC hospitals doing to prepare for possible monkeypox cases?
A: “UNC Health’s infectious diseases experts monitor a wide range of outbreaks and work closely with state and federal health officials, as well as their counterparts at other hospital systems across the state and the country, to be prepared. Certainly, the lessons learned during the past 2+ years of the pandemic have helped ensure we are ready for many scenarios.”
Q: How could monkeypox come to NC?
A: “Monkeypox transmission occurs through contact with infected people either through direct contact with monkeypox virus sores, body fluids or through respiratory droplets from infected individuals. For most of the population, monkeypox infection is a self-limiting disease that lasts up to a month. Most people who are infected with monkeypox are able to fully recover. However, the virus poses a higher risk in the immunocompromised population, as well as in young children and pregnant women.”
Q: What else should we know about monkeypox?
A: “Vaccination against smallpox was halted in 1980. This vaccine was highly effective against smallpox and also offered 85% protection against monkeypox infection. Due to the fact that we have not been vaccinating the human population with the smallpox vaccine since 1980, the rate of monkeypox virus infection has been predicted to increase as smallpox vaccine protection drops in the human population globally. Hence, what is happening today with monkeypox virus transmission is not entirely surprising.
“The good news is that we do currently have an FDA-approved vaccine (Jynneos) against smallpox and monkeypox viruses. Moreover, if you were born before 1980, you likely received the smallpox vaccine, which means your immune system should still offer some protection against monkeypox virus infection. Vaccines work and it is estimated that the smallpox virus vaccine has saved over 200 million lives around the world since the time it was developed.”
How monkeypox can spread
Anyone, regardless of sexual orientation, can spread monkeypox, per the CDC.
Here’s how the virus can spread:
Contact with bodily fluids
Contact with monkeypox sores
Contact with shared items contaminated with sores or fluids of a person with monkeypox
Through respiratory droplets between people in a close setting, like the same household
How to kill the monkeypox virus
Common household disinfectants can kill the monkeypox virus, the CDC press release says.
How to identify monkeypox
The clinical course of a monkeypox infection might mimic that of ordinary discrete smallpox, per the CDC. But monkeypox infections, unlike smallpox, often come with swollen lymph nodes.
▪ Shortly after the early symptoms, a rash will start to appear. Lesions can be on any part of the body. They will progress through a few stages before scabbing over and resolving, per the CDC.
This process typically happens over a two to three week period. The severity of the illness can depend on the strain of the virus (West African vs. Central African), initial health and route of exposure.
Some patients had genital lesions, the CDC press release said, and the rash could be confused with syphilis, herpes simplex virus (HSV) infection, chancroid, varicella zoster and other common infections.
For more on recognizing monkeypox, visit cdc.gov/poxvirus/monkeypox.
This story was originally published May 19, 2022 at 12:09 PM with the headline "Monkeypox in North Carolina. A UNC doctor answers questions.."
