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WSU experts: Washington monkeypox case cause for concern, not panic

Cellular image of the monkeypox virus.
The monkeypox virus. Image by Udomkarn Chitkul on iStock.

The now-confirmed case of monkeypox in Washington state should raise awareness of the virus, but it will not spread as easily as COVID-19, according to Washington State University infectious disease experts.

Monkeypox, unlike its eradicated-relative smallpox, does not prefer human hosts and usually only transfers to humans from animals. It is also typically found in Africa with the current virus originating in West Africa. Cases of human-to-human transmission outside its usual area are concerning, but monkeypox requires close physical contact to spread, said WSU virologist Heather Koehler.

“It’s very important to recognize that it’s not a time to panic, but it is a time to be vigilant and respect that viruses are always among us,” said Koehler, who studies the West African monkeypox virus in the lab. “We should take caution and be aware of the proper health steps to take.”

Monkeypox symptoms include fatigue and fever, but it’s known for causing pustule lesions. Contact with those lesion-sites allow the virus to spread.

“It requires very close contact. It’s not like coronavirus,” said Guy Palmer, WSU professor of infectious diseases. “So, if you were in the Seattle airport at the same time as a person infected with monkeypox, you would have nothing to worry about.”

The virus is also self-limiting, Palmer said, meaning for most infected people, it will go away on its own. In the most severe cases, it can cause death, and people who are already immunocompromised are the more vulnerable. This type of monkeypox has about a 1% fatality rate, but so far, no deaths from this current outbreak have been recorded, despite there being more than a hundred confirmed and presumed cases in the developed world. This underscores the need for people to seek treatment early if they have symptoms, the WSU researchers said.

Early detection will also help contain the spread. Simply isolating the infected person will limit contagion, but there are also two vaccines already developed that could be used to contain monkeypox: the vaccine that was used to eradicate smallpox and a relatively new vaccine approved for use in the U.S. in 2019 specifically for monkeypox as well as smallpox. The U.S. has a stockpile of this vaccine and just began releasing it on May 25. Both Palmer and Koehler anticipated that the vaccine will be used in a “ring” fashion—vaccinating any contacts of infected people. Broad community vaccination is likely unnecessary.

Science key to limiting future viral outbreaks

The researchers said this outbreak also highlights the ongoing need for research and detection of zoonotic diseases, the term for those that originate in animals but have potential to infect humans.

WSU’s College of Veterinary Medicine and its Paul Allen School for Global Health are deeply involved in these efforts both abroad and at home. For instance, WSU directs the National Institutes of Health-funded Center for Research in Emerging Infectious Diseases based in Kenya to better respond to infectious disease outbreaks in eastern and central Africa before they can spread widely.

In the U.S., Koehler’s research team is investigating how the body’s immune system interacts with West African monkeypox at the cellular level. Her colleague WSU virologist Stephanie Seifert, a specialist in zoonotic spillover, is studying the ecology of another, potentially more deadly monkeypox clade, or group, found in the Congo Basin in Africa.

Seifert is part of a team that is using available genetic data to try figure out which animals might be most likely transmit it to humans. The datasets are huge since the monkeypox genome has 200,000 base pairs.

“We’re using machine learning, essentially artificial intelligence, to try to take this very high dimensional data set to see if we can better predict which species would be a reservoir for these viruses,” said Seifert.

Most likely the species will be a type of rodent, as the misnamed monkeypox is more often found in rats, mice and squirrels than in monkeys. Once they have identified the reservoir species, the researchers can then work on interventions to stop potential disease transfer from animals to humans.

The good news is that both types of monkeypox are unlikely to mutate into strains that can evade interventions including vaccinations. While all replicating viruses acquire mutations, given what is known about this family of viruses, researchers do not expect the rapid emergence of new strains with that capacity. The bad news is that monkeypox has been around for a long time and will likely persist. It is a “smart virus,” Koehler said.

“We have to appreciate that this is part of our world. We are not going to ever live virus free, but what’s important is that we learn from them,” she said. “Our drug advancements and things that keep us safe and healthy are developed from the understanding we gain from these viruses.”

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