State health officials on Thursday urged vigilance in reducing the spread of monkeypox, an infectious disease that has been found in 87 people in Minnesota.
Close and prolonged skin-to-skin contact — often during sex — has been the dominant source of viral transmission in this outbreak, which includes 35,000 people worldwide and 82 men and five women in Minnesota.
Initial cases involved men who have sex with other men, and who were infected during travel to Europe or other states, but transmission has occurred within households and tight social networks, said Dan Huff, assistant commissioner for the Minnesota Department of Health.
"While there have been some reports from Europe suggesting the outbreak may be peaking, we should still expect case numbers in the United States and in Minnesota to rise for a while," he said.
Step one is understanding that anyone can be infected, Huff said, but that monkeypox spreads differently than common airborne and respiratory viruses.
"Monkeypox does not spread as easily as COVID-19 or influenza," he said. "Person-to-person contact typically requires close skin-to-skin contact — not casual contact or touching doorknobs or other surfaces out in public."
The disease is characterized by pimple-sized and sometimes painful rashes, which can weep fluids that spread the virus. Contaminated sheets or towels are another source of transmission. Face-to-face transmission is possible but rare, typically involving people within 6 feet of one another for three or more hours.
Three Minnesotans with monkeypox were hospitalized, but most people have recovered after mild illnesses. Health officials are concerned about worse outcomes if seniors are infected, because the age range so far has only been 22 to 61. Broad spread of the virus also could infect animals, which would then serve as reservoirs and keep the virus as an endemic problem in the U.S. — as is the case in parts of Africa.
Prevention includes avoiding close contact with people who have monkeypox or suspicious rashes, or who have recent histories of travel or sex with multiple, anonymous partners that could increase their risks.
Public confusion over monkeypox could be reduced if health officials simply declared it a sexually transmitted infection, said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy. Doing so would eliminate confusion with respiratory viruses and put the focus on the behaviors that spread monkeypox rather than the type of people who are infected.
"We've got to concentrate on behaviors, not on class," said Osterholm, noting that STIs such as syphilis and herpes are spread mostly during sex but in other ways as well.
The label is "semantics" in some ways, but calling it an STI might overlook other risks, countered Dr. Ruth Lynfield, state epidemiologist and medical director of the Minnesota Department of Health. "We do now have a number of cases in household members and it may not always be" transmitted during sex.
Nine U.S. cases in children have been identified and the transmission methods are being studied, she added.
A future concern is the possible spread of monkeypox through the close contact of fall sports such as football. Huff said the state is planning to issue prevention guidance to athletic organizations, but that it will likely emphasize measures already in place such as sanitizing mats after wrestling meets.
Monkeypox vaccine is another prevention strategy, though limited doses are reserved for people at elevated risk of severe illness or of infection because of their jobs or social and sexual interactions.
The state has received 6,000 vials, and under new federal guidance each one can be stretched to provide four or even five doses. More than 2,300 people have received monkeypox vaccine in Minnesota.
