New Hampshire hasn’t seen any new cases of monkeypox for more than a week and widespread vaccination is not being planned for the disease, partly because it is spread almost entirely by men who have intimate contact with other men.
“In this current state where there’s limited vaccine and the risk factors are so clearly clustered … a person who doesn’t have those risk behaviors doesn’t need to access the vaccine,” said New Hampshire Deputy State Epidemiologist Dr. Elizabeth Talbot during a webinar Wednesday sponsored by Dartmouth College. “It may be that it gets into the general population … then we’ll change recommendations. But the snapshot today suggests there’s not a need for widespread vaccination.”
New Hampshire has reported 15 cases of monkeypox as of Wednesday, a figure that has hardly changed since the start of the month.
“I hope that people are recognizing that this risk factor needs to be taken seriously,” Talbot said. “The message is getting out – that’s my hopeful answer as to why we’ve been stuck on 15 for a while.”
Vermont has reported two cases, Maine three, and Massachusetts 228. The United States as a whole has more cases of the current outbreak than any other country, almost 13,000.
There have been no U.S. fatalities reported but the rash and sores can be very painful and can result in disfiguring scars and lesions. There may be also lingering symptoms such as fever, headaches and fatigue.
Monkeypox – so named because it was first reported in some monkeys in a test laboratory – has been known for 60 years and is endemic in western Africa, although the current strain appears to have evolved to be more contagious from person to person, Talbot said.
Infection requires intimate skin-on-skin contact or contact with material that has been contaminated with a rash or fluid of a sick person. The latter possibility is why cleaning staff in hotels who handle sheets and towels used by guests are considered an at-risk population.
Anybody can get the disease, Talbot said, including young children in households with an infected adult.
Unlike COVID-19, monkeypox is not an airborne disease although in some cases, Talbot said, prolonged and very close breathing of another person’s respiratory droplets may spread the virus.
The monkeypox virus is a variant of the smallpox virus and an existing smallpox vaccine called Jynneos is considered some 85% effective against it. But Talbot said that people who received that smallpox vaccine as a child should not feel they are protected when indulging in risky behavior. They should get a booster shot.
There is a treatment for monkeypox called tecovirimate, or TPOXX, approved in 2018 by the FDA. Infected people should isolate for two weeks or more; Dartmouth College has isolation rooms available if the disease shows up on campus.
“We have had practice with handling COVID in terms of the infrastructure on campus for managing students,” said Dr. Ann Bracken, assistant professor o medicine at Dartmouth during the webinar.
Monkeypox produces skin sores ranging from small pimple-like rash to large, separated pustules.
A big difference from COVID-19 is that people who have the virus but do not have the rash cannot transmit monkeypox, since it is spread from the body lesions.
The city of Portland, Maine, is about to start monitoring its wastewater for the monkeypox virus. At least two wastewater treatment plants in New Hampshire are being monitored for COVID-19 virus right now and Biobot, the commercial firm doing the testing, does not have monkeypox testing available for them at this time.