Monkeypox in America: Who is at Risk and Why?

The United States declared monkeypox a public health emergency last week, an effort to bolster the US response to contain the outbreak.

The virus continues to be transmitted largely among gay and bisexual men, but experts say the disease could spread to other populations, particularly because of a shortage of vaccines. Monkey pox is transmitted by contact with infected cat sores and is rarely fatal.

Here’s the status of monkeypox now and some other populations that U.S. experts think may be at risk:

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Who is having Monkeypox now?

Last month, the World Health Organization declared monkeypox a global public health emergency. So far, 80 countries where the virus is not endemic have reported 26,500 cases of monkeypox, according to a Reuters count.

In the United States, as of July 25, 99.1 percent of U.S. monkeypox cases occurred among those assigned male at birth, according to a Centers for Disease Control and Prevention technical report. US Disease Prevention (CDC). Among male patients, 99% reported having had sexual contact with other men.

About 38% of cases occurred among non-Hispanic white men. Another 26% were in black men and 32% in Hispanic men.

As monkeypox infections rise in the US, people are taking preventative measures. Pictured: A person waits to receive the monkeypox vaccine in Fire Island-Cherry Grove, New York on July 15, 2022.
(REUTERS/Eduardo Muñoz/File photo)

The pattern of sexual transmission in men is not typical. In Africa, where monkeypox has been circulating since the 1970s, 60% of cases occur in men and 40% in women.

One reason may be that the virus appears to be transmitted “very efficiently through receptive anal intercourse and to some extent oral sex,” said Dr. Celine Gounder, an infectious disease epidemiologist and editor-in-chief at Kaiser Health News.

Who else is at risk?

Although the current explosion of cases has occurred in men, experts say there is no biological reason for the virus to remain largely within the community of men who have sex with men.

“We certainly know that it will spread to family members and other non-male partners that people have,” said Dr. Jay Varma, director of the Cornell Center for Pandemic Prevention and Response. He said the virus could also be spread through massage parlors or spas.

The real question, he said, is whether it spreads as efficiently in these groups as it does among the close sexual networks of men who have sex with men.

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Experts point to the way HIV spread as a possible indicator of where the virus will go next.

“My biggest fear is that as we try to contain this, it will seep out along the cracks in our social geography and go where HIV did, and that goes to communities of color in the rural South,” said Dr. Gregg Gonsalves, an associate professor of epidemiology at Yale University and a prominent HIV/AIDS activist.

They are places with limited infrastructure for testing, vaccines and treatments.

Gounder is particularly concerned about infections among black women, who account for the largest proportion of new HIV infections in the United States and already suffer significantly higher rates of maternal complications and deaths.

Who else could be at risk?

Other at-risk environments include college dormitories, health clubs, and sports teams.

Gounder is aware of some sports leagues preparing for possible infections, noting that sports like wrestling involve close skin-to-skin contact.

According to the CDC, wrestling, football, rugby and other sports teams have previously had outbreaks of the MRSA superbug.

“I think it’s something we have to think about and prepare for,” he said.

Employers may also need to start preparing. Gounder said some theaters in New York, for example, are considering how they might protect their workers from potential monkeypox infections through contact with shared costumes.

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“We’re still in the early days, but I’m encouraged to see that some are already thinking about it.”