Genetic Clues and How It Might Be Spreading

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Monkeypox samples are being studied at the University of Minnesota's Veterinary Diagnostic Laboratory.

Monkeypox samples are being studied at the University of Minnesota’s Veterinary Diagnostic Laboratory.
Photo: JUDY GRIESEDIECK / Star Tribune (Getty Images)

Cases of monkeypox continue to climb across the globe, with more than 200 confirmed and suspected cases documented in over 20 countries. Scientists are starting to gather their first clues about these outbreaks, including how the virus may have started spreading farther than it ever has before.

According to a tracker from the group Global.health, there have been 174 confirmed and 93 suspected cases reported from 21 countries as of Tuesday afternoon. The UK and Spain have reported the most cases, and at least seven cases have been found in the US, including one in New York City. No deaths are reported so far; the type of monkeypox virus associated with these cases is known to have a fatality rate around 1%.

The viral disease tends to cause large bumpy rashes throughout the body, along with flu-like symptoms. It can take up to three weeks following exposure for symptoms to start and two weeks for the illness to clear. The virus primarily spreads through direct contact, though it may also be spread through contaminated surfaces as well as respiratory droplets and aerosols. Infected people are not considered contagious until after they start showing symptoms.

Monkeypox, closely related to the now-extinct smallpox virus, is endemic to parts of Africa and is thought to typically infect rodents. Following its discovery in the 1950s, it has occasionally jumped from animals to humans, causing localized outbreaks with limited transmission between humans. That makes these newest cases far different from past incursions of the virus. But we may have some early indications of what’s going on.

An electron microscope image of a single monkeypox virus.

An electron microscope image of a single monkeypox virus.
Photo: Cynthia S. Goldsmith, Russell Regner / CDC via AP (AP)

Some researchers have been able to genetically sequence samples of the virus collected from patients. bag results suggest that the strains in these cases are closely related to strains recently collected from Nigeria, where outbreaks have been ongoing since 2018. So far at least, there does not seem to be evidence that the virus has mutated in any significant way since then, which is reassuring. But further research will be needed to rule out the possibility that it somehow became more inherently transmissible between humans.

If the virus has not changed intrinsically, then these outbreaks may be the result of other factors, including how it is now being caught. Many cases have been found in young gay and bisexual men who were recently sexually active. And a World Health Organization adviser has argued that its spread may have been amplified by two recent raves in Spain and Belgium where casual sex was common. Even if this does turn out to be true, though, it would not mean that gay or bisexual men are the only people at risk, since the virus can spread through direct contact between any sex partners. It is also possible that these cases were first found simply because these individuals tend to be more aware about the risk of sexually transmitted infections in general and are more likely to regularly see a doctor as a result.

Health officials in Europe have warned that if these outbreaks aren’t contained quickly and effectively enough, the virus could establish itself in new parts of the world and regularly cause outbreaks from here on out. And while monkeypox can be managed with preventative vaccines and treatments, the last thing the world needs right now is trouble from another emerging infectious disease.

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