UNC research scientists: We need to be vigilant, but realistic, about monkeypox.

·3 min read

The last two years have sensitized us to news about virus outbreaks, and rightly so.

Increased travel and habitat encroachment will likely result in more and more “virus sightings.” Monkeypox was first introduced into the U.S. in 2003 by animals captured in Ghana. It remains prevalent in West and Central Africa.

Rationality in the current situation is essential. Not every outbreak becomes a pandemic, and not every virus is deadly. Viruses are incredibly diverse, and so are the clinical outcomes of viral infections.

Monkeypox is not smallpox, even though both viruses are evolutionarily related and even though the overt signs of disease are similar. Despite the name and sometimes similar appearance, monkeypox differs from chickenpox, caused by an entirely different virus.

Monkeypox is unpleasant and stigmatizing, and the lesions are highly infectious but treatable. Unlike the Omicron variant of coronavirus, which is transmitted before fever and other symptoms, monkeypox transmission occurs mainly by close contact after the skin pustules emerge.

Unlike coronavirus, monkeypox infection, likely, induces sterilizing immunity for decades. Sterilizing immunity disrupts transmission. Hence, even worldwide, this outbreak will, in all probability, be short-lived.

The signs of monkeypox infection are obvious and aid in identification and in initiating personal quarantine and treatment. The first U.S. travel-associated monkeypox case occurred in 2021. None of the other travelers on the airplane developed the disease, and the person was successfully treated with an anti-viral drug.

However, we do need to be vigilant about protecting the most vulnerable members of our society. Those at higher risk for life-threatening complications following monkeypox infections are pregnant women, young children and the immunocompromised population.

Some estimates suggest that one in seven people will be temporarily immune suppressed during their lifetime. Episodes of temporary immune suppression may be due to cancer therapy, organ transplantations, untreated HIV infection, or medicines to alleviate diseases like rheumatoid arthritis.

The North Carolina Department of Health and Human Services is on the alert for monkeypox infections in our state. Any suspected cases of monkeypox should immediately be reported to NC DHHS. The N.C. State Laboratory of Public Health is also set up for testing for monkeypox infections. UNC Health’s infectious disease experts also are working to ensure that hospitals and clinics across the state are prepared.

Infectious disease knows no borders. As exemplified by the coronavirus pandemic, a viral outbreak in one corner of the world can spread to all corners of the world. Hence, research on all viruses is important.

We are fortunate that we are prepared to treat cases of monkeypox in the United States. Promising antiviral drugs and vaccine formulations are available in national stockpiles. These agents were developed earlier to prepare for a smallpox outbreak. They show activity against monkeypox, though it is important to recognize that no large-scale clinical trials have been conducted.

As Louis Pasteur, who developed the first rabies vaccine, famously mused, “chance favors the prepared mind.” The more research we can perform to understand how viruses replicate, cause disease, get transmitted, and infect people, the better prepared we will be to devise vaccines and treatments for emerging infections of any kind.

Blossom Damania, a Ph.D., is Vice Dean for Research at the UNC School of Medicine in Chapel Hill. Dirk Dittmer is a Ph.D. Professor of Microbiology and Immunology at UNC School of Medicine and director of the Viral Genomics Core at UNC Lineberger Comprehensive Cancer Center.

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