Monkeypox isn't going away any time soon. Here are signs to look for and how to avoid it

A gloved hand holds a testing tube vial
A medical laboratory technician inactivates suspected monkeypox samples to be PCR tested at the microbiology laboratory of La Paz Hospital on June 6 in Madrid, Spain.
Pablo Blazquez Dominguez | Getty Images

Monkeypox infections are continuing to climb in the United States. Illinois and California declared states of emergency Monday, and the World Health Organization says the outbreak is a global health emergency.

What does the disease look like here in Minnesota — and who is at risk? Dr. Beth Thielen, an assistant professor in the department of Pediatrics at the University of Minnesota who studies infectious diseases, spoke with Cathy Wurzer.

The following transcript has been edited for length and clarity. Click the audio player above to listen to their conversation.

Now remind folks, what is monkeypox?

Monkeypox is a viral infection, historically, meaning for over the last few decades we've known about this virus that is circulated primarily in Africa. Although we've seen cases that have resulted from export of animals or travel in parts of the world that don't typically have monkeypox.

I think what's really unique about this current outbreak is that we're seeing many cases in parts of the world that don't traditionally have monkeypox, all occurring simultaneously. And so I think right now we're at over 21,000 cases, globally, and nearly 6,000 cases in the United States. So this is larger than any outbreak we've seen previously.

Reports say the disease spreads through sexual contact, but it's not an STD, right?

Correct. So it's really close physical contact that spreads it and I think many people will know that it's hard to have sexual contact without a component of close physical contact. So it certainly can spread through sexual activity.

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But, the message we want to get out to people is that it doesn't necessarily have to be sexual activity. It can be just other forms of close contact or even contact with bedding or other cloth fabric like that.

Are you concerned that this might be feeling some backlash or discrimination against the LGBTQ community?

Certainly. That’s the concern based on experiences that we've had with other other outbreaks. And I think there's certain risks that do seem to be more common among men who have sex with men, that is primarily the population where we've seen this infection thus far. And certainly we want to get the word out to those communities so that they can take appropriate precautions.

We want to be aware that this actually isn't spread just through sexual contact, and that we want to be looking and getting protective messages out to other communities as well. So I think vigilance, not panic, is kind of what we're what we're aiming for.

Are kids at risk?

We did see infections among children and some have severe infections. So I don't want to downplay that risk. But at the same time, we've really not seen a large number of cases in the general population and it's really relatively rare cases amongst children.

Certainly, there are other infections of children, things like hand foot and mouth disease that are more common. I think the chances that it is monkeypox at this point is less likely than it is one of the more common childhood infectious illnesses.

How are the cases in Minnesota?

The new data that was announced [Tuesday] morning by the Minnesota State Health Department said we have 38 confirmed cases here in Minnesota. It was maybe around 33 or so late last week. And it's really been over the last few weeks that we've had cases coming up.

So adding a few new cases a day, but we haven't really taken off to the same extent where we've seen, you know, 800 or so cases in New York and over 500 cases in Illinois. We're not kind of on the same scale as some of the states with larger outbreaks. But we do have steadily accumulating cases here in Minnesota.

And how does someone know if they have it? Is it pretty obvious?

Yes and no. So really, the key feature that people are having is the rash. And it sort of changes over time over the course of the illness. So it may start as little spots on the skin and then progress to more blister like spots or spots filled with pus.

The issue is some of these rash illnesses can be fairly limited to small areas of the body. So particularly early in infection, or if there's a very limited spread of the infection on the body, it may be possible that people may miss those signs of rash.

So I think really, rash illness is something for people to check in with their health care provider about and particularly if they've had known exposures to someone with the disease or have engaged in types of activities that are known to be risk factors.

So fever and fatigue were historically thought to precede the rash. I think what we're learning with this current outbreak is that they may come later. I think the rash is probably the most important, that unique feature that people can kind of focus in on.

What is the best advice for how people can protect themselves?

I think being aware of where the disease is circulating and sort of taking precautions that are proportionate to the level of risk. So I think right now, we do know that this is spreading through sexual activity, and particularly sexual activity with multiple partners and partners met through some apps and websites and things like that. And so I think mitigating those risks at this point as much as possible while this is circulating.

We do have a vaccine available, and that vaccine has been fairly limited in its supply. So I think for people who are identifying as high risk, some of the typical locations where people seek sexual health care are really good places to to check in with about vaccines and talk to the health care providers.

I think this situation is evolving so quickly, that many community practitioners may feel a bit lost and sort of have a hard time keeping up. And that's really why infectious disease doctors, like myself, exist. So many of the health systems will have an infectious disease specialist. And I think we're paying particularly close attention to how this is evolving and making sure that we're getting accurate, timely information out to folks.

I will say that testing is really important. I think we've really scaled up our testing capacity. And so if people have rash or lesions, even if they don't have traditional risk factors, it is very important to test for monkeypox so we really get a handle on how many cases are out there and how this disease circulation is changing over time and we can give people the most accurate up to date information about this outbreak.

How effective are treatments if you're diagnosed with monkeypox?

We have a treatment that's available but it hasn't been widely used because this is such a new outbreak. We don't have a lot of data about how this works, but certainly it's something that's available for people with severe disease. And that could be just skin rashes that are limiting the ability of people to function.

So particularly, we're seeing this in the mouth and genital area — and that can be quite painful. People can get that treatment in consultation with their doctors who contract with public health authorities.

I think the most important thing is to seek medical attention if people are concerned, not all people with monkeypox will require treatment, but certainly it's available if people need it.

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Audio transcript

CATHY WURZER: Well, monkeypox infections are continuing to climb in the United States. Illinois and California declared states of emergency yesterday. And the World Health Organization says the outbreak is a global health emergency. So what does the disease look like here in Minnesota? Who is at risk?

Dr. Beth Thielen is on the line. She's an Assistant Professor in the Department of Pediatrics at the University of Minnesota, who studies infectious diseases. Welcome, Doctor.

BETH THIELEN: Yeah. Thanks for having me, Cathy.

CATHY WURZER: Glad you're with us. Now, remind folks-- what is monkeypox?

BETH THIELEN: Yeah, so monkeypox is a viral infection. Historically, meaning over the last few decades we've known about this virus, it has circulated primarily in Africa, although we've seen cases that have resulted from export of animals or travel in parts of the world that don't typically have monkeypox. I think what's really unique about this current outbreak is that we're seeing many cases in parts of the world that don't traditionally have monkeypox all occurring simultaneously.

And so I think right now, we're, I think, over 21,000 cases globally and nearly 6,000 cases in the United States. So this is larger than any outbreak we've seen previously.

CATHY WURZER: Industry reports the disease said it was spread through sexual contact, but it's not an STD, right?

BETH THIELEN: Correct. So it's really close physical contact that spreads it. And I think many people will know that it's hard to have sexual contact without a component of close physical contact. So it certainly can spread through sexual activity, but the message we want to get out to people is that it doesn't necessarily have to be sexual activity. It can just other forms of close contact, or even contact with bedding or other cloths, fabric, things like that that have been contact with someone who has monkeypox.

CATHY WURZER: Initially, LGBTQ organizations were warning about the risk of exposure. And there seems to have been a lot of misinformation out there about who can be infected, that kind of thing. Are you concerned that this might be fueling some backlash or discrimination against the LGBTQ community?

BETH THIELEN: Certainly that's the concern based on experiences that we've had with other outbreaks. I mean, I think there's certain risks that do seem to be more common amongst men who have sex with men is the primarily the population where we've seen this infection thus far. And certainly, we want to get the word out to those communities so that they can take appropriate precautions, and we want to be aware that this actually isn't spread just through sexual contact and we want to be looking and getting protective messages out to other communities as well. So I think vigilance, not panic, is kind of what we're aiming for.

CATHY WURZER: With kids going back to school soon, are they at risk?

BETH THIELEN: Well, I think your listeners may be aware we have seen some pediatric cases. And certainly historically and in some of the early outbreaks, we did see infections among children, and some severe infections among children. So I don't want to downplay that risk.

But at the same time, we have really not seen a large number of cases in the general population. And it's really been relatively rare cases amongst children. Certainly, there are other infections of children-- things like hand foot and mouth disease-- that are more common. And so I think any rash illness, I think, should be evaluated. But I think the chances that it is monkeypox at this point is less likely than it is one of the more common childhood infectious illnesses.

CATHY WURZER: By the way, how are case counts looking like in Minnesota? How are they trending?

BETH THIELEN: Yeah. So as of the new data from that was announced this morning by our state health department, we have 38 confirmed cases here in Minnesota. It, was I think, maybe around 33 or so late last week. And it's really been over the last few weeks that we've had cases coming up.

So adding a few new cases a day, but we haven't really taken off to the same extent where we are seeing 800 or so cases in New York and 500 cases-- over 500 cases in Illinois. So we're not kind of on the same scale as some of the states with larger outbreaks, but we are steadily accumulating cases here in Minnesota.

CATHY WURZER: And how does someone know if they have it? Is it pretty obvious?

BETH THIELEN: Well, yes and no. So, really, the key feature that we're having people kind of are keying in on is the rash. And it typically-- it changes over time over the course of the illness. So it may start as little as small sort of spots on the skin and then progress to more blister-like spots or spots filled with pus.

The issue is that in some of these rash illnesses can be fairly limited to small areas of the body. So particularly early in infection or if there's a very limited spread of the infection on the body, it may be possible that people may miss those signs of rash. So I think, really, rash illness is something for people to check in with their health care provider about, and particularly if they've had known exposures to someone with the disease or have engaged in types of activities that are known to be risk factors.

So fevers and general malaise, these are symptoms that were historically really thought to precede the rash. I think what we're learning with this current outbreak is that they may come later. And so I think the rash is probably the most important unique feature that people can kind of focus in on.

CATHY WURZER: Best advice for how people can protect themselves.

BETH THIELEN: Yeah. So I think being aware of where the disease is circulating and taking precautions that are proportionate to the level of risk. So I think right now, we do know that this is spreading through sexual activity, and particularly sexual activity with multiple partners, and partners met through apps, and websites, and things like that. And so I think mitigating those risks at this point as much as possible while this is circulating I think is generally good practice.

We do have vaccine available. And that vaccine has been fairly limited in its supply. So I think for people who are identifying as high risk, some of the typical locations where people seek sexual health care are really good places to check in with about vaccines and talk to the health care providers. I think the situation is evolving so quickly that I think many community practitioners may feel a bit lost and sort of have a hard time keeping up.

And that's really why infectious disease doctors, like myself, exist. So many of the health systems will have an infectious disease specialist, and I think we're paying particularly close attention to how this is evolving and making sure that we're getting accurate, timely information out to folks. I will say that testing is really important. And I think we've really scaled up our testing capacity.

And so if people have rash illnesses, even if they don't have traditional risk factors, I think it is very important to test for monkeypox so we really get a handle on how many cases are out there and how this disease circulation is changing over time so we can give people the most accurate, up to date information about this outbreak.

CATHY WURZER: And before you go, how effective are treatments if you are diagnosed with monkeypox?

BETH THIELEN: Yeah. So we have a treatment that's available. It's something called tecovirimat, or TPOXX. Because this is such a new outbreak, we don't have a lot of data about how this works. But certainly, it's something that's available for people with severe disease. And that could be just skin rashes that are limiting the ability of people to function.

So particularly, we're seeing in the mouth and genital area, and that can be quite painful. And so people can get that treatment in consultation with their doctors who consult with the public health authorities were making decisions about getting treatment out to folks. So I think the most important thing is to seek medical attention if people are concerned. Not all people with monkeypox will require treatment, but certainly, it's available if people need it.

CATHY WURZER: All right, a lot of good information you have here. Thank you so much.

BETH THIELEN: Thanks so much for having me, Cathy.

CATHY WURZER: Have a good day. Dr. Beth Thielen is an Infectious Disease Physician and Scientist at the University of Minnesota.

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