Tag Archives: Chordopoxvirinae

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CDC Says We Probably Can’t Get Rid of Monkeypox Now

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Image: Shutterstock (Shutterstock)

A new report from the U.S. Centers for Disease Control and Prevention offers some good and bad news about the country’s ongoing monkeypox outbreak. New cases are slowing down, likely thanks to a combination of vaccination and education efforts. But it’s also likely that the virus won’t be eradicated here and will continue to circulate locally at low levels.

The prognosis comes from the CDC’s most recent technical report on monkeypox released late last week. According to the report, based on data collected up through September 23, the peak in reported new cases occurred in mid- to late August. Since then, the growth in cases has steadily declined. As of September 30, there have now been 25,851 reported cases of monkeypox in the U.S., while the seven-day average as of September 28 is 144 cases a day. Based on known information, the majority of these cases have involved gay and bisexual men who likely caught it during sex with other men.

In trying to explain this decline, the CDC authors note that vaccination is only one piece of the puzzle. That’s because cases began to drop while the vaccination rate among the highest risk groups was still very low. But vaccines may still be playing a role in curbing the outbreak and will certainly be vital moving forward. Preliminary data from the CDC, for instance, has found that at-risk people given the first dose of the vaccine have been 14 times less likely to catch monkeypox than those unvaccinated, though it is still too early to confirm the vaccine’s exact effectiveness during this outbreak. Limited data in the past has suggested that the full two doses may be around 85% effective.

Meanwhile, survey data has suggested that high-risk individuals are heeding public health warnings and have changed their behavior to lower the chances of catching monkeypox, such as by having fewer one-night stands or reducing their number of sexual partners. “The slowing growth of the outbreak is likely due to a combination of many factors, including vaccination, behavior change, and possibly increases in infection-acquired immunity among a segment of the sexual networks at highest risk,” the authors wrote.

The CDC expects new cases in the U.S. to continue declining or reach a plateau over the next two to four weeks and to then decline significantly over the months to come. But the most likely scenario for the long-term future is one in which monkeypox lingers on. The report authors expect that these cases will remain concentrated among men who have sex with men (MSM), but they’re not certain about how far the monkeypox virus will ultimately spread among this group.

“We note that low-level transmission could continue indefinitely, and the cumulative number of cases that could occur among MSM is unknown,” they wrote.

Prior to the global outbreaks this year, monkeypox has predominantly been transmitted from animals to humans. But experts elsewhere in the world have feared that the extent of monkeypox in 2022 has made it impossible to fully contain and that it will become a routinely encountered human disease.

Of course, the path of monkeypox’s future isn’t set in stone yet, and there are still many factors that could affect its trajectory. Though unlikely, it is possible that the virus could burn itself out and be locally eliminated in the U.S. in the near future. Conversely, monkeypox could spread widely among other groups and/or in ways outside of having sex. At this point, though, the report authors note that neither scenario above seems to be happening in the U.S. or elsewhere.

Perhaps the silver lining to all this is that this situation could have been much worse. There were two major groups, or clades, of monkeypox viruses known to scientists before 2022 (a third has since been identified, which may have emerged during the outbreak). The more serious clade has had a fatality rate of 10% during past outbreaks, while the strains that have spread around the world this year have had a fatality rate lower than 1% (the U.S. has had two confirmed deaths). And unlike the other most recent emerging disease to circle the globe, covid-19, we had vaccines and antiviral treatments available for monkeypox even before it became widespread.

That said, it’s worth wondering whether more decisive action early on and a better functioning public health system would have been able to stop monkeypox from becoming established as a new human disease. And so long as monkeypox is circulating out there, it’s a public health threat that has to be managed and monitored.

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Italian Man With Fever Learns He Has Monkeypox, Covid-19, and HIV All at Once

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An example of monkeypox rashes.
Image: Shutterstock (Shutterstock)

A 36-year-old man in Italy appears to be uniquely unlucky, after he was hospitalized and diagnosed with covid-19, monkeypox, and HIV over a span of a single week in July. Thankfully, his covid and monkeypox co-infections did successfully clear up without issue, and he has since been placed on HIV treatment.

His doctors describe this unfortunate medical tale in a case report published last week in the Journal of Infection. According to the report, the man first became ill with a fever, sore throat, and headache on June 29, nine days after having returned from a trip to Spain. On July 2, he tested positive for the SARS-CoV-2 coronavirus, but that same day, he also noticed a rash starting to develop on his left arm. Over the next few days, the rash turned into small, painful blisters that spread along his face, torso, lower limbs, and glutes. On July 5, he sought care at the emergency department of a local hospital in Catania, Italy, where he was then admitted into the infectious disease unit.

Given the man’s symptoms and recent travel to Spain, doctors quickly suspected monkeypox infection and collected samples for testing (the country was one of the first to report cases this year). While in Spain, the man also reported having condomless sex with other men, which has been a risk factor for monkeypox during the current outbreak. Finally, on July 6, the man tested positive for monkeypox, HIV, and the coronavirus—specifically, the Omicron BA.5.1 variant.

“To date, no reports of co-infection with monkeypox virus and SARS-CoV-2 have been published,” the authors wrote. “Therefore, in this study we present the clinical features and diagnostic procedure of the first documented case of co-infection with monkeypox virus, SARS-CoV-2, and HIV-1.”

Due to their respective incubation periods, the man could have caught the coronavirus and monkeypox at the same time. It’s thought to take anywhere from three to 17 days after exposure for monkeypox symptoms to appear, and around two to 14 days for covid-19 symptoms to show up (though the incubation period has likely gotten shorter on average for Omicron). As for the HIV infection, the man told doctors that he tested negative for it in September 2021. And since his CD4 lymphocyte count was still normal, it’s likely that this infection was caught recently as well. It can take 10 to 90 days following exposure to test positive for HIV, depending on the test used, and early flu-like symptoms may appear within a few weeks to a month.

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Though co-infections can sometimes contribute to more severe illness, it’s not clear whether that played any role in this case. By day three of the man’s hospitalization, most of his rashes started to crust over; by day five, his symptoms had almost completely resolved and he was sent home soon after. By July 13, he was no longer testing positive for the coronavirus, and on July 19, a follow-up visit to the doctors revealed that his crusty rashes had healed over almost completely, though he was still positive for monkeypox on a swab test. He was also started on a standard combination therapy for HIV, which is known to be very effective at keeping the chronic infection at bay when taken regularly.

While monkeypox may be able to spread to others through any kind of prolonged close contact, evidence continues to show that the vast majority of cases during this outbreak have been transmitted during sex, and most often among gay and bisexual men who have had multiple recent partners—perhaps both from close contact with contagious rashes and through infectious semen or other bodily fluids. Because the covid-19 pandemic is still ongoing and monkeypox cases are on the rise, the authors say that doctors should be aware of the possibility of co-infection in high-risk groups. They also add that their case emphasizes the predominant role that sex could be having in spreading monkeypox.

“Therefore, complete STI screening is recommended after a diagnosis of monkeypox,” they wrote.

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The U.S. Is Rolling Out Monkeypox Vaccines to the Public

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The U.S. will soon greatly expand its vaccination program for monkeypox. On Tuesday evening, the Biden administration announced that it is planning to release a stockpile of over a million vaccine doses to the public by the end of fall. The vaccines will primarily be given to close contacts of confirmed cases and others with a higher risk of exposure, such as gay and bisexual men who have had multiple recent sex partners in areas where the emerging disease has been spotted.

The updated strategy announced by the U.S. Department of Health and Human Services Tuesday will call for a gradual rollout of the country’s supply of the JYNNEOS vaccine. Nearly 300,000 doses will be distributed nationwide in the coming weeks, including 56,000 doses immediately. Another 750,000 doses will be made available during the summer. And up to 500,000 doses should be released later in the year, assuming that they pass the inspection process. All in all, around 1.6 million doses of the two-dose vaccine are expected to be available through the stockpile this year.

The vaccines became available so quickly because the monkeypox virus is closely related to the now-extinct smallpox virus, which was eradicated through a massive global vaccination campaign in 1980. Countries have still maintained a stockpile of smallpox vaccines to this day, however, in part because there’s always the small possibility that the virus could be resurrected as a bioweapon agent. And these vaccines are also thought to be effective against closely related viruses like monkeypox. Indeed, smallpox vaccines do not contain the virus itself, but another related virus called vaccinia.

The U.S. does have a much larger stockpile of the ACAM2000 smallpox vaccine available as well, and the HHS has said that it will release doses to jurisdictions that request it. But the ACAM2000 vaccine comes with more significant side effects than JYNNEOS, making it less suitable for mass distribution, the agency said. In 2019, JYNNEOS became the first vaccine in the U.S. to be approved for both smallpox and monkeypox. It’s estimated to be 85% effective against monkeypox, but that estimate is based on limited real world data. The vaccine can also be given to people soon after a suspected exposure, which should reduce the risk of illness.

In announcing the expanded rollout of its stockpile, the U.S. is following in the footsteps of other countries like the UK. Like these countries, the U.S. will be allocating doses on a priority basis, depending on people’s risk of exposure. At the top will be people known to be in close, prolonged contact with confirmed or suspected cases, followed by those whose sexual partners have been diagnosed with monkeypox, and finally “men who have sex with men who have recently had multiple sex partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading.” Within these tiers, considerations like a person’s existing health will be taken into account as well.

“Our goal right now is to ensure that the limited supply of JYNNEOS vaccine is deployed to those who can benefit from it most immediately, as we continue to secure additional vaccine doses,” said HHS Assistant Secretary for Preparedness and Response Dawn O’Connell, in a statement.

Monkeypox is thought to primarily infect rodents. Until recently, it had only occasionally spread from animals to humans following its discovery in the 1950s. But there have been more than 4,000 confirmed or suspected cases reported globally in humans this year, including over 300 in the U.S., which is a caseload far above the sporadic outbreaks previously seen in some parts of Africa. Though it may have been circulating in humans at low levels for several years now, its current spread appears to be fueled by close contact during sex. So far, outbreaks have primarily involved men who sleep with men, but the virus can spread to anyone through close contact with someone’s infected rashes and possibly respiratory particles.

Last weekend, the World Health Organization declined to declare a public health emergency of international concern over monkeypox for the time being, though they continued to stress that greater international cooperation and action will be needed to contain the virus before it can permanently become endemic in more parts of the world.

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We Are Not Ready for Monkeypox

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Photo: Pablo Blazquez Dominguez (Getty Images)

Monkeypox is here, and it’s spreading. The couple of dozen cases in a few countries that we told you about last month are now up to over a thousand cases worldwide, with 35 reported in the United States. But the U.S. almost certainly has more cases than the statistics suggest, and there is reason to suspect that we’re already fucking up the response to the epidemic in some ways that will feel uncomfortably familiar.

We aren’t testing enough

For the first few months of the COVID pandemic, when we had the chance to contain the virus if only we could locate all the cases and their contacts, testing was woefully inadequate. Plenty of people who had the virus were never tested for it, and people who wanted a test couldn’t always get one. The way we knew at first that the virus was spreading unnoticed was that there were cases in the U.S. that were not related to each other. The genetics of different clusters of a disease outbreak can show that the virus must have been spreading undetected for a while.

That’s what’s beginning to happen here: There are small clusters of monkeypox cases that are genetically different enough from each other that we know there must be far more than the 35 reported U.S. cases. So a lot of cases must be going undetected.

One reason for under-testing is that people who have monkeypox may not realize that they have it. Normally, monkeypox lesions are widespread across the body. In the current outbreak, sometimes a person may only have lesions in one part of the body, and may even have a single lesion. When that happens, you don’t think, “oh my god, this must be monkeypox,” you think, “huh, I wonder what that spot is.” And maybe you’ll see a doctor, or maybe not.

Doctors also aren’t necessarily looking for monkeypox, and might not recognize it at first. It’s not a common disease in the U.S. (or in many of the other areas where it’s spreading) and the symptoms in this outbreak don’t always follow the textbook sequence. Normally you would expect a fever first, and then the rash; but some of the known cases got the rash before the fever. Some people have the lesions only in the anal or genital area, which may look confusingly similar to STIs like herpes or syphilis. (Molecular microbiologist Joseph Osmundson has put together a fact sheet that includes photos of anal and genital monkeypox lesions here.)

So the first obstacle in testing is that not enough tests are being done in the first place. Testing for monkeypox involves collecting secretions or scabs from the lesions, and sending them to one of a few specific laboratories. Former FDA commissioner Scott Gottlieb tweeted that the current bottleneck is the lack of sampling.

But if awareness gets better, we may soon run into a bigger problem: labs’ testing capacity. Currently there is a network of 74 labs that can run a test for orthopoxviruses, and they can process an estimated 7,000 tests per week. Monkeypox is the only orthopoxvirus of concern at the moment, since smallpox has been eradicated and other viruses in the family, like cowpox, are rare. If a sample tests positive for orthopoxvirus, the CDC will do further testing to confirm that it is monkeypox.

People with monkeypox (or orthopoxvirus that is suspected to be monkeypox) are supposed to isolate for 21 days, and in the meantime, health authorities will contact-trace, and offer vaccines to the affected person and their close contacts. There are also antivirals that may be helpful. But the vaccine brings another problem.

We have a vaccine, but we don’t know how well it works

The good news about the vaccine is that we already have one. More than one, actually: Smallpox vaccination dates back hundreds of years, with several modern vaccines still available. (Smallpox was declared to be eradicated worldwide in 1980, the only human virus to have that honor.) People could occasionally have fatal reactions to some of the older smallpox vaccines, so those—the ones that use live virus—aren’t being considered for monkeypox.

In the U.S., there is one vaccine that is licensed for use against monkeypox. It’s known as MVA (for Modified Vaccinia Ankara) and its brand name here is Jynneos. It doesn’t replicate in humans, but it does still trigger an immune response against smallpox. According to a 1988 study, vaccination is 85% effective against monkeypox transmission—but that was a small study and we don’t know if that’s the efficacy we can expect from the current vaccine and the current strain of monkeypox.

We also don’t know if we’ll have enough of it. The U.S. Strategic National Stockpile says they have 36,000 doses and have ordered 36,000 more. The company that makes the vaccine also has lots of recent orders from other countries, for obvious reasons, and they plan to ship out small batches to the various countries so that everybody can start vaccinating quickly.

That’s not enough vaccine to start vaccinating everybody, so the current strategy is “ring vaccination,” in which vaccine is offered to people who were close contacts of a person known to have monkeypox. (Monkeypox vaccine may also be given to the person with monkeypox, since it can reduce the severity of illness if caught early enough.) But contact tracing isn’t perfect, and in many recent cases, people didn’t have names or contact information for all their close contacts. Another possible strategy would be offering the vaccine to everybody in high-risk groups, which currently include men who have sex with men. So far, that strategy is only being tried in Canada.

People are already misunderstanding how it’s transmitted

Many of the recent cases have been in men who have sex with men. This has led to some people assuming that it’s sexually transmitted, like HIV or other STIs; I’ve already seen social media posts from people misunderstanding this and saying that you can only catch monkeypox from sex with somebody who has it.

Knowing that a virus is sexually transmitted is helpful to know if sexual transmission is the main way that virus spreads, like with HIV. But we know that monkeypox can spread with close contact of any kind, including contact with an infected person’s lesions, or with their respiratory droplets (like from a cough or sneeze) and possibly even with aerosols.

And on that note: The CDC briefly published a recommendation that travelers wear masks to avoid catching monkeypox, and then took down that recommendation saying that it “caused confusion.” Can monkeypox be airborne? Maybe! But if you’re concerned about catching a virus when you travel, you should be wearing a mask anyway. We already know that masks (especially well-fitting N95 style masks) are effective at protecting us against COVID, and COVID cases are on the upswing again—not that they ever went away. So, yes, wear a mask. But also be on the lookout for symptoms of monkeypox, and don’t be afraid to ask for a test or a vaccine if you think you have monkeypox or may have been exposed.

   



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CDC Says You Should Wear a Mask While Traveling—for Monkeypox

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A medical laboratory technician shows a test sample from someone suspected to have monkeypox.
Image: Pablo Blazquez Dominguez (Getty Images)

The Centers for Disease Control and Prevention is stepping up its guidance concerning monkeypox. While the risk of monkeypox is still thought to be low for the general public, the agency is now warning people to take more precautions while traveling. These precautions include avoiding contact with visibly sick people as well as wearing a mask.

The CDC changed its language over the weekend. As detailed in its travel notice concerning monkeypox, it now considers the situation to be a level 2 alert, which merits some enhanced precautions. The highest level is 3, which recommends against any non-essential travel to affected areas.

Monkeypox is thought to be native to rodents, and up until recently, it has only occasionally caused human outbreaks in parts of Africa where it may be endemic. This year, however, there have been around 1,000 cases confirmed or suspected in more than two dozen countries, including the United States. Many of these cases have had recent no travel history to Africa, suggesting that the virus is spreading locally between people.

The CDC is now cautioning travelers to avoid close contact with sick people, particularly those with skin lesions or genital lesions—monkeypox’s most distinctive symptom, along with flu-like illness. People should also avoid contact with dead or wild animals, including rodents; they should avoid eating so-called bushmeat or products made from wild animals in Africa; and they should avoid touching or sharing materials that may have been contaminated by infected individuals, such as bedsheets. Lastly, the CDC is now recommending travelers to mask up, noting that “wearing a mask can help protect you from many diseases, including monkeypox.”

Early investigations have found that many infected individuals may have caught it while having sex, though the exact mechanism of transmission is not yet clear. It may be spreading through close contact with an infected person’s rashes, for instance, but it could theoretically be spreading through infected semen as well. Many outbreaks have been linked to men who have sex with men, but the risk of sexual transmission isn’t exclusive to these individuals. And despite close contact being the presumed route of transmission for most cases, lab studies have suggested that the virus can spread through droplets or aerosols as well.

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Last week, new evidence surfaced suggesting that the virus has been circulating outside of Africa some time before these latest outbreaks became noticed. And while efforts are ongoing to trace the outbreaks and limit further spread, experts have warned that it may be not possible to stop the virus from establishing itself in new parts of the world. At the same time, monkeypox is considerably less contagious than covid-19, the other most recent illness to warrant widespread travel precautions, and there are effective vaccines and treatments available for it.

For those wondering, the CDC does still advise travelers to consider precautions—including mask-wearing—when traveling to countries with moderate-to-high levels of covid-19 transmission.

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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.
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 begun 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 U.S., 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 aren’t 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.
Photo: Cynthia S. Goldsmith, Russell Regner/CDC via AP (AP)

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Some researchers have been able to genetically sequence samples of the virus collected from patients. These 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 doesn’t 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.

“In the past, human to human spread has occurred but has been quite limited. We don’t know that it is spreading more easily from person to person yet. That is one possible explanation, but I am not aware of any evidence to support that idea yet,” Andrew Pavia, an infectious disease doctor at the University of Utah, told Gizmodo last week.

If the virus hasn’t changed intrinsically, then these outbreaks may be the result of other factors, including how it’s 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 wouldn’t mean that gay or bisexual men are the only people at risk, since the virus can spread through direct contact between any sexual partners. It’s also possible that these cases were first found simply because these individuals tend to be more cognizant about the risk of sexually transmitted infections in general and are more likely to regularly see a doctor as a result. On Tuesday, popular dating app Grindr sent out an alert about monkeypox to its users, advising them to seek medical help if they or a recent sexual partner develop unusual sores or rashes.

Other experts have argued that the virus may be spreading more now because of declining immunity to the related smallpox virus, following its eradication in 1980. Poxviruses often cause cross-immunity to other poxviruses, but this protection has faded over time in the general population for various reasons, according to Jo Walker, an infectious disease epidemiologist and modeler at the Yale School of Public Health.

“This ‘declining immunity’ is less due to waning immunity at the individual level, and more due to people with immunity dying, and people without immunity being born and then staying non-immune,” Walker told Gizmodo last week.

The risk of monkeypox to the general public is still considered to be low. And for now, Pavia says, there is no reason to panic or for most people to have any worries. “But it is early days, so that may change,” he noted.

Indeed, 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.

This article has been updated with comments from Andrew Pavia and Jo Walker.

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Where They Are and What We Know So Far

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Electron microscope image of monkeypox viral particles.
Image: Cynthia S. Goldsmith, Russell Regner/CDC via AP (AP)

Outbreaks of a seldom-seen disease called monkeypox are setting public health experts on edge. Several countries, including the U.S., have reported cases of the viral infection recently. No deaths are reported so far. Though the risk appears to be low to the general public for now, it’s possible something has changed about the virus or its relationship to humans that’s making it more transmissible than before.

Countries with reported monkeypox cases

As of Thursday afternoon, the UK, Canada, Spain, Portugal, Italy, Sweden, and the U.S. have documented cases of monkeypox. The U.S. case involves a Massachusetts resident who recently traveled from Canada, where there have been 13 suspected cases. In the UK, at least seven people are thought to have come down with it, with the first reported case believed to have contracted it while in Nigeria.

Monkeypox was first documented in Africa in the 1970s, and it’s been occasionally spotted on the continent since then. But it’s a zoonotic disease, meaning that infections are usually transmitted from animals to humans (despite the name, rodents are thought to be the primary vector) rather than between people. So these multiple outbreaks in several countries, with evidence of local transmission in some, are very different from what we’ve seen before, according to Andrew Pavia, an infectious disease doctor at the University of Utah. But there’s no clear answer yet as to why this is happening, he adds.

“In the past, human to human spread has occurred but has been quite limited. We don’t know that it is spreading more easily from person to person yet. That is one possible explanation, but I am not aware of any evidence to support that idea yet,” Pavia told Gizmodo in an email.

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What is monkeypox virus?

Monkeypox is caused by its namesake virus, a member of the poxvirus family. It’s a close cousin to the smallpox virus, the only human germ so far to be fully eradicated. Like smallpox, monkeypox infection causes distinct bumpy rashes that usually start in the face and spread throughout the body, along with flu-like symptoms.

It takes one to three weeks following exposure for symptoms to begin, and people are usually sick for about two weeks. As many as 10% of victims can die from it, though the cases documented in the UK appear to be caused by a lineage of the virus known to be less virulent, with a fatality rate closer to 1%.

There are available tools against monkeypox that we could use if these outbreaks expand to become a greater threat. Smallpox vaccines should remain protective against monkeypox and can be given after exposure to prevent illness, so they can be used as a part of a “ring-vaccination” strategy to short-circuit outbreaks. There are approved antivirals that have shown effectiveness against poxvirus infections, as well.

Why is monkeypox spreading now?

It’s plausible that the virus has evolved in some way to make it more inherently contagious between people. But some scientists like Jo Walker, an infectious disease epidemiologist and modeler at the Yale School of Public Health, have speculated that this seemingly increased spread could actually be related to our victory over smallpox decades ago.

Smallpox was declared eradicated in 1980, through the efforts of a global mass vaccination program that created a wide net of population immunity. Poxviruses are known for causing cross-immunity to other related viruses (indeed, the weakened virus in the classic smallpox vaccine isn’t even smallpox). And this buffer of smallpox immunity may also have hampered monkeypox from spreading in humans. As time has gone by, though, our collective protection has waned over time for various reasons, perhaps allowing monkeypox to finally spread more widely, without needing to change in any important way.

A patient with monkeypox lesions.
Image: CDC (Getty Images)

“This ‘declining immunity’ is less due to waning immunity at the individual level, and more due to people with immunity dying, and people without immunity being born and then staying non-immune,” Walker told Gizmodo in a Twitter message.

Walker notes that some researchers have long warned about monkeypox or similar viruses someday filling in the niche left behind by smallpox, and some have argued that it’s a major factor in why the germ made a reappearance in Nigeria starting in 2017, following four decades of zero reported cases.

Another possibility Pavia brings up is that some mystery animal has played an outsized role in seeding these outbreaks. In 2003, he points out, the largest known but still small outbreak of monkeypox in the U.S. (47 cases in total) was traced back entirely to contact with infected pet prairie dogs—an unknown vector back then.

At the same time, there is evidence of human-to-human transmission in at least some of these cases. In the UK and Spain, the majority of cases have been found in young gay and bisexual men, raising the possibility that these infections were sexually transmitted. Other research has suggested that monkeypox can theoretically survive in the environment in aerosol particles intact enough to be considered airborne.

Getting to the bottom of this monkeypox mystery will require classic medical detective work, Pavia said. Epidemiologic investigations will try to figure out the type of contact that resulted in people’s infections and the number of infections that seem to spring up from each index case. In the lab, scientists will be looking for possibly relevant genetic changes in the virus samples taken from patients, or testing out whether these infections behave differently in model animals.

“Given what we know today, there is no reason to panic or for most people to have any worries, but it is early days, so that may change,” Pavia said.



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FBI, CDC Investigating Vials Labeled ‘Smallpox’ Found in Lab Freezer

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A vial of dried smallpox vaccination is shown December 5, 2002 in Altamonte Springs, Florida.
Image: Scott A. Miller (Getty Images)

A scenario ripe for a zombie-horror movie has just happened. The U.S. Centers for Disease Control and Prevention revealed Tuesday that vials labeled “smallpox”—an extremely deadly virus that was eradicated in the 1970s—were found at a vaccine research facility in Pennsylvania. Despite the scary find, officials say there is no evidence that anyone’s been exposed to the pathogen.

According to the CDC, the frozen vials were found by a lab worker as they were cleaning out a freezer. The vials don’t appear to have been opened, and the worker was wearing gloves and a face mask at the time of the discovery. The facility is one of many that conduct vaccine research for the CDC.

“There is no indication that anyone has been exposed to the small number of frozen vials,” the CDC said in a statement to CNN. “CDC, its Administration partners, and law enforcement are investigating the matter and the vials’ contents appear intact.”

The CDC will transport the vials to another location for testing on Wednesday, Yahoo News reported, citing an alert sent to Department of Homeland Security leadership. According to the DHS alert seen by Yahoo News, there were 15 vials; five were labeled “smallpox” and 10 were labeled “vaccinia.”

Smallpox, named for the characteristic pockmarks it causes on the skin, is one of the more fearsome germs that has plagued humanity. It’s been responsible for countless epidemics and is estimated to have killed 300 million people in the 20th century alone. However, the virus was also the first to be beaten back through vaccination, when the technique of inoculation was improved and popularized by Edward Jenner in the late 18th century. The disease was finally eradicated worldwide in 1977, a feat aided by the fact that humans are the only known natural host of smallpox.

Though smallpox is (probably) gone from the wild, there do remain legally allowed samples of the virus at select labs in the U.S. and Russia—a decision that’s earned a fair share of controversy. In recent years, there have been discoveries of undocumented smallpox, such as when workers at the National Institutes of Health found six vials preserved from the 1950s during a move. Two of these vials were later shown to contain viable virus, though no cases of smallpox occurred as a result.

As scary as an accidental release of smallpox would be, there are smallpox vaccines available, though they’re only given to people who could be at risk of exposure, such as certain lab workers. Today, Americans are no longer routinely vaccinated against smallpox. In 2018, the Food and Drug approved the drug tecovirimat as the first antiviral specifically meant to treat smallpox, based on data from tests in the lab on smallpox and its cousins.

There are occasional cases of other related diseases in the U.S., such as monkeypox and Alaskapox, though none of these are as serious or prevalent as smallpox was in its heyday.

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