Biden administration officials Friday warned that the U.S. monkeypox outbreak has worsened, with at least 45 cases of the viral illness identified in 15 states and the District, up from 20 cases a week ago. But they stressed that the risk to the public remains low and that public health agencies have the tools necessary to protect people.
“We have tests for monkeypox. We have vaccines for monkeypox, and we have treatments for monkeypox,” Raj Panjabi, who leads the White House global health security efforts, said in a briefing. “We have a multipronged approach to deploy those tools to ensure we’re fighting this outbreak as effectively as possible.”
More than 1,300 cases of monkeypox have been detected around the globe, as the disease — which has repeatedly emerged in Central and West Africa in recent decades, but rarely spreads among humans — appears to be gaining a foothold in countries including Germany, Portugal and the United Kingdom. The current episode is likely to become the worst-ever monkeypox outbreak recorded in the United States, surpassing a 2003 outbreak in which 47 cases were confirmed or detected in six states, according to the Centers for Disease Control and Prevention.
But public health experts have stressed that monkeypox presents far less risk than the coronavirus pandemic, which has upended the world since 2020 and been linked to the deaths of more than 1 million Americans.
“My sense is that this isn’t going to be anything like what we have seen with covid. The general public does not need to get too worried about it at this point,” Don Milton, a University of Maryland environmental scientist who has advised the White House and others on combating the coronavirus pandemic, said in an interview.
“While [monkeypox] cases have continued to increase, I want to reemphasize that there have been no deaths yet associated with this outbreak,” CDC Director Rochelle Walensky said in Friday’s briefing. “While the overall risk of monkeypox in the United States public is currently low, we do want people to be aware of the signs and symptoms and just seek care right away if they think they might have monkeypox symptoms.”
Monkeypox symptoms frequently include fever, headache and lesions that can persist for weeks. While federal regulators have not approved specific treatments for monkeypox, officials said that treatments and vaccines prepared to fight smallpox — a closely related virus that presents more severe symptoms — are available through the Strategic National Stockpile.
“The [Strategic National Stockpile] holds enough vaccine … to vaccinate millions of Americans if needed,” said Dawn O’Connell, assistant secretary for preparedness and response at the Department of Health and Human Services. She said officials had more than 100 million doses of an older smallpox vaccine, ACAM2000, and about 72,000 doses of a newer smallpox vaccine that was also approved for monkeypox, Jynneos, in inventory. The stockpile also has reserves of antiviral treatments such as tecovirimat and cidofovir, officials said.
Federal officials said the monkeypox outbreak had been driven by Americans traveling abroad.
“I think that the majority of cases in the United States — so 75 percent or more — are still reporting an international travel exposure that likely resulted in their monkeypox infections,” said Jennifer McQuiston, incident manager for CDC’s monkeypox response.
A number of U.S. cases also have been linked to sexual contact, officials said, prompting them to warn about the risk that direct physical contact plays in spreading the virus.
But some experts have asked whether monkeypox also could be spreading through the air, echoing a debate that emerged early in the coronavirus outbreak. While CDC and other public health agencies initially said the coronavirus was not transmitted through the air, the agencies reversed themselves in 2021, and the Biden administration has increasingly warned that indoor air is a major driver of coronavirus infections.
CDC last week encouraged travelers to wear a mask as a precaution against contracting monkeypox but removed the recommendation this week, saying the guidance was unnecessary and leading to confusion.
Administration officials Friday said they had no reason to believe that monkeypox was spreading by air.
“When we consider airborne transmission at the CDC, we’re talking about small viral particles that become suspended in the air and can stay there for long periods of time,” Walensky said. “We have not seen documentation of that through our experience with this virus or with prior similar viruses.”
Outside experts such as Milton said they were critical of CDC’s decision to de-emphasize the possibility of airborne transmission for monkeypox, particularly because the World Health Organization has maintained that airborne spread could be possible.
“I really don’t understand it,” said Milton, citing evidence that smallpox has been transmitted by air. “If we don’t pay attention to the potential for short-range airborne transmission it could expand” the risk of who could contract monkeypox.