As monkeypox outbreaks continue to spread throughout the country, Washington University’s medical professionals and administrators are preparing for potential infection on campus. 

On July 23, the World Health Organization declared monkeypox to be a public health emergency in the United States, roughly two months after the first confirmed case on May 18. Since then, over 21,000 cases of the disease have been confirmed nationwide, the most of any country globally, and two individuals have died from contracting it. Locally, there have been 14 confirmed cases in St. Louis County and 17 in the City of St. Louis. There have been no confirmed cases directly among faculty, staff, and students in the University community.

BACKGROUND

Monkeypox is a viral disease that was first discovered in 1958 and falls into the same category as smallpox. While it is rarely fatal, with the CDC reporting that 99% of those infected have survived, individuals with weakened immune systems and other at-risk groups are more likely to become seriously ill. 

Dr. Rachel Presti, who serves as the Medical Director of the Infectious Disease Clinical Research Unit for the University, emphasized that monkeypox is not nearly as infectious as COVID-19. Ten of the confirmed cases within St. Louis County have been treated at the Infectious Disease (ID) Clinic, with a couple resulting in hospitalization and none resulting in death.

SPREAD 

The disease spreads through respiratory transmission, like the sharing of saliva, or direct physical contact with physical symptoms such as rashes, lesions, sores, and scabs. As such, those who have become infected with monkeypox having primarily contracted it through intimate contact, such as kissing, cuddling, or sexual activity. 

Dr. Presti stated that social scenarios like parties are less likely to spread the disease due to a lower degree of exposure, however, any direct contact with monkeypox lesions can lead to infection. 

CONTINGENCY PLANS

Although there have been no positive cases on campus, the Habif Center for Health and Wellness has been working with local public health entities to create contingency plans if an infection occurs.

If a student tests positive, the University will notify the St. Louis Public Health department in order to carry out contact tracing and treat the patient in collaboration with infectious disease experts in the medical department. Individuals who have contracted monkeypox would be quarantined in isolation housing, distinct from COVID-19 emergency housing, until they are no longer contagious. 

According to the CDC, individuals can still be contagious as long as they have either lesions or scabs, which can last two to four weeks.

“Usually it’s at least fourteen days before all of the lesions crust and scab,” Dr. Presti said. “Then the scabs fall off and they heal, when all of those are resolved, that’s when you would be considered not infectious anymore.”

The isolation period can extend into a month, requiring much more time in isolation housing compared to COVID-19, which could pose an issue with students attending class and staying current on their work.

Cheri LeBlanc, Director of Student Health and Wellness, emphasized that the University understands the resources necessary for longer-term quarantine housing. 

“We have discussed the potential need for prolonged isolation with our colleagues in Dining and ResLife,” LeBlanc wrote. “They are prepared to support students in isolation if necessary.”

TESTING

Monkeypox tests are available through Habif for community members who have been exposed or are presenting with symptoms. However, unlike a COVID-19 test, samples must be sent off-campus to be analyzed, so the process of receiving results is longer, roughly a week. 

“The biggest concern would be making sure people had information about what to look for,” said Dr. Presti. “If they did have any symptoms that were consistent they would get rapid medical evaluation and testing so that we could quarantine people quickly.”

Illustration by Adel Cynolter

VACCINE

The federal government has begun to distribute monkeypox vaccines through local public health departments, which has allowed the ID Clinic to vaccine members of the community who have been exposed to the disease or who are considered “at-risk.”

Dr. Presti stated that, in this specific outbreak, at-risk populations have generally been men who have sex with men, as 99% of current cases have been found in men, 94% of whom reported recent male-to-male sexual or close intimate contact. 

As part of a statement about the stigma surrounding monkeypox and sexual orientation, Washington University’s Pride Alliance emphasized the importance of getting vaccinated if eligible.

“Washington University and the US government must do more to expand access to vaccines for students,” the statement reads. “Our community should remember that any person can contract monkeypox, not just LGBTQ+ individuals. To combat the spread, we should encourage vaccinations, extend resources to access vaccination sites, and push the government to increase investment in securing additional vaccine doses.”

LeBlanc stated that health information is kept in extremely strict confidence by Habif.

“Only those who need to know the identity of someone in order to support them during isolation would be notified,” LeBlanc wrote. “And they would also be reminded of the importance of confidentiality.”

STIGMA

Although the primary demographic currently contracting monkeypox is men who have sex with men, people of other gender and sexual identities have been infected, and anyone could potentially contract it.

The Habif page for monkeypox information states that “transmission is a function of behavior, not identities.”

Pride Alliance echoed this point in their statement. 

“The rapid spread of monkeypox amongst men who have sex with men is similar to the start of the AIDS epidemic,” the statement reads, “when our community was disproportionately vulnerable to contracting the disease. Much like AIDS, a large LGBTQ+ patient base does not make monkeypox a “gay disease” and we want to avoid generating stigma. Labeling a disease as “gay” can lead to feelings of shame or disgust around accepting care as well as an increase in harmful language and actions towards those who contract the disease.” 

LeBlanc emphasized that anyone who has been in close contact with an infected individual can be at risk.

“The key here is to be sure those most impacted by this outbreak have improved access to information, vaccines, testing, and treatment,” LeBlanc wrote, “while taking care not to use language that could perpetuate stigma.”