Butler County recorded its first official monkeypox case this week as the virus gradually spreads into new parts of the country.
As of Friday, the CDC said there have been over 10,000 cases in the U.S. and 78 in the state since the virus began spreading in May of this year. In Ohio, the spread of the virus has mostly been contained to in-and-around Cleveland, Columbus and Cincinnati.
Erin Smiley, the health promotion director for the Butler County General Health District, said the county’s one confirmed case shouldn’t cause anyone to panic, but that residents should be aware of the virus, what it is, and how it spreads.
According to Smiley, the virus that causes monkeypox is in the same family as the virus that caused smallpox. The CDC said monkeypox has been observed for decades and was first discovered in lab monkeys over a decade before its first human infection was recorded in 1970.
Generally, there had not been community spread of the virus outside of Africa until this year. But now, in the months since May, the virus has been found across the world. According to the CDC, of the 89 countries to report a monkeypox case, 82 of those countries have never had a case before this year.
Although monkeypox is in the same family as smallpox, it’s a much more mild disease, Smiley said. Smallpox, which is now eradicated through the use of vaccines, had once killed as many as three of every 10 people to contract the virus, according to the CDC.
“Monkeypox symptoms are similar to smallpox but usually are very mild compared to smallpox, and monkeypox is very, very rarely fatal,” Smiley said. CDC data shows that of the nearly 37,000 reported worldwide cases, there have been 12 reported deaths.
Smiley said most folks who contract monkeypox will develop blisters or a rash.
“A majority of folks that get [monkeypox] will have some sort of sign, even if it’s just one pimple or one blister,” Smiley said. Sometimes, Smiley added, people can develop flu-like symptoms from the virus too.
Blisters and rashes can present anywhere on the body, but specific areas including hands, feet, arms, and genitalia seem to be the most common places for the rashes to begin.
“[The blisters] can be very painful. That is generally what most folks say about the virus, if they have it,” Smiley said. “It’s not a comfortable infection or disease to get, and severe cases can be extremely painful.”
The virus spreads either through “prolonged, close, skin-to-skin contact” or through near-proximity respiratory droplets, Smiley said.
Which is to say, people are most likely to contract monkeypox if they come into contact with an open blister or ingest an amount of respiratory droplets from someone with the virus.
“It’s not just a touch and that’s it,” Smiley said. “For most cases, there has to be that prolonged duration.”
Once the monkeypox virus gets on someone’s skin, it then has to enter the body in some way — it could be via open cuts, it could be someone touching their face and the virus coming in contact with their eyes, mouth, etc. — in order for the virus to actually transmit.
Generally, this has been occurring overwhelmingly often in LGBTQIA+ communities, specifically spreading most often from men who have sex with men.
An early study of cases from published this July in the New England Journal of Medicine showed that of the 528 studied cases, 98% of the infected individuals were gay or bisexual men.
“Right now, a majority of the cases in the US are within the queer community, specifically men who have sex with men,” Smiley said, “but, that doesn’t mean that it’s going to stay within that priority population.”
Smiley said it’s important to note that monkeypox is not a sexually transmitted infection, according to public health officials.
“It is not — and we need to avoid categorizing it as — a sexually transmitted infection,” Smiley said. “We really don’t know if the virus has shown up in any semen or any vaginal fluid, so for that reason we want to really avoid putting it in the camp with STIs.”
In actuality, sexual acts provide perfect conditions for monkeypox to spread: close contact, prolonged contact, with open lesions being less likely to be covered.
A less likely scenario, but still feasible, would be getting monkeypox from touching cloth of some sort — towels, bedding, or clothes. This spread, Smiley said, would be unlikely unless you are actively around someone who already has the virus.
“Anyone who has monkeypox should be aware that they should be the ones handling their own clothing, bedding, etc.,” Smiley said.
Regarding Butler County’s first monkeypox case, there are positive signs: Smiley said the case had a clear “epidemiological link.”
“That person traveled somewhere where there was a current outbreak, and then they came back to where they live, and then started having symptoms,” Smiley said.
“What that tells us is, right now, we are not seeing community spread in Butler County. If that person had zero link epidemiologically, then there would be more reason for the general public to be concerned.”
Given the lack of community spread here in the county, the overall risk of contracting monkeypox is inherently slimmer than it is in places where monkeypox is being transmitted from resident-to-resident.
But, of course, if more folks were to come back from places with community spread and bring monkeypox with them, it would increase the chance of community spread here in the county.
Right now, the Butler County General Health District is promoting the messaging that each county resident is at risk of contracting the virus, independent of sexual preference. But, at the same time, the district understands that men who have sex with other men are overwhelmingly more likely to get monkeypox, as things stand.
“It is predominantly impacting men that have sex with men right now,” Smiley said. “Overall, the general population should be aware but not panic, and be aware of what someone’s risk is.”
Smiley said that certain behaviors have higher risk than others.
“The key is that prolonged exposure,” Smiley said. “If someone is being intimate with others — hugging, cuddling, kissing, sex — those are high risk behaviors that [make] transmission more probable.”
The health district’s main message? “Don’t panic. Learn about what monkeypox is and how it’s transmitted,” Smiley said.
“The second thing is to identify what your risk is,” Smiley said. “If you are a man that is having sex with other men, you’re gonna have a higher risk level right now.”
If that’s the case, Smiley suggests having conversations about the virus before engaging with new sexual partners — in a similar way that public health officials recommend an open dialogue about STIs with new sexual partners.
If someone contracts the virus, they might find themselves in isolation for a month as their blisters heal, Smiley said. A monkeypox patient is considered transmissible until their blisters are fully healed — scabbed-over blisters reduces the risk of spread but doesn’t eliminate it.
Because monkeypox has been around for decades, the health community has a leg up on fighting its sudden surge.
“We already have a vaccine, we already have therapeutics. The challenging part right now is identifying the contacts and getting the message to the folks who are at the highest risk,” Smiley said.
In Ohio, a limited supply of vaccinations are being offered to those in high-risk groups who live nearby the areas with the most cases, mainly focused around Cleveland, Columbus and Cincinnati.
As more vaccines become available, Smiley said, more folks will be able to get vaccinated, should they want to.
“Even though we’re focusing within the queer community, a month or two from now, it might be more open to other folks down the line,” Smiley said. Especially, she added, if monkeypox begins spreading across boundaries of sexual preference.
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