South Florida Sun-Sentinel (Sunday)
Monkeypox questions rolling in
Can I get it from a handshake? How about at the gym or from a chair?
The cases of monkeypox are multiplying in South Florida, with nearly 400 of them only two months after the area saw its first confirmed infection, a clear sign the virus is spreading fast.
On Thursday the U.S. declared monkeypox a national health emergency, signaling that the outbreak now represents a significant threat to Americans. The declaration will give federal agencies more power to direct money and resources to test, treat and vaccinate people for monkeypox.
As infections multiply in South Florida, the current outbreak has brought fear, and questions, about how monkeypox spreads within the community.
A couple from Wilton Manors wonders if they can get infected from a bar stool or cloth couch in their local lounge. A Boca Raton mother wants to know if her son can contract monkeypox during a wrestling match when the school year starts. And a Miami businessman wants to know if he should stop shaking hands, worried a simple handshake could put him at risk.
Here’s what is known and still unclear about how the current version of monkeypox is spreading, and some answers to questions on transmission.
Thus far, monkeypox cases are mostly among gay and bisexual men, but the virus can spread to anyone through close, often skin-to-skin contact with an infected person’s rash. It also can transmit by sharing clothing or sheets used by someone with a lesion or by respiratory droplets produced when an infected person is face to face in close proximity.
But in the same way much was unknown when the coronavi
rus first surfaced in 2020, researchers still are studying how monkeypox transmits because this outbreak is unlike any previously experienced globally.
No one knows for certain whether the virus can spread through semen and vaginal fluids or people can be contagious before they develop visible symptoms like a rash.
What is known is the closer you are and the longer you have interaction with someone with monkeypox, the more your risk of getting it. For example, extremely close contact like the kind that occurs during sex or cuddling, hugging or kissing puts you in a position to contract the virus from someone who has a lesion.
If you live with someone who has monkeypox and open lesions, you can get the virus from touching clothes, towels and bedding used by that person.
Shared utensils could also spread monkeypox because they may carry an infected person’s saliva.
Those two methods of contracting the virus are less common than through skinto-skin contact.
Can you get it from a handshake?
Dr. Aldo Calvo, medical director of the ambulatory division for Broward Health, said technically, you could.
“If you shake hands with someone who has an open lesion on their palm or even fist bump someone who has a lesion on their knuckles and you then touch your mouth or nose, you can definitely get it, which is why you want to continue handwashing,” he said.
However, if you shake hands with somebody who had monkeypox, and they don’t have any lesions on their hand, it would be extremely unlikely, he said. You need to be in contact with the virus.
It’s really more about prolonged skin-to-skin contact of 15 minutes or more that raises the chances of contracting monkeypox.
Dr. Zachary Henry, medical director of AIDS Healthcare Foundation in Fort Lauderdale, said in the Broward County cases he has seen over the last two months, all patients have contracted monkeypox through sexual contact or kissing.
“All reported some sort of sexual or intimate contact with someone within one month prior to the development of symptoms,” Henry said. “No one admitted to knowledge of the person having a rash. So this is about much more than shaking someone’s hand.”
Can you get it from a chair or couch?
Calvo said that scenario also is unlikely.
“If you sleep in the same bed as someone who has monkeypox for six to eight hours, it has more of a possibility to get on you,” he said. “Sitting on surface where an infected person sat does not have the same ability to infect you.”
Can you get it from trying on clothes or the handle of a shopping cart?
There’s little evidence to suggest that “incidental” contact frequently spreads the virus, Angela Rasmussen, a virologist at the University of Saskatchewan in Canada, told Time.com.
“You have to be exposed to enough virus to actually get infected with it,” she said.
Can you get monkeypox from sitting next to someone on a plane?
On its website the Centers for Disease Control and Prevention wants the public to know monkeypox is not airborne like COVID-19.
The CDC said, “Monkeypox is not known to linger in the air and is not transmitted during short periods of shared airspace.
“People who have monkeypox have traveled on airplanes, [but] no known cases of monkeypox occurred in people seated around them, even on long international flights.”
Can my child get it at school?
Five children in the U.S. have gotten monkeypox in recent weeks: two in California, two in Indiana and an infant who is not a U.S. resident who tested positive in Washington, D.C.
That’s concerning to parents because if children under 8 years of age get infected with monkeypox, they’re at an increased risk of developing severe illness.
CDC director Rochelle Walensky said the children’s cases “are traced back to individuals who come from the men-who-have-sex-with-men community.”
The CDC website says children who are close contacts of an infected person may be offered the Jynneos vaccine. While data is limited on how well the Jynneos vaccine works, there are no adverse events in children.
With children, symptoms start off just like other childhood viruses — fever, headache, muscle aches and fatigue, and then the rash usually follows up to three days later. If your child does get a rash, a pediatrician can test for monkeypox by swabbing the rash or pox.
How close do you need to be to get monkeypox through respiratory droplets?
When it comes to respiratory droplet transmission, close, sustained, face-toface contact within 6 feet can put you at risk. However, there have not been cases of people catching the virus just by being in the same room briefly as someone with monkeypox — which happens with COVID-19.
You will want to avoid attending crowded indoor parties, particularly raves, where men who have sex with men are in close contact for longer periods of time.
Can you still get monkeypox if you use a condom? Right now monkeypox is spreading mostly through sexual contact with infections clustered in sexual networks. Though monkeypox can be spread sexually, it is skinto-skin contact that is the primary mode — which is why it is not considered a sexually transmitted infection (STI).
So wearing a condom could help but it won’t protect you from rubbing up against lesions in other areas of a partner’s body.
The World Health Organization has recommended that gay and bisexual men limit their number of sexual partners to help slow the transmission of monkeypox.
Monkeypox cases seem to be all men, so can women get it?
All but 1% of U.S. monkeypox cases so far are people who were assigned male at birth, the Department of Health and Human Services said last week. Florida’s Surgeon General Joseph Ladapo said Wednesday the same statistics hold true in Florida.
The average U.S. monkeypox patient is around 35 years old, but people of all ages — and genders — could become infected. A simple swab of a lesion by a health care provider can test for monkeypox.
How bad is it if you get monkeypox? Can you die from it?
No one in the U.S. has died of monkeypox in this current outbreak.
But some patients suffer excruciating pain from the lesions caused by the virus and require hospitalization. The blisters usually scab or become crusty and then fall off, and could potentially leave scars on the skin.
People with monkeypox are contagious until the rash completely goes away, which could take as long as four weeks.
Is there a treatment that works?
First, there is prevention for anyone at risk of exposure or who recently came into contact with someone who is infected.
The FDA-approved vaccine Jynneos already is being given out in South Florida, but it’s currently in short supply in the United States. Now that the U.S. says monkeypox is a national health emergency, more resources will be given to get vaccines and treatments out faster.
Monkeypox typically goes away on its own, but doctors are prescribing patients Tecovirimat, also known as Tpoxx. The drug has not been approved for monkeypox, so the process of enrolling a patient in a realtime clinical trial has been cumbersome.
Henry said most of his patients who have received this drug have reported that it helped clear up their rash faster and reduce their pain substantially.
“I feel like it shortens the duration of the illness,” he said.