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UNC health experts explain the monkeypox outbreak

Student reviews monkeypox Frequently Asked Questions on UNC's Campus Health website on Aug. 13, 2022.

As monkeypox case numbers continue to rise in North Carolina, UNC is continuing research and taking action to flatten the curve.  

UNC is one of only three academic medical centers in the U.S. conducting monkeypox testing. According to Media Relations, Campus Health is prepared to identify symptoms and test when clinically indicated.

Although ​​Campus Health has been approved as a monkeypox vaccine provider by the North Carolina Department of Health and Human Services, they have not yet received any vaccine doses due to supply chain availability, per Media Relations. 

As a "think tank" and a medical epicenter,  Dr. David Wohl, a UNC professor of medicine in the Division of Infectious Diseases, thinks the University should look beyond the immediate threat and to the bigger picture. Wohl is familiar with epidemic crises, having researched treatments for Ebola and other diseases around the world. 

“I know we're reacting to monkeypox, but what's the next big thing that can happen ​​and where will it come from? And what can we do now to make that not happen as a University?” Dr. Wohl asks. 

What is monkeypox? 

Monkeypox was first recognized in 1958 in primates and is endemic to West and Central Africa, Dr. David Weber, a professor of medicine, pediatrics and epidemiology at UNC, said.

Previously, the disease was mostly observed sporadically, possibly mainly transmitting from animals to humans, Dr. Myron Cohen, a professor of medicine, microbiology and immunology and epidemiology at UNC, said.

Dr. Cohen said the virus spreads through close physical interaction with infected individuals, most often by prolonged skin-to-skin contact, commonly during sexual intercourse. However it is not a sexually transmitted disease. 

“You can get it through sex, but it's not the sex that's giving it to you — it's the skin-to-skin contact,” Dr. Weber said. 

Additional concerns have been raised about transmission via inanimate objects or through the air, but there isn't enough evidence to support this, Dr. Cohen said.

“The CDC is saying, 'We don't really understand the rules,' and UNC Hospitals is saying,  'We don't really understand the rules,'" Dr. Cohen said. "Therefore, we're going to use a lot of precautions to try to prevent further spread, and among those precautions, we're going to try and avoid contaminating inanimate objects with monkeypox.”

Monkeypox in the U.S.

According to the CDC, 99 percent of reported monkeypox cases in the U.S. occurred in men, 94 percent of whom reported recent male-to-male sexual or close intimate contact shortly before exhibiting symptoms. However, Dr. Wohlsaid he is confident the spread will start to be seen in other populations.

“I think it's foolish and narrow-minded to think that this is going to only be something that we see among men who have sex with men,” he said. “(Monkeypox) clearly will be spread through intimate and close contact. 

"That means that cis-women will get infected from men. This means that some women might transmit it to other women. This means that athletes might transmit it to each other. All that has to happen is the right pathways for the virus to find routes of transmission from person to person.”

Symptoms are seen within three weeks of exposure to the virus, including fever, chills, headache, muscle aches, fatigue, swollen lymph nodes, clear or pus-filled bumps and rashes. 

Dr. Weber said Campus Health faculty members are helping lead a soon-coming national clinical trial of Tecovirimat — a treatment drug for the monkeypox virus.

Handling the virus

Currently, vaccines are available to people with known or suspected exposure to monkeypox, as well as men who have sex with men or transgender individuals who have a history of multiple or anonymous sex partners. Certain health care workers designated by public health authorities are also eligible, according to Campus Health. 

Any person meeting one of the above eligibility criteria may call 919-560-9217 to request vaccination at the Durham County Department of Public Health.

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“We have a bunch of tools at our disposal and we're pretty prepared to recognize the infection and deal with the infection,” said Dr. Cohen. “We don't anticipate this is going to be common among college students; it's not our anticipation that this will become a common infection. And the way people can reduce their probability of infection is by judicious intimate behavior.”

Campus Health has also compiled a monkeypox FAQ with additional information about the virus.

Health officials and researchers have advocated for greater attention to the sources of these infections rather than their consequential “spillover events,” such as Ebola or monkeypox, Dr. Wohl said. 

“If more people were protected against monkeypox, we would never have an event like this where it's starting to spread across the world and causing all this issue,” he said. “So I think that as a University, we should realize we do have a global responsibility.”