While you may be worn down by pandemic life and the merry-go-round of rising cases and new COVID-19 variants, a new concern is brewing locally: monkeypox. 

In a few months, the monkeypox virus went from a handful of reported cases in the United States to a public health emergency of international concern. Prior to the 2022 outbreak, monkeypox was reported in several central and western African countries and almost all cases outside of Africa were linked to international travel to places where the virus is common.

Allegheny County health officials reported that 29 monkeypox cases have been detected locally between June 26 and Aug. 1.

Health officials maintain the monkeypox outbreak differs from COVID-19 because of its slower transmission and lower fatality rate.

Monkeypox can begin with a fever, exhaustion, headache, muscle aches, backaches or swollen lymph nodes. A few days after symptoms begin, a painful rash or skin lesions may develop on the face or other parts of the body. Sometimes people may develop a rash first. There have been no monkeypox virus deaths reported in the U.S. 

The World Health Organization [WHO], which declared a public health emergency on July 27, said 99% of U.S. cases are related to male-to-male sexual contact. Public health experts continue to stress that anyone can get the virus. 

There have been concerns about misinformation leading to the possible stigmatization of gay and bisexual people due to messaging about who is impacted most by the virus. There has also been criticism about the name of the disease (its origins are rooted in racist stereotypes). 

Some infectious disease experts and other medical professionals worry the overemphasis on men who have sex with men may lead clinicians to dismiss the signs of monkeypox seen in others. There have been two reported cases of U.S. kids with monkeypox. For some, it’s a pattern reminiscent of the early days of COVID-19 when tests were mostly only available if you had recently traveled to Wuhan, China.

As cases continue to rise locally, PublicSource spoke with Dr. Debra Bogen, the county’s health director, and Dr. Barbara Nightingale, head of the county’s clinical services who has been coordinating the monkeypox testing and vaccine efforts. 

(To stay updated on Allegheny County monkeypox cases, visit the county’s confirmed case count tracker.)

(Here’s what to do if you think you have monkeypox.)

How is monkeypox developing locally and how are you anticipating those case numbers to move?  

“The numbers are continuing to increase,” Nightingale said. “They have not plateaued off yet. So I think we’re definitely going to expect that the numbers are going to continually, slowly increase as they have been. I wouldn’t expect a rapid increase in the numbers overnight just based on the way that monkeypox is transmitted from person to person and the amount of time it takes for the virus to get into a person’s body and actually become infected. It’s a slow transmission.”

Do we get the sense that the current case count is accurate or possibly an undercount? 

“It’s an undercount just because some people don’t know that they have the virus and so they’re not going to get testing,” said Nightingale. “It’s not as much that they don’t have the access to the testing. They may just not recognize it and go get the testing. Some individuals in the current outbreak really just have pretty mild symptoms, so they might not recognize it enough or be bothered enough. So I’m sure to some degree that’s there.”

Can I get monkeypox? Who can get monkeypox? 

“In general, anybody can get it,” Nightingale said. “So it is not confined within one type of group of individuals by any means.”

How can I become infected with monkeypox?

Monkeypox and smallpox are essentially cousins, but monkeypox is milder and rarely fatal. People can be infected with monkeypox if they come into extended contact with sores, scabs or body fluids of someone with the virus. While most infections have occurred through close, intimate situations, such as cuddling, kissing and sexual contact, there are other avenues for infection, such as by encountering contaminated materials, such as clothing, bedding and other linens used by an infected person.

Scientists who studied rooms hospitalizing monkeypox patients found the highest viral loads on bathroom surfaces and cabinet door handles.

People can also get monkeypox from infected animals, through scratches, bites or eating meat, or using products from an infected animal.

Scientists are still researching if the virus can be spread by someone without symptoms.

Is monkeypox an STD or STI?

“It is not an STD, no,” Nightingale said. “Can it be traveled through behavior that’s associated with sex? Yes. … But in itself, it is not a sexually transmitted disease. So it’s from contact with the lesions itself, which is any direct contact with the lesions.”

What is the concern at this point about kids contracting monkeypox?

Bogen said much of our understanding of the risk to kids is based on experience with the African version of the virus.

Nightingale added: “I think the concern is a legitimate concern just because kids younger than 8 are at high risk for more severe disease, so we definitely want to be mindful of that age group,” Nightingale said. “If you’re in direct contact, sort of prolonged contact with someone who has monkeypox, kids could be getting it.”

She continued: “We haven’t seen any kids with monkeypox in Allegheny County.”

What are the symptoms of monkeypox?

Monkeypox symptoms include chills, fever, headache, muscle aches, exhaustion and swollen lymph nodes. A rash – which can look like pimples or blisters and may be painful or itchy – usually follows a few days after initial symptoms begin. Over the course of two to four weeks, the lesions usually go through multiple stages then crust and fall off.

How deadly is monkeypox? 

Nightingale said of the two monkeypox virus strains that exist, “this current outbreak that’s affecting the United States is much less lethal than other strains.” The estimation of fatal cases is around 1% with the current strain, she said, with expectations that would drop over time. The WHO says the monkeypox case fatality rate in recent times has been about 3% to 6%.

The CDC says “over 99% of people who get this form of the disease are likely to survive.”

However, people with a weakened immune system or a history of eczema, people who are pregnant or breastfeeding, and kids under 8 may be more likely to get seriously ill or die.

How can I get tested for monkeypox?

Tests for monkeypox are available at the county’s health clinic and throughout the county, with more sites expected in the coming weeks. People with health insurance who want to be tested should contact their primary care provider to make an appointment, especially if they have flu-like symptoms, a new rash or sores, or if they’ve been in close contact with an infected person. 

Free testing is also available for people without insurance at the county’s public health clinic at 1908 Wylie Ave. 

Can I get vaccinated for monkeypox?

Monkeypox vaccines are available throughout Allegheny County. Availability of the JYNNEOS vaccine – one of two monkeypox vaccines – recently expanded through several community health providers.

The vaccine is being offered to those who have been identified as positive with the virus or having a high-risk exposure to a person who has been diagnosed with monkeypox. Vaccine eligibility is on a case-by-case basis once someone is identified as having close or confirmed contact with a monkeypox-positive person.

“The vaccine can prevent disease if given within four days of exposure to the virus. In some circumstances, the vaccine may be offered after four days in discussion with a vaccine provider,” said ACHD medical epidemiologist Dr. Kristen Mertz, in a press release.

An antiviral medicine called Tecovirimat is used to help treat positive patients but is prescribed under limited circumstances because it’s not FDA-approved for monkeypox. The medicine is also a treatment for smallpox. 

What is vaccine availability like locally?

“At this point, we have enough vaccine to be able to vaccinate people that we can identify that have been at high risk of being exposed, someone that has been in contact with someone who has diagnosed or presumed monkeypox,” said Nightingale, who mentioned the county has also vaccinated a few people who were at risk and “one step removed from a direct exposure.” 

“We’re not at the stage right now, because of the limitations in the amount of vaccine, that we can give people vaccine in order to prevent potential exposure,” she said. She anticipates the county will be able to provide preventative vaccinations within the next month, but right now the supply is for people “at highest risk in the county.”

What is monkeypox vaccine availability like in Allegheny County?

The county received four shipments of vaccines from the state department of health, with 1,422 total doses of the monkeypox vaccine, according to the health department’s spokesperson. The vaccines are being distributed to sites across the county that will provide them. 

What to do if you think you or someone you love has monkeypox:

  1. Symptom check: Do you have an unexplained rash, or are you matching these symptoms?
    1. Rash, fever, headache, chills, muscle aches, fatigue, swollen lymph nodes
    2. If so, avoid close contact with others.
  2. Look into testing: Call your primary care doctor or the Allegheny County Health Department at 412-687-ACHD (412-687-2243) to ask about testing and/or vaccine availability.
  3. Stay isolated until you receive test results and remain cautious and preventative until any rashes have healed and all scabs have fallen off. 

How can I prevent monkeypox?

The virus can survive on linens, clothing and surfaces. 

Avoid people, bedding and other linens or materials infected with the virus. Avoid skin-to-skin contact with someone with a rash. Use masks, gloves and other protective gear when caring for infected people. Wash your hands with soap and water. The CDC gives guidance on how to disinfect your home and infected linens safely.

TyLisa C. Johnson is the audience engagement editor for PublicSource. She can be reached at tylisa@publicsource.org or on Twitter at @tylisawrites.

The Jewish Healthcare Foundation has contributed funding to PublicSource’s healthcare reporting.

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TyLisa C. Johnson is the Audience Engagement Editor at PublicSource. She’s passionate about telling compelling human stories that intersect with complex issues affecting marginalized groups. Before joining...