You Don’t Need To Worry About Monkeypox When You Travel

The U.S. has declared monkeypox a public health emergency. The U.S. is late and failing badly in its response to contain the virus. Our public health establishment hasn’t improved much since the start of Covid and that’s a very bad thing if we were to face an outbreak of a deadlier virus that spreads more easily.

Let’s be clear, just being around people probably isn’t going to give you monkeypox. It doesn’t appear to be airborne except in some very specific circumstances.

This is really important

Moneypox is "not known to linger in the air & is not transmitted during short periods of shared airspace"

"Long range (e.g., airborne) transmission of monkeypox has not been reported"


— Prof. Gavin Yamey MD MPH (@GYamey) August 2, 2022

In fact if someone in your household has monkeypox you probably will not get it. Estimates of household attack rate have ranged from 1% – 8% (outside of sexual contact). The CDC has been on a kick promoting that ‘anyone can get monkeypox’ and while that is technically true it is – at this point – highly misleading.

The virus could cross over into broader communities with an R0 > 1. It could mutuate. But for now transmission is limited to close contact with people who have it, and so far that’s meant mostly men having sex with men. Pointing to the existence of outlier cases doesn’t change the overall risk framework.

How likely is monkeypox to be transmitted in a household (not sexually)?

This systematic review estimated the secondary attack rates among unvaccinated household members to be ~8%.

This isn't nearly as effective a mode of transmission as sex.

— Céline Gounder, MD, ScM, FIDSA 🇺🇦 (@celinegounder) July 31, 2022

The Points Guy website published a FAQ about monkeypox raising all sorts of scare issues – picking up monkeypox from your airplane seat, from the hotel pool, or from the bed linens in your room. It correctly states each of these things is very low risk. In fact they are almost no risk for most people.

They include the question, should I get vaccinated, but the truth is there’s very little vaccine supply in part because the Department of Health and Human Services “failed early on to ask that bulk stocks of the vaccine it already owned be bottled for distribution” so the vaccine’s manufacturer “booked other clients.”

The government is now distributing about 1.1 million doses, less than a third of the 3.5 million that health officials now estimate are needed to fight the outbreak. It does not expect the next delivery, of half a million doses, until October. Most of the other 5.5 million doses the United States has ordered are not scheduled to be delivered until next year, according to the federal health agency.

Unfortunately the word ‘men’ does not appear in the piece. The word ‘gay’ appears only once in the text. So let’s be clear: if you are engaging in sex with men and you are not a woman, especially if you have multiple partners, you are at some risk and should try to get vaccinated. The people who are most at risk deserve to know, and the CDC has been very bad about straight talk and clear messaging here.

Here’s California’s data so far. Out of 786 cases only 11 have been hospitalized (under 2%) and no one has died. (HT: TheZvi)

Here’s how to think about monkeypox. If you have it you should isolate. Take precautions if engaging in close contact within high risk groups and absolutely get vaccinated if you can. But if you don’t have monkeypox and aren’t engaging in high risk activities with people who might have monkeypox then you don’t have to think much about it. That could change, it could cross over into other communities, and if that happens you should update your priors.

Right now I am taking zero precautions against monkeypox. I hope that doesn’t change. But any change that I make will be based on scientific evidence.

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