The current monkeypox outbreak is moving faster than any in recent history, but Washington State University virologist Heather Koehler sees no reason for the rapid spread of the virus itself.
As an expert in virus-host interactions, Koehler is investigating the currently circulating strain of monkeypox, working to understand the genetics of the virus by studying its DNA sequence and protein structures.
“There are no new, large mutations that can explain the change in transmission,” Koehler said. “I am not an epidemiologist; I don’t want to predict how or where we should get vaccinated, but something doesn’t line up.”
Koehler said it could be that containment strategies aren’t being implemented properly or vigorously enough, or that infected people aren’t recognizing symptoms and seeking treatment early.
Previous outbreaks have been relatively small and quickly contained. This time, however, the virus has spread to more than 16,500 cases by the end of July, mostly in countries that historically have not had many reported cases of the virus.
However, little has changed in the monkeypox genome, Koehler said. While it’s possible that a small change could be driving the spread, researchers haven’t found any obvious changes that seem to have such a big impact. Analysis has shown there are fewer than 100 of more than 197,000 nucleotides, a type of DNA base pair, that are different in the current virus than in a smaller 2017 UK outbreak.
“It’s more or less the same virus,” he said.
Koehler studies virus-host interactions at the molecular level. She has been investigating how human proteins interact with proteins from the currently circulating strain of monkeypox that originates from West Africa.
That region is considered endemic for this monkeypox virus, which means that it has animal species that act as a reservoir for the zoonotic disease that can be transferred from animals to humans. It is not uncommon to find cases there. In the past, non-endemic countries have seen cases that were related to travel to endemic countries, non-traditional animal hosts, or person-to-person spread. This current outbreak, Koehler said, appears to rely primarily on person-to-person transmission.
The size of the current outbreak prompted the head of the World Health Organization to override an advisory panel on July 23 to declare monkeypox a global health emergency. On July 28, the White House announced the first phase of a national monkeypox vaccine strategy in the US, Koehler is pleased to see these urgent steps being taken.
“The widespread nature of this outbreak is unprecedented.”
Heather Koehler, virologist
Washington State University
“This is something that is spreading faster than any virologist would have predicted based on previous outbreaks that were quickly contained,” he said. “The widespread nature of this outbreak is unprecedented.”
There have been many situations in the past where people traveling to endemic regions come back with the disease, but by isolating and vaccinating people’s contacts it was contained. Many countries have stockpiles of the vaccine, including the US Centers for Disease Control and Prevention, which has distributed doses in hard-hit areas like King County in Washington state. However, the response has not been enough to stop the spread.
One problem could be that people don’t identify themselves as exposed to monkeypox, Koehler said. The disease has an incubation period, but people are not usually contagious until symptoms appear. Symptoms include fever, muscle fatigue, and severe headache, but skin lesions are a telltale sign of the virus.
“The lesions are quite characteristic or distinct. Not that there’s a lot of room for interpretation,” Koehler said. For example, monkeypox lesions can appear anywhere on the body, including the palms of the hands and the soles of the feet, unlike lesions from other diseases such as herpes or chicken pox.
Koehler also fears the misrepresentation that the disease is spread primarily by men who have sex with men is making the problem worse. Monkeypox can be spread through any type of close contact, including a handshake or hug. Recently, two cases have been identified in children, a worrying sign because children and pregnant women are among the most vulnerable to the worst effects of the disease.
There’s nothing about this virus that targets a particular community, Koehler said, noting that viruses sometimes show up in a particular community simply because it’s a close-knit group of people who interact regularly.
Koehler said the way some media outlets talk about monkeypox is not only biased and inaccurate, it could also prevent people from seeking medical attention.
“We shouldn’t put any kind of label on a disease that is spread by contact,” he said. “It doesn’t matter your sexual orientation; no matter what kind of physical compromise you have, if you have prolonged physical contact with an infected lesion, you have the ability to contract it.”