Monkeypox is in the news. Why are we talking about smallpox?

Why are we talking about smallpox again?

The virus is estimated to have killed more than 300 million people in the 20th century. But in 1980, thanks to a successful vaccination campaign, it was eradicated. Today, no one gets routine smallpox vaccinations for children because you can no longer catch it.

But the disease has returned to public consciousness because of monkeypox. In fact, monkeypox was discovered during the worldwide smallpox vaccination campaign. And the global eradication of smallpox may have created an opening for monkeypox, said Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital and dean of the National School of Tropical Medicine at Baylor College of Medicine

“Monkeypox is believed to have become more common after we stopped vaccinating populations against smallpox,” he said. “We pretty much slowed down or stopped the smallpox vaccination programs” — the last routine vaccinations were given in the US in the 1970s — “and that actually allowed monkeypox to appear in the human population because immunity waned.”

The first human case of monkeypox was recorded in 1970.

Both smallpox and monkeypox are caused by orthopoxviruses. Symptoms are similar, although monkeypox is rarely fatal. The diseases are so similar that the same vaccine is used for both: Jynneos. So the monkeypox vaccine is the smallpox vaccine; they are not different shots.

What if you had been vaccinated against smallpox before 1980? Georges Benjamin, executive director of the American Public Health Assn., said you probably would have some protection from monkeypox, but you should still get the Jynneos vaccine if you’re exposed or otherwise eligible.

“Unless you’ve recently been vaccinated against smallpox, like in the last two to three years, you most likely want to go ahead and get vaccinated if you’re exposed,” he said.

With cases of monkeypox on the rise in the United States, do we all need to get vaccinated against smallpox? At the moment it doesn’t look like that will be necessary.

It’s alarming to see another infectious disease gaining a foothold while we’re still trying to fight off COVID-19. But COVID and monkeypox are very different, said Anne Rimoin, a professor of epidemiology at the UCLA Fielding School of Public Health and a member of the World Health Organization’s Monkeypox Emergency Committee.

“I’ve been working on this virus for 20 years. It’s a virus that doesn’t spread as easily as something like SARS-CoV-2. The most efficient route of transmission is close, prolonged skin-to-skin contact,” she said.

SARS-CoV-2, the virus that causes COVID-19, was known as “the novel coronavirus” because we had never seen it before 2019. In monkeypox, “this is not a novel virus. This is a virus that we know,” Rimoin said.

You can already look at the data histories and see how different things are: The first case of monkeypox in the US was confirmed on May 18th. Cumulatively we had 7,083 cases, with 2,186 in the past seven days, and zero deaths. Four months after COVID-19 first appeared in the United States—late May 2020—we were averaging more than 20,000 new cases and approximately 1,000 deaths each day.

“Monkeypox can spread in a number of ways. It can spread through contaminated objects and respiratory secretions, but that’s really not what we see as the primary route of transmission in this outbreak. What we’re seeing is that the vast majority of cases are due to prolonged skin-to-skin contact, generally sex-related,” Rimoin said.

Right now, “the disease is really spreading through specific sexual and social networks,” Rimoin said. And outside of these communities – gay and bisexual men and transgender people – are currently at risk of catching monkeypox “is pretty low,” said Rimoin.

You must be at least 18 years old, a gay, bisexual or transgender male and meet at least one of the following criteria to be eligible for the vaccine:

  • You have had multiple sex partners, including (but not limited to) sex in exchange for food, shelter, or other goods or needs, in the past 14 days.
  • You are taking HIV PrEP medication.
  • You have had anonymous sex or sex with multiple people at a commercial sex venue or other location in the past 21 days.
  • You had high or moderate exposure to monkeypox (the CDC has a list of what counts as exposure at these levels).
  • You attended an event or venue where there was a high risk of exposure through skin contact or sexual contact with people with monkeypox.
  • They are homeless and behave risky.
  • You have had gonorrhea or early syphilis in the past 12 months.
  • You are in prison and have been classified as a high-risk patient by clinic staff.
  • You are severely immunocompromised – for example, you are undergoing chemotherapy, are taking high doses of steroids or other immunosuppressants, or have advanced or uncontrolled HIV infection.

The Los Angeles Department of Public Health provides a link to register for monkeypox vaccine appointments for eligible individuals. The list will be closed when there are no more places available. The district has a newsletter that will email you when spaces open.

If you think you’ve been exposed to monkeypox, contact your doctor, call 211, or visit a public sexual health clinic.

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