Electron microscope image of monkeypox virions in a sample of human skin. Credit: Centers for Disease Control and Prevention

The number of reported monkeypox cases in this current outbreak has risen in an unprecedented manner in a short period of time, according to Dr. Irfan N. Hafiz, an infectious disease specialist and the chief medical officer at Northwestern Medicine’s Huntley, McHenry and Woodstock Hospitals.

Since early May, authorities have tracked over 16,000 cases globally and nearly 3,000 cases in the United States, including 238 in Illinois and three in Evanston as of Friday, July 22, according to the Illinois Department of Public Health. 

“The time to say that we can contain this – we’ve probably lost that window, to be honest,” Hafiz said in a phone interview with the RoundTable on Monday. “And therefore, we do need to make sure that we’re rapidly identifying cases when they occur, trying to make sure that we are providing immunizations to any person or groups of people that may be at risk so that we can further contain spread.”

Over the weekend, the World Health Organization declared the global outbreak of monkeypox cases a Public Health Emergency of International Concern, a designation that gives the agency more power to coordinate resources and combat the spread of the virus. 

Meanwhile, the New York City Department of Health and Mental Hygiene has reported more than 1,000 cases of monkeypox as of July 25. During an appearance on CNN Monday morning, U.S. Health and Human Services Secretary Xavier Becerra described his level of concern about the domestic outbreak of cases as a 10 out of 10 because public health officials have simply not dealt with a monkeypox emergency before. 

Thus far, the U.S. has seen very few hospitalizations and no reported deaths from monkeypox, but the illness can cause severe pain, difficulty eating or using the bathroom and potentially weeks of missed work, which can devastate individuals, families and communities.

Are there enough vaccines?

About 85% of the cases reported in Illinois have occurred in Chicago, but the entire state has only received some 5,000 vaccine doses at this point, which have mostly gone to Chicago.

Evanston has yet to receive any vaccine allocation, the city’s Health and Human Services Director Ike Ogbo told the RoundTable.

Last Thursday, July 21, Illinois Gov. J.B. Pritzker and Acting Illinois Department of Public Health Director Amaal Tokars also put out a statement calling on the U.S. Department of Health and Human Services and the U.S. Centers for Disease Control and Prevention to ramp up their monkeypox vaccine rollout and illness prevention efforts. 

“Despite our efforts in Illinois to limit the spread of this virus, we are experiencing a steady increase in cases,” Tokars said in the statement. “The best defense against this disease is the rapid distribution of effective vaccines. While we are grateful for all the federal support we have received to date, we urge the federal government to make every effort to the extent possible to streamline the process and ramp up deliveries of vaccines so they can be promptly administered to the population that is most at risk.”

The available vaccines against monkeypox are part of a national stockpile held by the military and the federal government in case of a smallpox bioterrorism event, according to Hafiz and IDPH.

The U.S. has also purchased more doses to supplement its existing supply, but authorities do not yet know when the vaccines will become widely available.

At the moment, the CDC only recommends vaccination for people who were in close contact with a known positive case or for people who have had multiple sexual partners recently and reside in a place with high community transmission of monkeypox. 

What is monkeypox?

Monkeypox, an illness that animals, especially rodents, can transmit to humans, begins with symptoms similar to flu. People who become infected typically experience fever, chills, body aches and lesions around the face and genitals. Health officials identified the first cases of monkeypox in humans in the 1960s and 1970s.

Human transmission of the monkeypox virus usually happens through prolonged skin-to-skin contact and exposure to the bodily fluids of someone infected.

So far, the vast majority of cases reported around the world in this particular outbreak have occurred in gay, bisexual and other men who have sex with men, but that phenomenon does not make monkeypox a sexually-transmitted disease, according to Northwestern Medicine’s Hafiz.

Anyone can still contract the virus through close contact with an individual carrying the disease. “It is still skin-to-skin close contact, which also happens to occur during sexual contact, as well, but it’s not exclusive to sexual contact,” Hafiz said. “So therefore, it’s not [a sexually transmitted disease], but it is a close contact disease transmission.”

One of the issues that could also contribute to more cases, according to Hafiz, is that most Americans are either not vaccinated against smallpox or have waning immunity. The smallpox vaccine could have offered some level of cross immunity to monkeypox, but routine vaccination against smallpox stopped in 1972 after the U.S. had not recorded a single case for a number of years. 

In an email to the RoundTable, Ogbo said Evanston’s health department will announce vaccine eligibility and a rollout plan once the city receives an allotment of doses. In the meantime, Ogbo and other local health officials have partnered with Howard Brown Health, a Chicago nonprofit specializing in LGBTQ+ health care, “to provide vaccinations and treatment to Evanston residents who meet the criteria,” he said. 

Moving forward, public health authorities have to do everything in their power to prevent monkeypox from becoming a stigmatized disease, especially due to the lesions it can cause, according to Hafiz. If monkeypox does gain a reputation as a social stigma, that could encourage people who become infected to not seek treatment or admit that they are sick, he said.

“Without vaccination and [with] the stigmatization of people – if they’re not coming forward – we can start to develop endemic pockets of disease that could go on for a very, very long time, and that is a concern,” Hafiz said. “We would not need reintroduction from the wild, from animals, because we’ve already created a means of circulating that [disease] among humans. We’re already kind of seeing that, but we need to stop that cycle before it becomes a long-term issue.” 

Duncan Agnew covers Evanston public schools, affordable housing, City Hall and more for the RoundTable. He also writes long-form investigations, features and the morning email newsletter three times a...