By Jyotsna Chawla, PhD, MS, MS

The World Health Organization has declared a global health emergency for mpox, formerly known as monkeypox. Florida is facing a formidable public health challenge, with more than 100 mpox cases reported this year, over half of which involve residents from South Florida. This rise in monkeypox cases mirrors a global trend, where increased international travel and close human contact are accelerating the virus’s spread across multiple counties.

Monkeypox: From Origins to Outbreaks

Monkeypox, often referred to as mpox, belongs to the Orthopoxvirus family, which also includes smallpox and cowpox viruses. The virus is divided into two main clades: Clade I, primarily found in Central Africa, is associated with more severe disease, and Clade II, more common in West Africa, typically causes less severe illness. The eradication of smallpox in 1980 was a monumental public health victory, but it left populations with waning immunity, creating an environment where monkeypox could thrive. Recent outbreaks, particularly involving the new Clade 1b variant, have demonstrated the virus’s ability to spread far and wide, challenging global health systems in a world that once believed smallpox was a thing of the past.

How Monkeypox Spreads and What to Watch For

Monkeypox is a zoonotic disease, meaning it can be transmitted from animals to humans. The virus spreads through direct contact with the bodily fluids, lesions, or respiratory droplets of an infected person, as well as through contaminated materials like bedding and clothing. Additionally, the virus can be transmitted from animals to humans through direct contact with the blood, bodily fluids, or skin lesions of infected animals.

The disease often begins with non-specific symptoms such as fever, headache, muscle aches, and fatigue. A unique feature of monkeypox is lymphadenopathy, or swollen lymph nodes, which distinguishes it from other similar viral infections. These early signs are soon followed by a rash that progresses through several stages: flat macules, raised papules, fluid-filled vesicles, and pus-filled pustules before finally crusting over. This progression usually takes 2 to 4 weeks. Recognizing these symptoms and understanding how monkeypox spreads are crucial for preventing further outbreaks.

Why Early Detection Matters

A timely and accurate diagnosis is crucial for controlling monkeypox outbreaks and stopping the virus. The PCR (polymerase chain reaction) test is the gold standard, detecting viral DNA from skin lesion samples with pinpoint accuracy. This test is vital for confirming cases early on. Although serological tests detect antibodies to the virus and can be useful for tracking the spread of monkeypox, they’re less effective for early diagnosis.

Vaccine Shortage: Creative Solutions for a Critical Issue

The shortage of the JYNNEOS mpox vaccine has put public health authorities in a tough spot. This non-replicating, live attenuated smallpox vaccine is highly effective against both smallpox and monkeypox, but high demand and limited production have led to a significant shortage. To tackle this issue, innovative strategies are being explored. One promising approach is intradermal administration, which allows up to five doses to be derived from a single subcutaneous dose. This method helps stretch limited supplies and ensures broader coverage, especially for high-risk groups.

Public Health Response: A Multi-Pronged Strategy

In response to the monkeypox outbreak, public health authorities in South Florida and beyond are implementing a comprehensive strategy. This includes increasing awareness among healthcare providers and the public, swiftly isolating confirmed or suspected cases, and intensifying targeted vaccination efforts. These vaccination campaigns focus on high-risk groups, including healthcare workers, individuals with known exposure, people with HIV who are immunocompromised, and children under the age of 1 year. Antiviral treatments like Tecovirimat (TPOXX) are also being considered for severe cases, particularly among immunocompromised individuals.

Community involvement is key to controlling the outbreak. Ongoing research, stronger surveillance, and equitable healthcare access are vital to prevent future crises. Together, we can build a more resilient future.

Dr. Jyotsna Chawla is Assistant Professor of Medical Microbiology, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University.