Monkeypox: What does the science say?

Monkeypox—it’s the latest virus to make headlines, but there’s still so much we don’t know about it. How contagious is it? Which public settings are most susceptible to community spread?

What is monkeypox?

Characterized by rash, lesions, and flu-like symptoms, monkeypox is of the same family as the smallpox virus and is endemic to central and west Africa. Patients can remain contagious for weeks or months, and as of August 25, there are over 46,000 global cases.

How transmissible is monkeypox?

The chances of contracting monekypox is low: averaging around 450 cases per day in the U.S. as of early August. In light of this, researchers suggest that cases will not reach Covid-level heights as the Coronavirus evolves quite differently than monkeypox. When it comes to propogation, the CDC lists three methods of spreading the virus:idirect skin-to-skin contact, contact with surfaces that have been used by someone with monkeypox, or contact with respiratory secretions. While the transmission rate is low, evidence suggests both behavioral and environmental risk are factors. In a recent study, investigators found live monkeypox virus on hard, non-porous surfaces 15 days after an infected person was present. Porous surfaces like fabrics and wood can harbor live viruses for even longer. 

As with any virus, the spread happens as a chain of events: the virus source, the exposure method, and the receptor. 

With monkeypox, the virus may be present, but that doesn’t mean it will spread as fast or efficiently as SARS-CoV-2. Monkeypox is primarily spread through surface and person-to-person contact, unlike SARS-CoV-2 which is primarily airborne. Monkeypox also differs from SARS-CoV-2 in the third stage of exposure; the receptor. When airborne, all that is needed for viral spread is to breathe in the virus. Monkeypox requires touch through open skin, lesions, or mucus contact.

Viral spread is more likely among young children who have frequent hand-to-mouth contact and share items with peers. While this may mean that exposure to the virus in more likely in places where young children interact, current data shows that a parent, caregiver, or older family member is usually the original source of the virus.

What is the environmental risk?

High-risk environments such as elementary schools, daycare centers and preschools, healthcare facilities treating monkeypox patients, and senior living facilities with immunocompromised residents should maintain thorough sanitation practices.

For example, families with children at an Illinois daycare were recently warned of possible exposure to monkeypox by local officials. According to experts, the virus replicates more rapidly in suppressed or juvenile immune systems, which can increase the number of viral particles in places where children and immunocompromised people are.

Monkeypox particles linger for a long time in infected individuals, and anyone with skin lesions can pass on the virus for up to two months. In senior communities, this is especially challenging for caregivers who are not able to work until they no longer test positive for the virus.

Key takeaways for disinfection and prevention:
  1. Clean bathroom surfaces more frequently.
  2. Test staff regularly for symptoms, and ensure they stay quarantined for at least two weeks if positive.
  3. Evaluate disinfection mechanisms that don’t require physical touch

As of recently, hospital environments seem to be most prone to the virus. In some studies, patient rooms had the highest concentration of the virus on bathroom surfaces, toilet seats, and cabinet handles used by medical staff. 

“[Surfaces have] an extremely low risk of transmission, but it’s not zero,” according to Internal Medicine Physician Dr. Berry Pierre speaking with Buzzfeed News. Pierre says that his team still cautions patients to be aware of the possibility. 

Areas with likely exposure to lesions or mucus (such as toilets, sinks, and bathroom counters), porous surfaces (such as untreated wood, fabric, and certain tiles), and surfaces which children interact with (such as play areas, toys, or table tops) should be cleaned more frequently and with additional caution.

UV-C disinfection: essential to stopping the spread

The CDC recommends regular cleaning and disinfection of spaces to limit community contamination. The CDC reports that the monkeypox virus is very sensitive to UV light, which has been used to fight viral spread since the 1930s. It inactivates microorganisms by penetrating cell walls and disrupting the replication of their genetic material. UV-C can neutralize harmful microorganisms such as bacteria, mold, mildew, and viruses. A 2007 study on the UV-C light sensitivity of the vaccinia virus demonstrated that the use of UV-C at 254 nm successfully reduces virus concentrations. 

Surface disinfection with chemicals can be an inconsistent, laborious process. Following disinfectant manufacturer instructions to the letter as the CDC advises requires heavy human involvement. Solutions that do not require direct human or chemical contact to disinfect can prove to be more effective and efficient to maintain. UV-C provides an effective and efficient option to sanitize spaces on demand as a preventive measure, as well as a containment during active virus outbreaks.

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