Commercial testing for monkeypox begins amid fears of an endemic disease

As commercial testing for monkeypox becomes more readily available, some local infectious disease experts fear it may become endemic in the U.S. unless vaccines become more widely available.

Dr. Gary Green, an infectious disease expert at Sutter Santa Rosa Regional Hospital, said monkeypox is now being efficiently transmitted from human to human outside of Africa for the first time since its discovery in 1958.

“So many countries are involved, with nearly 10,000 cases internationally now. That tells you that this is going to be not just a one-time thing,” Green said. “It’s very likely going to be an endemic process.”

An endemic disease is one that is ever-present or has unusual prevalence in a population within a geographic area, according to the Centers for Disease Control and Prevention.

Green said an additional concern is that monkeypox, as a zoonotic virus, has the potential to transmit between species.

“If this establishes itself in local animals, then it's going to stay in the environment and pingpong back and forth, from human to human to animal to human,” Green said. “That’s kind of what’s happening, that’s why it’s actually endemic in Africa.”

Dr. John Swartzberg, an infectious disease expert at UC Berkeley, agreed that monkeypox could become endemic unless the vaccine becomes more widely available to high-risk populations and people curb risky behavior.

Large commercial laboratories, such as Labcorp and Quest Diagnostics, have begun making monkeypox available to local health care providers, who have been hampered by current limitations on testing.

The good news, said Green, is that monkeypox doesn’t appear to be too dangerous. He said, as far as he knows, there have been no reports of deaths caused by the virus, though there have been a few cases where people were hospitalized for pain.

“It’s not smallpox,” Green said. “I consider this a dermatologic disease and much more of a nuisance. I don’t think this is going to be anything that strains our health care system or that puts a population at risk for serious illness.”

Monkeypox often appears as a rash, which can look like pimples or blisters that appear on the face, inside the mouth and on other parts of the body, like the hands, feet, chest, genitals or anus. It can include flu-like symptoms, such as fever and low energy.

Both Green and Swartzberg said that outside of Africa monkeypox is for the most part being spread like a sexually transmitted disease, though it is not officially classified as one. In many cases, the telltale pustules and lesions occur in the genital or perianal areas of the body.

Green said many of the current cases involve men who have sex with men and bisexual men, especially when they’re in “social networks with a high number of partners and especially anonymous sex.”

Swartzberg agreed. “It’s not about men who have sex with men, it’s people who are having sex with lots of different partners that’s increasing their risk,” he said. “This happens to be in the men-who-have-sex-with-men population right now. But of course, it could spill over just like HIV did in the early ’80s.”

Green and Swartzberg said the virus can also be transmitted through intimate, skin-to-skin contact with lesions and sores; and by touching items, such as clothes or bedding, that came into contact with an infectious rash or body fluids.

Swartzberg pointed to a new study that found monkeypox viral DNA in semen, saliva, urine and feces. The study, which examined 12 infected monkeypox patients in Barcelona, Spain, suggested at least a possibility of transmission through saliva or sexual fluids.

The study stressed that the primary mode of transmission is skin-to-skin contact with infected lesions.

Earlier this week, Sonoma County announced three cases of suspected monkeypox had been detected locally. All three cases involved men who have sex with other men; one involved international travel.

Currently, local testing in the public health lab can only confirm the presence of orthopoxvirus, a genus that includes monkeypox. To confirm monkeypox infection, health officials must send samples to the CDC. Two of the three cases have come back from the CDC as positive for monkeypox, while results are still pending for the third case.

But this week, federal health officials announced commercial testing for monkeypox is now available to medical providers. On Wednesday, Quest Diagnostics said it was making its own polymerase chain reaction, or PCR, test available to providers across the country.

Quest, which played a huge role in rolling out widespread COVID-19 testing at hospitals and clinics, said it will be able to perform 30,000 tests a week by the end of July. The company said it will also make available to providers CDC-supplied orthopox tests in the first half of August.

Green said local testing for monkeypox will also be provided by Labcorp. He said Sutter is likely to start using commercial testing services next week.

“Right now we have to go through public health and it’s a tedious process,” he said. “It takes time and we have to get permission to test at public health. With commercial testing we won’t need permission to test, we can just test like we test for anything else.”

Dr. Kismet Baldwin, Sonoma County’s deputy health officer in charge of the local monkeypox response, said local medical providers are quickly trying to educate themselves on how to identify and diagnose the virus. Many have never encountered the rare disease, she said.

“Providers are doing a pretty good job of not jumping to the conclusion that it’s monkeypox, but also at least thinking about it and having in the back of their mind that it could be and that it’s something they should consider,” Baldwin said.

During a recent call with state health officials, Baldwin learned that of all the samples being sent to the state lab for monkeypox testing, 40% have returned positive for orthopox virus.

Kaiser Permanente said local Kaiser members experiencing symptoms consistent with monkeypox or who believe they may have been exposed to monkeypox should contact their physician immediately for possible testing.

Kaiser said, as with any infectious disease, it is important current information, vaccination and treatment are widely available and that no stigma is attached to people who have contracted the virus or been exposed to it.

The vaccine is not currently widely available and the CDC recommends it be used as a post-exposure prophylaxis, after a possible exposure, Green said.

According to the CDC, it should be given within four days from the date of exposure to help prevent onset of the disease. Given between four and 14 days after exposure, the vaccine could reduce the symptoms of disease, the CDC said.

UC Berkeley’s Swartzberg is among a growing number of experts who argue that more should have been done to stop monkeypox from becoming endemic. He likened the nation’s monkeypox response to that of COVID-19 during the early months of the pandemic, and even after.

“Every day that we’re not doing what we need to be doing, we’re losing ground,” he said. “This is another example of the complete failure on our society’s part for not adequately funded public health for decades … all of this could have been prevented. We could have could have stopped this in its tracks.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.