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Monkeypox cases are increasing across America and around the world, with the US Centers for Disease Control and Prevention reporting over 15,000 confirmed stateside cases as of August 23. The Biden Administration is accelerating vaccine distribution efforts and ramping up community outreach, including through community partnerships and education of clinicians and patients.
In the meantime, students are coming back to school. Parents, caregivers, teachers and students have a lot of questions. Can monkeypox be spread by sitting next to someone with the virus in a classroom or playing in the playground together? Could it be transmitted by sharing food or drinks? Are there certain activities for K-12 students that are higher risk? What about for college students? And what about the risk of other infectious diseases?
To help us with these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and the mother of two young children who are both starting school next week.
CNN: Can you remind us how monkeypox is spread and who is at high risk?
Dr. Leana Wen: Monkeypox is spread primarily through prolonged, direct, skin-to-skin contact with someone who is actively shedding virus. It is associated with intimate sexual activity but can be spread by other close contact, such as kissing and cuddling. The earliest groups affected have been gay, bisexual and other men who have sex with men. A study recently published by the CDC found that 99% of cases have been in men, with 94% reporting recent male-to-male sexual or close intimate contact.
This contrasts with another disease we’ve been talking about a lot over the past two years, Covid-19. Covid-19 is caused by an airborne virus that is extremely contagious. You could get Covid-19 from talking with someone or just from sharing the same air with someone who’s in the same room as you. Monkeypox could be spread through some objects – for example, bedding, towels, and utensils used by someone who is infected – but that is a much less common route of transmission than direct contact.
CNN: Let’s talk about some examples of common scenarios in school settings. Can monkeypox be spread by sitting next to someone in a classroom or riding the bus together?
Wen: That’s extremely unlikely. Monkeypox is not transmitted just by sitting next to a person. Again, this is not Covid-19 – this virus is not nearly as contagious.
CNN: What about kids playing closely on the playground together? Would touching the same objects put them at risk for monkeypox transmission?
Wen: In theory, it’s possible that a child who has an exposed rash could touch another child while playing together. Small kids also put objects in their mouth that could then be touched by other kids, and transmission could occur that way.
I’m not worried about my two young kids, ages 2 and 5, getting monkeypox because, thus far, it has not been spreading in children in the United States. There are a couple of isolated reports of kids with monkeypox, but no reports of kids transmitting to each other. The incidence of monkeypox among kids is currently so low that I am not worried about spread while my kids are in their preschool and kindergarten.
This could change if outbreaks start happening in children, but that’s not what we have seen thus far.
CNN: Could monkeypox be spread by sharing drinks or food?
Wen: Yes. Again, this is lower risk than the other close activities discussed earlier like sexual activity, but sharing drinks or food is a possible method of transmission. People infected with monkeypox should not be sharing utensils or food or drink with others.
CNN: You said earlier that it could be spread through bedsheets and towels. Should parents and caregivers worry about their kids trying on clothes and avoid travel in hotels?
Wen: I don’t think so. If someone is infected with monkeypox, they could shed the virus onto their clothing and other things that touch their rash — for example, bedsheets, towels and other linen. If someone in your family has monkeypox, no one should share their clothes or bed.
But that’s very different from going so far as to avoid trying on clothes at the mall or staying in hotels. Of course, there is a theoretical possibility that the person who just tried on the same clothes had monkeypox and left virus on the clothes, but the odds of that happening are very low. Same goes for hotels, where the sheets and towels should be replaced between guests anyway.
CNN: Are there certain activities for K-12 students that are higher risk?
Wen: Activities that involve prolonged skin-to-skin contact will be higher risk. Kids involved in wrestling or tackle football, for example, would be higher risk than if they did cross-country running or swimming.
That doesn’t mean children shouldn’t participate in contact sports. Again, the incidence of monkeypox in kids is currently so low that this shouldn’t be a major concern.
Some students in school are sexually active. My concern would be for those students, especially those with multiple partners or engaging in sexual encounters with people they don’t know well, as it’s through such intimate activity that monkeypox is primarily spread.
CNN: That brings me to college students. What are high-risk activities for them, and what precautions should they be taking?
Wen: Let’s go through activities by level of risk. Highest risk would be sexual intercourse with multiple partners. Intimate activity like kissing and cuddling with multiple people would also be high risk.
Sharing drinks, food and objects like cigarettes and vapes, could also result in monkeypox transmission, though that risk is lower. Monkeypox transmission has also been documented in individuals dancing for long periods of time in close quarters with numerous other people, especially if most individuals are not wearing clothes over parts of their body – that results in more skin-to-skin contact.
Being platonic roommates with someone is lower risk, as is participating in most sports. Other day-to-day activities, like going to class, dining with peers and socializing with friends, are extremely low risk. Teaching staff, professors and other school and university staff are at extremely low risk if they are not engaging in skin-to-skin direct contact with students or one another.
CNN: What precautions would you advise college students to take?
Wen: Know the activities that have the highest risk and try to reduce your risk. Since sexual activity is highest risk, consider reducing the number of sex partners until you are vaccinated. Before engaging in intimate activity, ask if the other person has had new or unexpected rashes – and, if possible, consider exchanging contact information with any new sexual partners in case you or they later develop symptoms. Try not to share drinks, food or cigarettes with multiple unknown people. If you’re going to nightclubs or bars where you expect to be in very close quarters with many individuals, consider wearing long sleeves and pants to cover the areas that will be closely touching others.
I’d also urge everyone to know the signs and symptoms to watch out for. In most cases, monkeypox presents as fever, lymph node swelling and a rash that then results in blistering. However, fever and lymph node swelling may not always be present. You could also have just one or two small rashes anywhere on your body. Monkeypox can also present as sores in your mouth, on your genitals, or in your anus. If you have any of these symptoms, get tested.
This reminds me – students should know where to go for testing. Many colleges will offer testing on-site. Others will recommend that you go to a nearby commercial laboratory. Colleges should all have isolation procedures set up. It would help to know what they are in advance so that you’re not caught off-guard in case your test is positive.
Finally, those students who are eligible to be vaccinated should do so. The CDC has suggestions for eligibility. Inquire with your local health department and sexual health clinics in your area. The availability of vaccines and how to access them will differ depending on the part of the country. My strong advice to people who meet the CDC’s eligibility suggestions is to get the vaccine if you can – that will reduce your chance of getting infected and also of passing monkeypox onto others.
CNN: Big picture – how should parents, caregivers, teachers and students consider the risk of monkeypox along with the risk of other infectious diseases?
Wen: This differs by age group. For anyone not yet engaged in any sexual activity, the risk is very low, given the populations affected by monkeypox thus far. The communal living environments in college, combined with higher-risk activities, makes monkeypox a much more significant concern for students in that age group.