Dr. Priya Sampathkumar on monkeypox in Minnesota

A gloved hand holds a testing tube vial
A medical laboratory technician inactivates suspected monkeypox samples to be PCR tested at the microbiology laboratory of La Paz Hospital on June 6, 2022 in Madrid, Spain.
Pablo Blazquez Dominguez | Getty Images

Updated: June 29, 12:45 p.m. | Posted: June 27, 12:14 p.m.

The first case of monkeypox has been found in Minnesota. The news came Monday morning from the Minnesota Department of Health. State health officials say the Twin Cities adult is receiving treatment for an infection that likely occurred during overseas travel.

As of last Friday, the CDC reported 201 cases of monkeypox in 26 other states. In recent months more than 4,100 cases have been reported in 47 other countries where the disease is not typically reported. Dr. Priya Sampathkumar is a professor of medicine and infectious disease expert at Mayo Clinic.

Here are four things to know about the disease, according to Sampathkumar.

1) What is monkeypox?

“Monkeypox is what we describe as a febrile rash illness,” said Sampathkumar. “In simple terms, you have a fever and a rash. And there are a number of different viruses that can do this. The thing about monkeypox is that it generally is a rash that's all over your body … and people feel fairly sick with it. It's something that most of us in the U.S. have never seen, because there have been so few cases in the United States.”

The disease is considered a zoonotic disease, meaning it can spread from animal species to humans. Sampathkumar said that transmission was caused when humans made contact with the animals through bites or scratches.

While it can spread from human to human, Sampathkumar said it’s not an efficient transmission.

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“You need very close, prolonged contact for it to spread from person to person. And it is spread primarily by close contact with the skin lesions, the rash that the infected person has, contact with their clothing or bedding that might be contaminated with secretions from the rash. And also from very close, prolonged contact face to face when respiratory droplets can pass from one person to another.” Or, for example, kissing.

2) What symptoms are associated with monkeypox?

Monkeypox has a fairly long incubation period, or the time you were exposed to the time you develop the first symptoms. Sampathkumar said it can be as long as three weeks, long enough where you might forget you were even exposed.

“The symptoms start out as a non-specific illness. You have some fever, you feel like you just may feel generally unwell,” Sampathkumar said. “And then two to four days later, you develop the rash. And the rash can just be mild discoloration of the skin. That then progresses to what we call a papule or a little bump under your skin and then that becomes a tiny blister. That then becomes filled with pus and eventually it scabs over. So the rash progresses through multiple different stages.

3) How is monkeypox treated?

Sampathkumar said most who are infected don’t need extensive treatment, but supportive care is helpful. Sometimes a rash can become infected with bacteria, which could need antibiotics, and people with underlying immune deficiencies may require antivirals that are not commercially available but are released through the CDC.

4) How much of a concern is this monkeypox outbreak?

While monkeypox is not a new disease, Sampathkumar said any time a disease begins to act differently, public health officials start to pay attention. She highlighted three factors that are raising concerns:

  • Previous cases were limited to certain countries in Africa, but more cases are emerging in Europe and the U.S. “[This] is worrying as to whether or not the virus might have changed in some way that's making it more transmissible,” Sampathkumar said.

  • In newer cases, the way the disease presents makes it harder to detect. “Some people have no fevers, some people have just a little bit of the rash,” she said. “So again, there's fear that what we're seeing might just be the tip of the iceberg, that there are more cases.”

  • So far, infections are occurring in healthy people. But if a virus becomes more widespread, public health experts become concerned about people who are more vulnerable. “If it gets a foothold in them, would the disease be more severe, more transmissible, more of an issue?”

Use the audio player above to listen to the full conversation. See a full transcription of the conversation below.

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Audio transcript

[MUSIC PLAYING] INTERVIEWER: Our top story, the first case of monkeypox has been found in Minnesota. The news comes this morning from the State Department of Health. State health officials say the Twin Cities adult is receiving treatment for an infection that likely occurred during overseas travel. As of last Friday, the CDC reported 201 cases of monkeypox in 26 other states.

In recent months, more than 4,100 cases have been reported in 47 other countries where the disease is not typically reported. Dr. Priya Sampathkumar is a Professor of Medicine and an Infectious Disease Expert at Mayo Clinic. Dr. Sampathkumar, welcome to the program.

PRIYA SAMPATHKUMAR: Thank you.

INTERVIEWER: What is monkeypox? How do you describe this disease?

PRIYA SAMPATHKUMAR: So monkeypox is what we describe as a febrile rash illness. In simple terms, it's you have a fever and a rash. And there are a number of different viruses that can do this. The thing about monkeypox is that it generally is a rash that's all over your body until this outbreak and people feel fairly sick with it. It's something that most of us in the US have never seen, because there have been so few cases in the United States.

INTERVIEWER: Is this a zoonotic disease, meaning spread from animal species to humans?

PRIYA SAMPATHKUMAR: Exactly. So in the wild, you can get it from contact with animals. There was a large outbreak in the US in 2003 that people actually got from pet prairie dogs that had been infected with some other animals from Africa that had been stored in the same facility.

INTERVIEWER: How-- Go ahead. I'm sorry.

PRIYA SAMPATHKUMAR: And most people got it from contact with these animals, bites, scratches, et cetera.

INTERVIEWER: How then is monkeypox spread from human to human?

PRIYA SAMPATHKUMAR: Most of the time, human to human transmission is not very efficient. So you need very close, prolonged contact for it to spread from person to person. And it is spread primarily by close contact with the skin lesions, the rash that the infected person has, contact with their clothing or bedding that might be contaminated with secretions from the rash. And also from very close, prolonged contact face to face when respiratory droplets can pass from one person to another.

INTERVIEWER: Say, kissing, that kind of thing?

PRIYA SAMPATHKUMAR: Mm-hmm.

INTERVIEWER: Mm-hmm. What are the symptoms if you have or you think you may have monkeypox?

PRIYA SAMPATHKUMAR: So one of the things about monkeypox is that it has a fairly long incubation period, which is the period of time from when you were exposed to when you first have symptoms. It can be as long as three weeks. So you might have forgotten about your exposure by that time. The symptoms start out as a non-specific illness. You have some fever, you feel like you just may feel generally unwell.

And then two to four days later, you develop the rash. And the rash can just be mild discoloration of the skin. That then progresses to what we call a papule or a little bump under your skin and then that becomes a tiny blister. That then becomes filled with pus and eventually it scabs over. So the rash progresses through multiple different stages.

INTERVIEWER: What's the treatment for this illness?

PRIYA SAMPATHKUMAR: Fortunately, most people don't require any treatment. They need supportive care. If sometimes this rash can become infected with bacteria, that needs antibiotics. For people who are immunosuppressed and have a very extensive rash, people who have some underlying immune deficiencies, there are some antivirals that are not available commercially but can be released by the CDC when a case has been confirmed.

INTERVIEWER: As I mentioned in the introduction, this has been reported now in a number of countries where the disease really isn't typically seen. So how much of a concern is monkeypox? Why are some public health officials worried about it?

PRIYA SAMPATHKUMAR: So anytime something is behaving differently than it has in the past, it sort of sets off our antennae. So all previous cases were limited to certain countries in Africa. The fact that now we're seeing so many cases in Europe and the US is worrying as to whether or not the virus might have changed in some way that's making it more transmissible. So that's one worry.

The second thing is the way the disease is presenting. It's not as easy to detect as before. Some people have no fevers, some people have just a little bit of the rash. So again, there's fear that what we're seeing might just be the tip of the iceberg, that there are more cases than otherwise.

And thirdly, it so far has been happening in healthy people and most people are recovering completely without any problems. But when something becomes more widespread, we're always worried about our vulnerable populations. If it gets a foothold in them, would the disease be more severe, more transmissible, more of an issue?

INTERVIEWER: As an infectious disease expert, now that we have one confirmed case, what are you going to be watching for in the coming weeks?

PRIYA SAMPATHKUMAR: I think we need to be alert for more cases and really be thinking in the back of our mind about monkeypox when we see anyone with a rash. Things like chicken pox, measles will likely be more likely to happen, but we need to be alert for monkeypox.

And I just want to make a plug for vaccination too. During the COVID pandemic, a lot of routine vaccinations got kind of missed. So if you have a child who was hasn't been vaccinated against chickenpox or measles, none of these vaccines protect against monkeypox, but you will be better off because you won't have a rash illness.

INTERVIEWER: All right. Dr. Sampathkumar, thank you so much.

PRIYA SAMPATHKUMAR: You're welcome.

INTERVIEWER: We've been talking to Dr. Priya Sampathkumar. She's an infectious disease expert at Mayo Clinic.

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