The version of monkeypox recently sequenced in Europe—which is seeing 70 percent of the global cases—seems to have picked up mutations that may make it more suitable for human-to-human transmission than prior forms of this zoonotic disease, according to a new preprint study that has not been peer-reviewed or published.
“I think we’re all going to be learning as this goes along.”
Monkeypox may have then found a new niche—transmission among those with multiple sex partners, especially queer men, which is one of the more distinctive attributes in the current outbreak—and its evolution may have helped spread in this type of person-to-person contact. “Some people were quick to presume that, well, it just started here, of course it’s going to spread to the general population. And I think we need to be open, to say we don’t really know,” said Crowley.
Early in outbreaks, sometimes things just happen by chance: A virus works its way into a certain network and spreads rapidly. That pattern can stick, with an illness becoming highly associated with that network, or it can be a warning of what can happen when the next network is infiltrated. Congregate settings, like prisons and shelters, are a major concern, as well as spillback into animal reservoirs, which is poorly understood. As cases accumulate—and the United States continues ramping up testing, which has been a major weak point in the response—we could discover that the pattern so far is not just an accident and that this virus really is confined primarily to sexual contact. Early indicators are pointing in that direction, but it’s simply too soon to say. “This is, again, the biggest outbreak outside of the endemic areas in West Africa and Central Africa, and I think we’re all going to be learning as this goes along,” Blackstock said.