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As the number of monkeypox cases in South Carolina ticks up, doctors at MUSC Health are working with the South Carolina Department of Health and Environmental Control to alert the public and let people currently at higher risk of getting the virus know they may qualify for a vaccine.

Infectious diseases specialist Allison Eckard, M.D., said so far, the outbreak is mostly affecting men who have sex with men. “It’s contagious through close contact. People need to be cautious. If they are at high risk based on their sexual behavior, they should consider getting the vaccine as a prevention strategy.”

Eckard said monkeypox is not a sexually transmitted disease but one that can spread through skin-to-skin contact and respiratory droplets. And while men who have sex with men are considered at the highest risk, at least two children have caught the virus. One is a toddler in California, the other a baby from another country who, when tested, was traveling through Washington, D.C., according to ABC News. Both had monkeypox symptoms but are now in good health. Both are believed to have gotten the virus from men in their households.

Eckard, a professor in the College of Medicine at the Medical University of South Carolina and the director of the Division of Pediatric Infectious Diseases with a joint position in Adult Infectious Diseases, said they probably won’t be the last children affected.

“We don’t really know, but monkeypox may expand more into the female population or within children through contacts, and then it could spread through households and day cares. Even if the fatality rate’s low and many of these kids won’t have severe disease, I think the risk is there, particularly in the younger children,” Eckard said.

“The concern is that it can cause severe disease in limited populations. Those include children less than 8 years old, pregnant women, people with skin conditions like eczema and immunocompromised individuals.”

But that’s not happening right now, at least not on any large scale, Eckard said. At the moment, men are the focus of DHEC’s monkeypox vaccine push. And they have to meet certain criteria:

• Be age 18 or older.
• Identify as a gay or bisexual man, trans man, transgender, gender-fluid or gender nonconforming individual who has sex with men.
• Have had multiple male sexual contacts within the last two weeks.

DHEC has what it called a very limited supply of the vaccine, Jynneos. It has set up more than a dozen sites to vaccinate people who qualify. To make an appointment, call DHEC’s CareLine at 1-855-472-3432.

So what’s the scope of the virus so far? In South Carolina, not very big at this point. The Centers for Disease Control and Prevention’s interactive map showed that as of July 27, South Carolina had 13 cases.

But a few states are already seeing much bigger numbers, including New York at 1,228 and California at 799. Our neighboring state of Georgia has 312 diagnosed monkeypox cases so far.

Eckard has been treating the first patient with monkeypox to arrive at MUSC Health and wanted people to know that its best-known symptom may not look like they expect. “People think it’ll be what they see on the news, these very distinctive, large monkeypox pox. And this outbreak does not look like that. They look like little pimples in a lot of cases that are easily missed or misdiagnosed,” Eckard said.

“My patient, for example, didn’t have any large or widespread lesions. He had two tiny pimple-like pox on his face, one on his chest, a couple on his thigh, a couple on the bottoms of his feet. They were all over. What I mean is that there weren’t very many, but they were in different places all over his body.”

She said people also need to be aware that monkeypox lesions go through four stages before they start healing. “Each of those stages looks like other very common rashes, such as shingles or the common pediatric virus called molluscum, and a variety of other things: scabies, insect bites, et cetera. And so I think that they are very underrecognized. People just don’t have monkeypox on their minds yet. But as we have more and more cases, and we start seeing the outbreak expand into other populations of patients, people will start realizing that they need to be thinking about monkeypox.”

Eckard said MUSC Health is alerting high-risk patients about the threat of monkeypox and considering setting up testing sites in coordination with DHEC. “Ideally, we would set up a testing site the same way we’ve done with COVID – where people, particularly individuals at higher risk of monkeypox, can drive through and have their lesions swabbed and the samples sent off to DHEC or another lab for testing.”

For now, she said those who think they have monkeypox should contact their doctors as a first step toward possibly getting tested. Eckard also encouraged people to check out the CDC’s monkeypox prevention steps, which state that people should:

• Avoid close, skin-to-skin contact with anyone has a rash that looks like monkeypox.
• Don’t touch the rash or scabs of a person with monkeypox.
• Don’t kiss, hug, cuddle or have sex with someone with monkeypox.
• Don’t share eating utensils or cups with a person with monkeypox.
• Avoid handling or touching the bedding, towels or clothing of a person with monkeypox.
• Wash your hands often with soap and water or use an alcohol-based hand sanitizer.

As more people become aware of the need to take precautions, they may be wondering if monkeypox could become as big a threat as COVID. But it won’t, doctors say. DNA viruses such as monkeypox tend to be very stable and evolve slowly compared with RNA viruses such as the coronavirus. They also say we have the tools to contain monkeypox, according to a report in the New York Times.

But the virus is causing anxiety among young gay and bisexual men, in particular, right now, the Times also reported. Eckard wants them to know that MUSC Health, which offers a series of LGBTQ services, is there for them. “My goal is to provide the best health care that I can for all of my patients.”

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