What puts someone at risk for monkeypox?

People line up to get vaccinated against monkeypox at a sexual health clinic in the Harlem neighborhood of New York, on July 7, 2022. (Victor J. Blue/The New York Times)

People line up to get vaccinated against monkeypox at a sexual health clinic in the Harlem neighborhood of New York, on July 7, 2022. (Victor J. Blue/The New York Times)

As monkeypox spreads across the United States, people may remember the days when they cleaned counters and grocery stores to get rid of the coronavirus. But for most people, the risk of getting monkeypox remains low. Almost all cases in the current outbreak, 98%, have been in adult men who have sex with men.

So how does the virus spread? Studies of past outbreaks suggest that the monkeypox virus is spread in three main ways: through direct contact with an infected person’s rash, by touching contaminated objects and fabrics, or by respiratory droplets produced when an infected person coughs or sneezes. There is also evidence that a pregnant woman can transmit the virus to her fetus through the placenta.

Scientists are still trying to understand if the virus can be spread through semen, vaginal fluids, urine, or feces, and if people can be contagious before they develop visible symptoms.

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Several factors can determine your risk of getting monkeypox, whether it’s from caring for someone who is sick, attending crowded parties, or just having sex. How close you are to someone who is sick, how infectious they are, how much time you spend in their vicinity and your own personal health can affect your susceptibility, said Dr. Jay Varma, a physician and epidemiologist who specializes in infectious diseases at Weill. Cornell School of Medicine in New York City.

This is how experts think about everyday interactions, how the virus is transmitted during them, and what behaviors carry the greatest risk.

High risk

Activities that put a person at higher risk of contracting the virus involve close and intimate contact with another infected person. This includes the type of skin-to-skin contact that occurs during sexual intercourse, as well as when hugging, caressing, massaging, or kissing another person. Condoms are likely to add a layer of protection during sex, but they are unlikely to prevent contact with lesions on an infected person’s groin, thighs, buttocks, or other body parts.

Roommates and family members in the same house also have a significantly higher risk of contracting monkeypox compared to anyone else with whom a patient may have close contact, said Dr. Bernard Camins, director physician for infection prevention at Mount Sinai Health System.

Household contacts can contract monkeypox through contaminated clothing, towels, and bedding. Shared utensils that may contain the saliva of an infected person should also be considered high risk, said Saskia Popescu, an infectious disease epidemiologist at George Mason University.

Medium risk

When it comes to respiratory droplet transmission, face-to-face or near-face-to-face contact is riskier than being several feet apart. Health officials recommend keeping at least 6 feet away from patients without a mask to avoid exposure, though some experts argue this number is arbitrary. Still, as with COVID-19, wearing a mask indoors is a good idea if you want to protect yourself from monkeypox. Attending a packed indoor party could put you at risk of contracting the virus, particularly in parts of the country where cases are high. Raves where people have direct skin-to-skin contact and dance together for longer can be even riskier, Popescu said.

lower risk

People are unlikely to catch the virus by trying on clothes in a store or by touching non-porous items like door handles and countertops, Popescu said. “Personally, I’m less concerned about trying on clothes in the store,” he said. For those who are really nervous, he suggested simply putting a new item in the laundry when they get home for peace of mind.

Also, some activities that people learned to limit during waves of COVID-19 are probably not as risky for monkeypox transmission. For example, sitting on a subway, bus, or other public transportation or going to an office or school is unlikely to put people at risk of exposure to monkeypox. But experts warn that this guidance could change as researchers collect more data on monkeypox. If the virus continues to spread unchecked, it could eventually spread to a broader population, increasing everyone’s chances of infection. But, Camins said, “we’re not there yet.”

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