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Can monkeypox spread through respiratory symptoms? New CDC guidance keeps local health officials wary

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What is monkeypox, and how can you stay safe as it spreads? (copy)

While not the primary means of transmission, monkeypox may spread through respiratory secretions, according to the CDC. 

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A new warning about the spread of monkeypox is leading to calls for more caution and preventive measures from local health officials.

That comes after the Centers for Disease Control and Prevention on Monday urged isolation for those who test positive for monkeypox for the full duration of symptoms, typically two-to-four weeks.

"While symptomatic with a fever or any respiratory symptoms, including sore throat, nasal congestion, or cough, remain isolated in the home and away from others unless it is necessary to see a healthcare provider or for an emergency," the CDC website reads. 

In a report June 9, the CDC said the virus "may" spread through respiratory secretions "when people have close, face-to-face contact."

Monkeypox spreads primarily through prolonged skin-to-skin contact with lesions or bodily fluids containing the virus, according to the CDC. Dr. Gale Burstein, the Erie County Department of Health commissioner, called it a "sexually associated disease" most urgent for Buffalo's LGBTQ+ community.

But questions remain about respiratory symptoms as a secondary cause of spread. Health officials nationally and locally have early this week urged caution regarding this mode of transmission, which includes the coughs, sneezes and other respirations of a symptomatic infected person.

The Erie County Department of Health said Tuesday that those experiencing flu- or cold-like symptoms should wear a mask around others to prevent spread, even if they have not tested positive for monkeypox. Kara Kane, the health department's public information officer, said wearing masks is a "sound practice" to prevent the spread of respiratory pathogens, regardless of virus type.

A bullet point in the CDC's "What We Still Don't Know" section alluded to uncertainty about monkeypox transmission: "How often monkeypox virus may be spread from respiratory secretions, or at what point during infection a person with monkeypox symptoms might be more likely to spread monkeypox virus through respiratory secretions."

But fears of catching monkeypox through a brief exposure should be alleviated.

"Transmission during brief interactions has not been reported," the CDC said, a statement Kane emphasized.

The coronavirus was determined by the CDC to spread through aerosols, which differs from transmission through respiratory droplets. Burstein last week contrasted Covid-19's spread with that of monkeypox.

"This is not the same type of a disease as Covid-19," she said. "The transmission dynamics are very different, whereas Covid-19 is very contagious and transmitted through aerosols and in respiratory transmission." 

But a previous change in monkeypox's transmission method from its historical course has already worried Buffalo infectious disease experts, including the University at Buffalo's Dr. John K. Crane. 

"It's behaving differently than it has in the past," Crane said last week. "It's spreading sexually now – that's one of the big differences. In the past, monkeypox outbreaks were usually due to outbreaks with animals."

More than 5,800 cases of monkeypox have been reported in the United States as of Aug. 2, with 1,573 in New York State. Erie County has four cases, while Niagara County has one. The local numbers have not changed since late last week, although Burstein predicted that area cases will increase soon.

The World Health Organization (WHO) issued the warning on July 25.

Ben Tsujimoto can be reached at, at (716) 849-6927 or on Twitter at @Tsuj10.

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