Universities and colleges across the U.S. are preparing for potential outbreaks of monkeypox this fall as students begin returning to campus amid an upswing in cases nationally, marking another public health challenge for schools to manage after years of grappling with Covid-19.
Dr. Ina Park, a professor at the University of California San Francisco School of Medicine, told Forbes that while monkeypox “does pose a risk to students,” the risk is different from that posed by Covid-19 and there is not a concern about catching the virus through everyday activity or passing someone in a corridor.
The main issue is that students live together in close quarters and gather to socialize, including hookups where close contact like kissing, skin-to-skin contact and sex might happen, Park explained, adding that the virus could also potentially be transmitted through sharing clothing or sleeping in someone else’s bed.
Numerous universities told Forbes they are in contact with local and federal health authorities to plan their responses and some schools, such as Texas A&M University, said clinicians at student health services have taken part in CDC training related to the disease.
Other universities, including Georgetown University and NYU, said student health services are able to carry out the specific testing needed to diagnose monkeypox.
Disinfecting desks or public toilets—surfaces the monkeypox virus can live on—could be one way of minimizing the risk to students, Park said, as would vaccinating students who are men or transgender people who have sex with men and expanding access to all college students when supplies permit.
Evidence-based education—especially alerting people to “the fact that monkeypox is transmitted through intimate contact”—will be crucial, Dr. Marina Klein, a professor of medicine at McGill University, told Forbes, as well as training campus health services to be on the lookout for potential monkeypox cases.
Monkeypox primarily spreads through close physical contact, as well as contact with contaminated objects and surfaces like bedding or clothing. While infections are clustered among men who have sex with men—data suggests the outbreak is largely driven by sexual activity—there have also been cases in women and children and experts told Forbes there is a risk the disease could spill over into other groups and obviously these communities are not self contained and members also attend university.
Experts stress the importance of balancing the provision of accurate information about the risks of monkeypox and how it is spreading and avoiding stigmatizing the groups most affected. Campuses also face a number of unique challenges when managing disease outbreaks, the American College Health Association (ACHA), told Forbes, such as how to isolate people with limited housing available and managing the disruption a two-to-four week isolation period can cause to students. The organization said it is working to develop tailored guidance for campus settings.
What To Watch For
How universities communicate about monkeypox. Several universities told Forbes they are following guidance from local health departments and the CDC, though this advice does not specifically address university settings. Many universities have set up informational websites providing resources and guidance on the virus, while some like NYU, the University of Texas at Austin, Texas A&M University and the University of Michigan told Forbes they have also emailed staff and students about the outbreak and will provide updates as the situation evolves.
Other universities have gone, or plan to go, further in communication efforts: the University of Florida told Forbes it is increasingly promoting safe sex messaging and Texas A&M University said the school is pushing out information on the disease via social media and flyers in residence halls and high-traffic areas. Guidance and protocols are sure to evolve as the outbreak does; NYU spokesperson John Beckman told Forbes the university is “closely following developments” and staff at the student health center are on “heightened alert” to respond.
There are also broader impacts of monkeypox to be considered, Cornell’s director of media relations Rebecca Valli told Forbes, adding that the school is considering “the potential academic impacts and accommodations which may arise” should a student come down with monkeypox.
There have been 10,768 confirmed cases of monkeypox in the U.S., according to numbers from the Centers for Disease Control and Prevention. The overwhelming majority of cases have been among men who identify as gay, bisexual or who have sex with men and transmission is suspected to have occurred through sexual activity in most of those infected.
The World Health Organization , the White House and a number of local jurisdictions have declared the outbreak a public health emergency and a vaccination campaign is underway to target groups most at risk of the virus. Supplies of Jynneos, the only vaccine licensed against monkeypox in the U.S., do not come close to meeting demand for the shot and U.S. officials have greenlit a dose-saving strategy to stretch the stockpile.
Though the outbreak is largely, though not exclusively, limited to men who have sex with men and spread through sexual activity, concern has grown among officials that the disease could spread more widely. The close-contact campus environment, notably dorms, contact sports and sex, have flagged colleges as more likely to experience outbreaks. At least five schools—Georgetown University, George Washington University, the University of Texas at Austin, Bucknell University and West Chester University—have already reported monkeypox cases, according to STAT News.
McGill’s Klein said it is “inevitable” that monkeypox will spillover into populations other than men who have sex with men, which could happen more easily in situations where people are living in close quarters. “There is no need for panic,” Klein stressed, urging strong and sensible messaging on how monkeypox is transmitted and reinforcing “messages about how to be safe when having sex,” especially with casual contacts. “Making vaccines easily available in safe spaces for those at risk would also go a long way to helping stem any potential outbreaks on campus,” Klein added.
Critics by: Nicole Karlis
One of the first public health measures triggered by the onset of the COVID-19 pandemic was mass closure of daycares and schools. Indeed, the proximity with which students and teachers congregate in close quarters means that viruses are more apt to spread in such conditions, which made school closures a sensible means of slowing the spread of COVID-19.
Then, last week, news broke that an Illinois daycare worker tested positive for monkeypox. While the worker is isolating, it remains unclear how many children — if any — were exposed to the virus while the infected person was at work. The news raises questions over whether schools, daycares, and the like are safe — from monkeypox — for both workers and their charges.
“An adult at a day-care center in the Rantoul area has tested positive for a case of monkeypox,” Dr. Sameer Vohra, director of the Illinois Department of Public Health, said at a news briefing. “Screening of children and other staff is taking place now.” As parents gear up to send their children back to school, should they expect monkeypox outbreaks to occur in school and daycare settings?
The answer to that requires understanding the way that monkeypox spreads, and how it differs from COVID-19. Monkeypox symptoms start within two to three weeks after exposure to the virus. The primary mode of transmission for monkeypox is skin-on-skin contact or contact with contaminated items.
Currently, there are more than 7,500 confirmed cases in the United States, according to the US Centers for Disease Control and Prevention, which is nearly double the number of cases since late July. Last week, the Biden administration declared the monkeypox a public health emergency. While transmission is mostly occurring in adult men, in the United States there have been at least five reported pediatric cases.
Yet experts are optimistic about the safety of schools. Dean Blumberg, chief of pediatric infectious diseases and associate professor in the Department of Pediatrics at the University of California–Davis, told Salon he doesn’t anticipate K-12 schools to be particularly rife with outbreaks this school year.“Since transmission is primarily via prolonged skin to skin contact,” Blumberg said. “So of course children horse around and they might have skin to skin contact, but usually it’s not prolonged during most activities.”
Blumberg added that another way monkeypox could be transmitted in a school setting is via contaminated linens or bedding. Unlike COVID-19, which is more transmissible but usually less severe for children, monkeypox is less transmissible but can pose a higher risk of severe disease for children under the age of 8.
“I suppose during nap time if kids are sharing bedding or linens, it’s possible that there might be transmission,” Blumberg said. “But most schools and daycares, for now, have their own dedicated area, their own dedicated space, for nap time.”
Dr. Katrine Wallace, an epidemiologist University of Illinois–Chicago, told Salon via email that monkeypox could potentially spread at school “by touching someone’s rash/lesions, exchanging body fluids via kissing or prolonged face to face contact, hugging, etc.”
“So, it’s best (for [monkeypox virus] and for COVID-19 reasons) to emphasize giving each other space in the classroom and not touching one another,” Wallace said. According to the CDC, monkeypox spreads through direct contact with body fluids or sores on the body of someone who has monkeypox. It can also spread through sores that have been in contact with someone who is infected, or materials that have touched body fluids — for example, clothing or bedsheets.
Monkeypox may also spread through respiratory droplets when people have close face-to-face contact. However, experts say this is not the main mode of transmission. According to data from the World Health Organization, 91.4 percent of cases have been linked to sexual contact.
Wallace agreed it is possible for a monkeypox outbreak to occur in communities like college campuses. Understandably, this raises questions about college students in a university setting. “If students are having prolonged skin to skin contact with many others, such as having sex with multiple partners, that will be a risk factor for transmission,” Blumberg said. “And in that case, it’s easy to prevent transmission — if somebody has a rash, then they shouldn’t have prolonged skin to skin contact with others until they get that rash diagnosed and make sure it’s non-infectious.”
Wallace agreed it is possible for a monkeypox outbreak to occur in communities like college campuses.”It is important that colleges and universities are prepared to provide public health education/information about monkeypox to students, have testing/medical resources available to if students develop symptoms, and have an isolation protocol ready,” Wallace said.
Still, there are reasons to protect younger children from any exposure to monkeypox. Unlike COVID-19, which is more transmissible but usually less severe for children, monkeypox is less transmissible but can pose a higher risk of severe disease for children under the age of 8, as noted by the CDC based on limited pediatric data on infection.
“Children who have monkeypox are at higher risk for severe disease and higher fatality rates have been reported in children less than eight years of age,” Blumberg said. “There’s a variety of complications that may occur, including inflammation of different organs, myocarditis, meningitis” — hence the concern about young children being infected.
Notably, there are vaccines for monkeypox, although supply is limited. As Salon previously reported, the U.S. has released the Jynneos vaccine against monkeypox from the Strategic National Stockpile. Meanwhile, those who received the smallpox vaccine before it stopped being regularly given in the 1970s will likely have protection against monkeypox. While the Jynneos vaccine isn’t being publicly offered to kids nor is it licensed for children, those who have been exposed to it can be vaccinated if it is recommended by the local health departments.
As noted by CDC, Jynneos has been used in studies as part of vaccines against other diseases including tuberculosis, measles, and Ebola. These studies included children as young as five months old, and were found to have no adverse health effects or safety concerns. For worried parents, Blumberg said it is a good idea to make sure that daycares and schools and policies are in place to prohibit potentially infectious staff and students.
“Most schools and daycares do have policies in place so that if somebody is suspected to be infectious to others, they are excluded — and for monkeypox, the key would be an undiagnosed rash,” Blumberg said. “There are many different infections that may cause rashes that may be transmitted to others — so schools and daycares should be pretty experienced with screening for rashes.”
Wallace emphasized how different monkeypox is from SARS-CoV-2, stating bluntly: “this is not COVID-19.””It spreads very differently and is nowhere near as contagious,” Wallace said. “If your child develops symptoms, definitely see a health care provider before sending the child back to school.”
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