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Monkeypox cases in the U.S. have been falling since a peak in early August

LEILA FADEL, HOST:

Just a few months ago, it looked like the U.S. had lost its chance to get monkeypox under control. Cases were soaring, and vaccines were in short supply. But now the story has taken a turn and this time in a good direction. In fact, some disease experts are even raising the idea that the U.S. could nearly eliminate the virus. Here to talk about the news are NPR health correspondents Pien Huang and Michaeleen Doucleff. Hi.

MICHAELEEN DOUCLEFF, BYLINE: Good morning.

PIEN HUANG, BYLINE: Good morning.

FADEL: Good morning. So, Pien, it doesn't seem like we're hearing the same alarm bells about monkeypox anymore. Why is that?

HUANG: Well, that's because the outbreak has legitimately simmered down. Yes, the U.S. has had more than 26,000 confirmed cases since May, and unfortunately, two people have died from monkeypox in the U.S. But if you look at the trends, new cases have been falling since the peak in early August, and it's the lowest that it's been since June. Dr. Boghuma Titanji, an infectious disease doctor at Emory University, says that's a huge accomplishment.

BOGHUMA TITANJI: I think that where we are now is certainly, I would say, the best-case scenario in terms of really showing the reflection of what can happen when you actually commit the tools that you have to fight an outbreak.

HUANG: Given the way that things look, the CDC says cases are probably going to plateau or decline over the next few weeks and fall significantly over the next few months. That's because the data shows that cases are still mostly concentrated among people with multiple sex partners and primarily gay and bisexual men and trans women. So as people within these populations get immunity from the virus, either by recovering from infections or getting vaccinated, the virus is finding fewer and fewer new people that it can spread to.

FADEL: So, Michaeleen, this wasn't always a given, right? There was a lot of concern initially that monkeypox could start spreading widely, especially places like daycares or in schools. Have we seen that at all?

DOUCLEFF: You know, we haven't seen that. There has been very little spread to children just across the board. I was looking at the data from the CDC the other day. And right now, only about 0.2% of cases have been in kids below age 16, so very few cases. And there has been no evidence the virus has spread in schools or daycare centers. If a person comes to school sick with monkeypox, there's no evidence they caught it there or that the virus has spread to anyone else.

FADEL: So Pien mentioned most cases are still among men who have sex with men. Do scientists have an understanding for why this might be the case and why monkeypox hasn't spread much among cisgender women or children?

DOUCLEFF: Yes. So several studies actually recently are starting to answer this question. One of those studies was published in the journal Science. And what they found was that monkeypox spreads at very different rates in different groups of people, and that rate depends on people's sexual activity. Remember, monkeypox spreads primarily through contact during sex. In this study, scientists created a mathematical model of the current outbreak and found that outbreaks are very likely in sexual networks where a small number of people have a high number of sexual partners. Outside these kinds of networks, outbreaks of monkeypox are actually really rare because the virus just doesn't spread very well between people.

FADEL: So it isn't a virus that spreads all that well outside of sex.

DOUCLEFF: Absolutely. You know, a big concern with schools and daycares was largely because the virus can in some instances - very rare instances - spread through saliva. So you can get it by being up close in somebody's face while they're talking or coughing. But another study that came out recently showed that there isn't very much virus found in people's upper respiratory tracts. Instead, the virus particles are primarily located on the skin and in the anus, where the lesions are. Otherwise, there isn't much virus elsewhere.

FADEL: OK, I'm going to turn back to you, Pien. Given the way things are going, is monkeypox still a public health emergency in the U.S.?

HUANG: Yeah, it's still officially a public health emergency, and there's still work to be done. You know, the gains that we've been talking about, the cases coming down - while they're heading in the right direction, they're happening unevenly. And, you know, the most recent CDC data shows that monkeypox cases are down dramatically in white men, but nearly 70% of cases are now being found in Black or Latino men. All of this means that the outbreak could still use the national resources, the national coordination that comes with being a public health crisis.

FADEL: Do we know why the numbers are much higher among Black and Latino men? Is this access to health care or...?

HUANG: You know, we've seen the same thing with COVID, where the people with the education, the resources, the networks get access to the resources and the vaccines first, and then you're sort of left with a more diffused group of people who are harder to reach, who aren't necessarily connected in the same way to all the resources. So I think that's what we're seeing now. I think that's what I've heard from other experts as well.

FADEL: So at this point, with enough time, does the U.S. have a shot at getting rid of monkeypox?

HUANG: There are a lot of different opinions on this. Dr. Jeffrey Klausner, for one - he's an infectious disease doctor at the University of Southern California - he's super optimistic.

JEFFREY KLAUSNER: I think we can expect to see, you know, certainly, you know, regional elimination, potentially national elimination, where we would not see a sustained number of cases.

DOUCLEFF: So this is Michaeleen. I want to jump in here and push back a little bit, because I think there are several reasons why eliminating this virus is going to be really hard, perhaps impossible. For starters, there's good evidence now that the virus spreads cryptically. That is, some people have monkeypox but don't know it. They're either asymptomatic or have very mild symptoms, but they are still contagious. And when a disease spreads this way - so hiddenly (ph), kind of hidden transmissions - it can be extremely difficult to eliminate, as you can imagine. On top of that, you know, monkeypox cases are still rising in many countries around the world. Outside North America and Europe, people have had very little access to the vaccine. Over in Nigeria, monkeypox has been spreading in people for seven years and, for most of that time, almost completely under the radar. And yet the country still hasn't been offered any vaccine. You know, as long as monkeypox in these other countries spreads this way, it is likely going to be a problem here in the U.S., at least at some level.

FADEL: And Pien, is that your sense as well?

HUANG: Yeah, I think that viruses can be really, really hard to predict. And we're now hearing of some evidence that the monkeypox virus is going through huge changes as it spreads, and we don't really know what those implications are yet. So a lot of the people that I've talked with said they can certainly see how the U.S. can get to a place where monkeypox is not necessarily a public health emergency of national concern but is still a problematic disease that looks like a lot of other STDs.

FADEL: NPR health correspondents Pien Huang and Michaeleen Doucleff, thank you so much.

DOUCLEFF: You're welcome.

HUANG: You're welcome.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

Leila Fadel is a national correspondent for NPR based in Los Angeles, covering issues of culture, diversity, and race.
Pien Huang is a health reporter on the Science desk. She was NPR's first Reflect America Fellow, working with shows, desks and podcasts to bring more diverse voices to air and online.
Michaeleen Doucleff, PhD, is a correspondent for NPR's Science Desk. For nearly a decade, she has been reporting for the radio and the web for NPR's global health outlet, Goats and Soda. Doucleff focuses on disease outbreaks, cross-cultural parenting, and women and children's health.