Monkeypox: Lessons learned about ‘stigma’ disease

Monkeypox cases were declining by year’s end, but some observers believe progress could have been swifter.

In the U.S., about 27,635 cases were reported in late October, about 85% down from the peak at the outbreak, reported Demetre Daskalakis, MD, White House National Monkeypox Response deputy coordinator. However, he added, “the outbreak is really concentrated in communities of color, specifically among Black individuals.”

The CDC reported on a clinical consultation for 57 hospitalized patients with severe manifestations of monkeypox, most of whom were Black men with AIDS. Delays had been observed in initiation of monkeypox-directed therapies. Twelve patients died, and monkeypox was a cause of death or contributing factor in five patients to date, with several other deaths still under investigation.

As a result, CDC advised clinicians to consider early treatment with available therapeutics for those at risk for severe monkeypox disease, particularly patients with AIDS. Engaging all persons with HIV in care remains a critical public health priority.

According to one U.S. epidemiologist, the monkeypox experience demonstrated that the world has made little progress since the 1980s AIDS epidemic. “As with the AIDS epidemic, sluggish responses from governments and international institutions, plus outright homophobia and bureaucratic bumbling, have hampered efforts to contain the outbreak,” wrote Gregg Gonsalves, an epidemiologist at the Yale School of Public Health in New Haven, Connecticut, in a commentary in Nature. “Very often, humanity has the ability to prevent and treat infectious disease; not doing so is a political choice.”

That said, public health officials around the world were applying lessons learned from the AIDS epidemic to monkeypox. “Local staff in the most affected states [in Nigeria] have reported that stigma, connected with commentary from across the world blaming gay people for monkeypox, is discouraging some people from seeking care,” said Dr Leo Zekeng, UNAIDS Country Director and Representative in Nigeria in August. “State Health officials are working to ensure that staff at health clinics are sensitized to break down such stigma, and not to reinforce it. State Ministry of Health officials are also embarking on community sensitization on monkeypox, emphasizing identification of symptoms, prevention and the need to get tested.”

In September, the U.S. FDA made a significant step forward in early detection of monkeypox by authorizing emergency use of in vitro diagnostics for the detection or diagnosis of monkeypox. These diagnostics may detect the monkeypox virus specifically or more generally detect non-variola orthopoxviruses, which include monkeypox virus.