Man Catches Monkeypox at ‘Crowded Outdoor Event,’ Heightening Concerns About Outdoor Transmission
Monkeypox cases continue to spread across the U.S. And, while cases have mostly been spread through sexual contact in men who have sex with men, there have been stories of people getting the virus in other ways.
Now, a new report from the Centers for Disease Control and Prevention (CDC) details how a man contracted monkeypox from dancing at a “crowded outdoor event.”
According to the report, the man developed his first lesion and a rash about two weeks after he went to a “large, crowded outdoor event at which he had close contact with others, including close dancing, for a few hours,” the report says. The event wasn’t a rave and wasn’t attended specifically by people identifying as gay or bisexual, the report notes.
The man didn’t have any fevers, chills, headache, lymph node swelling, cough, fatigue, or anus or rectum pain before the rash developed.
He went to the ER seven days after developing his first lesion and was diagnosed with monkeypox. According to the man, most people at the event were in sleeveless tops and shorts, but he wore pants and a short-sleeved top.
The man told doctors that he didn’t notice anyone with skin lesions or who seemed sick. The man said he shared an e-cigarette with a woman that he met while there and that he went to similar outdoor events over the next four days, where he drank alcohol. He also didn’t wear a mask and, the report notes, he petted a few dogs (who we now know can get monkeypox) along the way.
The man didn’t report having any recent sexual contact, which led researchers to believe he contracted monkeypox from one of these events. “His case highlights the potential for spread at such gatherings, which may have implications for epidemic control,” the researchers wrote in the paper.
The report raises a lot of questions about the spread of monkeypox and how the virus may spread in the future. Here’s what you need to know.
How monkeypox spreads
Monkeypox can spread to people through close, personal, and usually skin-to-skin contact, according to the CDC. That can include:
Direct contact with monkeypox rash, scabs, or body fluids from a person with the virus
Touching objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox
Contact with respiratory secretions from an infected person
Oral, anal, and vaginal sex or touching the genitals or anus of a person with monkeypox
Hugging, massage, and kissing
Prolonged face-to-face contact
Monkeypox has largely spread in the U.S. during this outbreak through sexual contact among men who have sex with men, says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York. However, there have been a few reports of monkeypox outside people who in this group, including some children (but details are scarce on those cases).
Is it safe to go to crowded outdoor events?
The CDC vaguely addresses this online, noting that “people can get monkeypox if they have close, skin-to-skin contact with someone who has monkeypox.”
“Early indications are that events with activities in which people engage in close, sustained skin-to-skin contact have resulted in cases of monkeypox,” the CDC continues. “If you plan to attend an event, consider how much close, personal, skin-to-skin contact is likely to occur there.”
As a whole, experts say, this report doesn’t change what is known about how monkeypox can spread. Dancing closely with skin exposed can be considered intimate skin-to-skin contact, for example, says William Schaffner, M.D., infectious disease specialist and professor at the Vanderbilt University School of Medicine. Monkeypox can also spread through infected respiratory droplets, which someone might come into contact with while dancing closely with a person, points out infectious disease expert Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security.
But it’s “unclear” what the takeaway should be from this report because it’s a single case, Dr. Adalja says. “Clearly this type of transmission, even though it can occur, isn’t driving cases or there would be more of them and more spread outside the already identified at-risk group,” he says.
Dr. Russo agrees. “I don’t think this changes anything,” he says.
Experts warn that it can be tricky in the medical field to know exactly what a person’s history is when they develop a disease or virus. “You always take sexual histories with a grain of salt,” Dr. Russo says. “People aren’t necessarily fully forthcoming.”
Dr. Schaffner agrees. “Those of us who have dealt with infections transmitted through intimacy have to have in the front of our minds that people don’t always tell you the complete story,” he says, adding that the man in the report “wasn’t put on a lie detector.”
Overall, Dr. Russo says you shouldn’t stress about your risk of picking up monkeypox at a concert or other crowded outdoor event right now. “A very small portion of people in this country have monkeypox and have lesions that are infectious,” he says. “Statistically, the chances of you running into a person with monkeypox at a concert is very low.”
But, Dr. Russo says, if you want to be especially cautious, try to avoid skin-to-skin contact. “Depending on how you’re clothed, you could largely protect yourself,” he says. “People can still go to concerts. You don’t have to freak out and be nervous about this.”
As for other crowded places like public transportation, Dr. Schaffner says you shouldn’t worry about picking up monkeypox there. “I would have no hesitation getting on a subway in New York City, for example,” he says.
In general, Dr. Russo says that people should still be more concerned with another infectious disease. "You should still be way, way more nervous about COVID," he says. “Not only is monkeypox much less transmissible, but it’s much less lethal.”
This article is accurate as of press time. However, some of the information may have changed since it was last updated. While we aim to keep all of our stories up to date, please visit online resources provided by the CDC and WHO to stay informed on the latest news. Always talk to your doctor for professional medical advice.
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