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Fact Check-What do we know presently about masks and monkeypox?

On June 6, 2022, the Centers for Disease Control and Prevention (CDC) removed a mask recommendation from its monkeypox travel notice to avoid "confusion" over the disease (here). The retraction of mask guidance for travelers led to speculation and confusion online as to how monkeypox is transmitted and what methods are effective to mitigate the disease.

One user took to social media and said: “That the CDC is telling people to wear masks to stop the spread of monkeypox, when monkeypox ISN’T EVEN AIRBORNE just shows you how much the people who “follow the science” actually follow the science” (here).

Users commented underneath the post making claims about how the virus is transmitted.

One user added in the comments: “It’s frickin [sic] sexually transmitted!” Another said: “Yet the only way to get it is through touching the sores.”

Another user claimed that the initial suggestion by the agency that travelers wear masks to protect against "many diseases, including monkeypox" was proof that “it's never been about science and has only been about control” (archive.ph/wip/cS6ZF).

Reuters consulted experts in infectious diseases to determine what we know about the transmission of the virus and ways to mitigate the spread of the monkeypox disease.

Monkeypox belongs to the Orthopoxvirus genus in the Poxviridae family and is a cousin of smallpox (here).

“Transmission is mediated by close physical contact: Sources of infection include skin lesions, oral mucous membrane lesions (e.g. oral ulcers), and respiratory droplets,” Dr Sameer Elsayed, Professor in the Division of Infectious Diseases (Department of Medicine), Division of Microbiology (Pathology & Laboratory Medicine), and Department of Epidemiology and Biostatistics at Western University, told Reuters.

“Transmission is from skin to skin if there is a break in the skin (pre-existing skin lesion or through a scratch or bite), skin to mouth (by direct contact of the mouth with a skin lesion or by touching a skin lesion and then the mouth or the nostril), mouth to mouth (spread from infected oral secretions/ulcers or by a pox lesion on the face), and by respiratory droplets (cough, sneeze, speaking) which enter the nasal cavity, oral cavity, and/or lungs” (here), (here).

Reuters has previously debunked the claim that monkeypox can only be spread between men who engage in sexual relations with other men (here).

Elsayed said that a sexual act is not required for monkeypox virus transmission, although the risk is higher with sexual activity if there is exposure to oral secretions or skin lesions.

Dr Hugh Adler of the Respiratory Infections Group, Liverpool School of Tropical Medicine, who performs patient care for those who are confirmed or suspected to have monkeypox, told Reuters: “Spread in sexual networks has not been identified before, but is plausible based on the known transmission mechanisms of the virus (i.e., closer personal contact); whether there is anything more directly related to sexual contact that drives transmission is another important research question.”

While the virus can be transmitted through close contact during sex, it can also be spread by touching material used by an infected person, their coughs and sneezes, or other skin to skin contact (here).

“We have no reason to suspect it can become airborne or linger in the air,” Adler said.

Adler explained that respiratory droplet transmission differs greatly to aerosol or airborne transmission. According to Adler, the virus probably transmits via large respiratory droplets the same way as other non-respiratory viruses such as chickenpox, but it is likely that direct close contact is a more important way of transmission.

“Tiny aerosols (airborne particles) from the lower respiratory tract remain in the air for longer - there is currently no evidence for monkeypox being transmitted via this route,” he added.

Adler also mentioned that he “can’t see mask-wearing on its own being a silver bullet against monkeypox acquisition. As a clinician performing patient care to people with suspected or confirmed monkeypox, I wear a mask as part of a whole suite of PPE; a mask by itself would confer minimal protection.”

“For people out and about, or travelling, the individual risk of having any contact with somebody with monkeypox remains incredibly low. Therefore, wearing a mask solely to prevent monkeypox acquisition in this context isn’t particularly rational. If people feel more comfortable wearing masks for other reasons (e.g., COVID concerns on a crowded plane), this remains valid.”

When in close contact with a known or suspected case, surgical masks are recommended, “given that droplet transmission is one of the common modes of dissemination,” Elsayed said.

A representative for the CDC confirmed to Reuters via email that the mask recommendation on its monkeypox travel notice had been removed after causing confusion.

“Travel Health Notices inform travelers and clinicians about current health issues that impact travelers’ health, like disease outbreaks, special events or gatherings, and natural disasters, in destinations around the world,” the statement read. “In countries where there is a current monkeypox outbreak, CDC continues to recommend masking in high-risk situations including for household contacts and healthcare workers, or for other people who may be in close contact with a person who has been confirmed with monkeypox.”

On June 8, 2022, the World Health Organization (WHO) said that more than 1,000 cases of the disease had been reported to the organization in the current outbreak outside the countries in Africa where it more commonly spreads (here).

This article was produced by the Reuters Fact Check team. Read more about our fact-checking work here.

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