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The Centers for Disease Control and Prevention updated its guide last week for travelers looking to protect themselves against monkey disease. it was one of your recommendations: “Wear a mask. Wearing a mask can help protect you from many diseases, including monkeypox.”

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“The CDC has removed the mask recommendation from the monkeypox travel health notice because it causes confusion,” the agency said in a statement Tuesday.

However, the agency still says that “households and healthcare workers” should consider wearing masks in countries where monkeypox has spread. This guide also applies to “other persons who may be in close contact with a person who has been confirmed to have monkeypox”.

The turnaround points to a less-discussed aspect of the current monkeypox epidemic: The virus can be airborne, at least over short distances. Experts said in interviews that while airborne transmission is only a minor factor in the overall spread, there is no firm estimate of how much it contributes.

More than a thousand people have been diagnosed with the virus in 31 countries since May 13, when the first case was reported in the epidemic, and at least a thousand more cases are being investigated. United States on Tuesday had recorded 31 cases in 12 states and the District of Columbia.

In previous outbreaks, most cases were reported in those who had close contact with an infected patient or animal. But in some cases, airborne transmission was the only explanation for infections.

elsewhere on the websiteThe CDC still urges people with monkeypox to wear a surgical mask, “especially those with respiratory symptoms.” He also asks other household members to “consider wearing a surgical mask” when near the person with monkeypox.

It is assumed that the Monkeypox behaves like its viral cousin, smallpox. in 2012 review A specialist in viruses at the University of Maryland, Dr. Donald Milton described several instances of smallpox transmission.

That was the only plausible explanation at the time. 1947 epidemic He wrote when a patient in New York apparently infected another patient at a hospital seven floors away. Then, in 1970, a single patient infected several people on three floors of a hospital. in MeshdeGermany, with the help of air currents in the building.

And scientists reading 2017 monkeypox epidemic Cases of transmission were observed in a prison in Nigeria, and two healthcare workers who had no direct contact with patients were infected.

At a scientific conference organized by the World Health Organization last week, several researchers discussed many unknowns about monkeypox, including its primary mode of transmission.

“What the actual or predominant route of transmission is is very unclear, and some of it can be addressed in animal models,” said Nancy Sullivan, a researcher at the National Institute of Allergy and Infectious Diseases at the conference. “Probably this needs to take a front seat for some lab research.”

However, in briefings with the press and the general public, health officials possibility of airborne transmission or the use of protective masks.

And in interviews, they highlighted the role of large respiratory droplets expelled from infected patients and drifted onto objects or people. The CDC’s lead expert on the virus, Andrea McCollum, said Monkeypox infection requires “really close constant contact.”

“This is not a virus that can be transmitted from a few meters away,” he said. “So we have to be really careful about how we frame it.”

When asked if paramedics should make the possibility of airborne transmission more common, Ms McCollum said: “This is a fair point and it’s definitely something we need to consider moving forward.”

The CDC’s quick facial expression on masks for travelers concerned about monkeypox reminded them of their early denial that the coronavirus was transmitted through the air. In September 2020, the agency published guidance on airborne transmission of the virus and subsequently suddenly withdrawn only days later.

Agency until May 2021 accepted He said the coronavirus could “hang in the air for minutes or hours”.

Most information about the monkeypox virus has been gathered from studies on smallpox. For the past two decades, scientists have been investigating how smallpox spreads, including its presence in tiny droplets called aerosols, to prepare for its potential use by bioterrorists.

“Most people think that smallpox is usually transmitted by large droplets, but for whatever reason, it can sometimes be transmitted by aerosols of small particles,” said Mark Challberg, a virologist at the National Institute of Allergy and Infectious Diseases.

Dr. Milton cautioned that planning for potential airborne transmission of monkeypox is particularly important in hospitals, as measures to prevent the spread of viruses via aerosols are not universal.

As the monkeypox epidemic continues, many patients are isolated at home because their symptoms are mild. Members of these households may need to consider the possibility of airborne transmission, experts said.

There are many unanswered questions about monkeypox, including why the current outbreak has produced only relatively mild cases. Scientists do not know whether people can transmit the virus even in the absence of symptoms, how long the virus has been circulating in populations, and whether it can be transmitted through semen or vaginal secretions.

There is evidence that a pregnant woman can pass the monkeypox virus to her fetus. inside observational study Five of the 216 patients, the largest of their kind in the Democratic Republic of the Congo, miscarried in four of the pregnant women. Researchers found viruses and viral lesions in fetuses.