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The first suspected case of monkeypox in the U.S. was reported on May 17, and the CDC has reported 7,000 cases of monkeypox nationally since June. Last week, the Biden administration declared monkeypox a public health emergency.

While cases thus far have been concentrated primarily among gay and bisexual communities, the World Health Organization has outside those communities.

So could monkeypox threaten kids in daycare centers or schools? Can the virus be transmitted on dollar bills or door handles?

Clinicians at Duke University in Durham, North Carolina, took on questions to debunk misconceptions about the U.S. monkeypox outbreak in an online webinar. Participants were:

• Cameron Wolfe, MBBS, MPH, associated professor of medicine, Duke Infectious Disease Clinic
• Ibukun Kalu, MD, assistant professor of pediatrics, Duke University School of Medicine
• Vincent Guilamo-Ramos, PhD, MPH, RN, dean, Duke University School of Nursing

Questions were presented by webinar moderator Gregory Phillips, director of global communications for the university. Responses below have been edited for clarity and brevity.

What do we know about the symptoms of monkeypox and who gets it?

"This is a virus that is most closely related to smallpox but ," said Wolfe. "It starts as a flat, red rash that moves into, classically, a blister. As it evolves, that blister actually becomes more of a firm pustule, often quite painful."

Over a period of 2-3 weeks, the blisters will dry out, the dead skin will peel, and once the blisters have healed, "that's when we think people are no longer infectious," he noted.

The virus is unique in that it is spread mostly through "close, intimate skin-to-skin contact," Wolfe explained. "We've seen that intimate contact mainly, so far, occurs actually through sexual networks and partner networks; friendship networks dominated so far by men, particularly men who have male sexual partners [men who have sex with men or MSM]."

He cautioned that there is "nothing about how the virus moves that cares about your gender, who you love, who you hang out with. There's no reason this needs to stay in those populations."

What should people do if they suspect they have monkeypox?

"I think the is really important here, because not only does it help the individual know that they're positive or not, it also helps us set up contact tracing," Wolfe said.

Testing is "readily available" at , , and . An individual's blisters are swabbed and results are returned in 24-48 hours to get results.

Is the monkeypox virus airborne like the COVID-19 virus? What about via the exchange of cash or using a door handle?

Wolfe stressed that "I would caution people against sort of falling into the trap of assuming that, just because you find residue of virus on a respiratory tree, that that is a means of how it transmits ...that is not the case here."

"When you look at the way that [monkeypox is] transmitted, it is overwhelmingly skin-to-skin contact and intimate contact and prolonged contact," he said.

As for things like currency and door handles, that type of "...seems overwhelmingly the least likely way that this transmits," Wolfe stated.

Does the smallpox vaccination offer protection against monkeypox?

Unlike the current vaccine, , the old smallpox vaccine, , was a living vaccine that created small pustule on the shoulder, and left behind a scar. ACAM2000 is rarely used in treatment and prevention today, Wolfe said. But the ACAM200 vaccine, "does likely confer some memory, and some protection, but we don't exactly know how much," he said.

How long ago a person received ACAM200 is relevant, he added. Wolfe advised that for "someone who's had a meaningful exposure...you should go ahead and get one of the newer vaccines, the Jynneos vaccine. They have been studied in sequential order and we know that giving both is safe ... And we guarantee that you get a much better response, I think, in that [you're getting] sort of more antibodies here right now."

Also, Jynneos is a non-replicating virus instead of a living vaccine, so it is safer in anyone over age 18, pregnant individuals, and people who are immunocompromised, he said.

Could a new discussed among officials -- dividing the current vaccine dose into fifths, and delivering it as an intradermal injection rather than a subcutaneous one -- be effective in stretching vaccine supply?

Wolfe stated that the "immune system of the finest layers of the skin is really very well primed to receive foreign things like a vaccine and respond quite vigorously. So it is true that you need less of the vaccine to make the same response," but he warned that, to date, he hasn't seen any data in the public space for dose-sparing with the Jynneos vaccine.

"So, I think whilst the theoretical immunologic background behind that [dose-sparing strategy] is really strong... I would want the FDA to show us data, or the company [manufacturer ], to support that approach, before I think it would really take off."

What data are there on the safety and effectiveness of available treatments in children?

"There's not a lot of data," in the pediatric population, explained Kalu, and there seems to be fewer resources dedicated to research on monkeypox in children, she noted.

She conceded that the "advantage here is that there is a vaccine [Jynneos]...that was already approved prior to this [monkeypox] outbreak...and although it's not yet approved for use in children less than [age] 18...we have ways to account for appropriate dosage in children to provide the antiviral medication or, if necessary, to provide the vaccine."

She also stressed that there are certain groups of children who may be particularly vulnerable to monkeypox infection, such as "children with a history of skin inflammation, eczema being one of them; younger children -- so children less than 8 years of age and particularly infants who might have household exposure...or happen to be positive -- and children with any immunocompromising condition may be more likely to require treatment... and potential vaccine options."

Is it a misconception that monkeypox could spread in daycare centers and schools?

Kalu stressed that "children can get infected. And it's still important to ensure that a new rash, potentially a new rash, plus fever, is assessed properly."

She noted that adults working in childcare settings and schools likely have the highest risk of spreading the virus to children if they are infected, so it is important that these adults seek care if they notice a new rash, or have a fever, or an exposure, before returning to work in those settings.

"I think if we emphasize those actions -- so ensure your child gets evaluated if they're ill ensure; that adults are seeking proper care -- I doubt that schools will be the main site for spread," she said.

Kalu warned against stigmatizing any person with a skin condition and assuming it's monkeypox: "Policies around school attendance or daycare attendance should allow room for medical evaluation but not carte blanche remove kids from those settings with any potential skin inflammation," she stated.

How do you raise awareness that monkeypox is spreading among MSM without bolstering the misconception that that is the only way it could spread?

Guilamo-Ramos called it "critical" to focus on fact-based messaging that doesn't seek to blame individuals who become infected with monkeypox.

Often messaging can be medically accurate, but lacks guidance, and therefore isn't as helpful to the groups that it is trying to support, he explained. "We need to think about close contact and ... individuals that may be having multiple sex partners."

"We also need to , and that they can continue to have sex, even within the context of monkeypox, that will reduce their risk. And I think oftentimes, that kind of messaging is more realistic. It's less stigmatizing. It takes away from blame and it allows us to work side-by-side in trying to prevent monkeypox," Guilamo-Ramos said.

The WHO has an initiative aimed at changing the name of the virus to help reduce stigma. Will it make a difference?

"I'm not sure that the issue is really with the name," Guilamo-Ramos said, pointing out that "it is possible that anyone can be infected, and there's no reason why, given close contact, that we wouldn't see transmission [in other groups], but that there is a chance that there could be a kind of framing of this as a 'gay disease,' and with that comes the potential for stigma."

He emphasized that what "we need to do is think about this as being a public health emergency that has the potential to spread beyond a specific community."

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