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Public health experts are urging universities to prepare for the arrival of monkeypox before students return to campus in the coming weeks.

As the current outbreak has rapidly spread around the U.S., five campuses already confirmed cases this summer, even with most students away. Monkeypox is a viral infection that is primarily transmitted through close skin-to-skin contact. It is currently concentrated among communities of gay, bisexual, and other men who have sex with men, but it is not limited to those populations. Schools need to develop a clear communication strategy and plan to identify suspect cases, access testing and vaccines for students and staff, and provide contact tracing services, public health experts said.

“I think universities really do need to prepare, and we’re going to see outbreaks at universities,” said Lawrence Gostin, a professor of global health law at Georgetown University in Washington, one of the five schools where cases have been reported. The others are George Washington University, also in Washington; the University of Texas at Austin; and Bucknell and West Chester universities in Pennsylvania.

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“I’m particularly worried about contact sports, wrestling, football, locker rooms, and particularly sex in dormitories,” Gostin said. While there is guidance from the Centers for Disease Control and Prevention about containing spread in congregate settings, it’s not targeted to colleges and universities. “I think that CDC and local health departments should develop a specific set of guidance for higher education,” he said. “They did that with Covid-19 and I think it’s critically important, particularly because this academic year is just around the corner. We really needed the guidance yesterday.”

Rachel Cox, an assistant professor at MGH Institute of Health Professions who studies infectious disease epidemiology, said parties, dancing, or sharing towels and bedding in dorms can all increase risk of transmission as students seek a traditional college experience. Speaking about the CDC guidelines, she added, “It’s really going to be up to the schools to figure out the best way to disseminate this information to their students.”

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Many schools have begun preparing for cases. A spokesperson for Georgetown said the university’s Student Health Center and university hospital will work together “to identify, test, and manage suspected and confirmed cases.” Students and staff will be able to get tested at the campus health center.

A spokesperson for Johns Hopkins University said administrators are “closely monitoring the situation and having conversations with the Maryland Department of Health regarding monitoring of cases, testing, contact tracing, and procedures for treatment of infected individuals.” Like with Covid, they have also assembled a group of public health and medical professionals to guide their response.

Cox said that schools should prepare onsite clinicians for testing and try to acquire tests from large lab service providers. The American Clinical Laboratory Association said on Sunday that five laboratories nationally have capacity to test up to 70,000 patient samples per week, which is more than current demand.

Cox also said colleges should stockpile gloves and gowns that would be required when treating a student with monkeypox, find local sites that offer vaccinations, and establish protocols for in-house contact tracing and isolating students safely.

The University of North Florida put up an informational website, focusing on guidance for students who suspect they have the virus based on initial viral symptoms like having a headache, fever, sore throat, chills, or upon spotting lesions. Valerie Morrison, director of Student Health Services, said UNF will rely on some of the same health experts, committees, contact tracing, and deep cleaning protocols put together over the last two years for Covid to formulate a monkeypox response plan.

“Covid really set out a great template of how community resources need to work together,” she said. “We have a great mechanism in place.”

A University of South Florida spokesperson said the school is focused on promoting messaging about safe sex. If a case is identified, the Florida Department of Health would be contacted to conduct contact tracing.

Northwestern University released a statement stating that it does not expect a large number of monkeypox cases on campus. It will provide initial assessment, diagnosis, and treatment, but refer students to community partners for vaccination and contact tracing. Students living in on-campus housing must isolate off campus for the two- to four-week recovery time when they are contagious from the time symptoms of lesions start until all rashes or lesions have fully healed. There will be a limited number of rooms for students to isolate on or near campus.

With more information about monkeypox (which isn’t a novel disease like Covid), an approved vaccine (though the supply is limited), and medications already available, campuses should be better equipped to handle the situation.

“It’s really important to learn from mistakes and pitfalls we made during Covid … not moving quickly enough to kind of contain spread,” Cox said. “I think it’s really important that campuses get committees together to discuss the best way to get this going before students come to campus in the fall.”

Unlike Covid, there is not a need to regularly test all students. There is, however, a greater need for cleaning surfaces and stigma-free messaging.

“The first thing we need is really good public health communication and messaging in ways that’s informative, but at the same time, supportive and non-stigmatizing,” said Gostin, who is also a director of the World Health Organization’s Center on Global Health. He said communication needs to include messaging focused on individuals at highest risk. Having lived through the AIDS pandemic, he said this “deeper engagement with affected communities is the absolute secret sauce to an effective strategy.”

“The monkeypox virus is targeting a certain community [now] … but this is a virus that anybody can get, and we are very clear on that in our social media posts,” Morrison said.

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