The monkeypox outbreak poses a key question for a world weary of fighting coronaviruses.
The answer is reassuring. Experts said in interviews that most children and adults have healthy immune systems. There are two high-risk groups.
Babies younger than six months are included. They are not currently affected by the outbreak. Studies suggest that many older adults are protected from the monkeypox virus by the decades-old vaccine.
Older adults who have beenvaccinated are likely to escape with only mild symptoms.
The director of the National Institute on Aging said that even those who werevaccinated a long time ago still have high levels of antibodies.
He said that the protection should still be there even if they werevaccinated 50 years ago.
In the United States, the routine immunization for smallpox stopped in 1972. The vaccine program was continued until 1991 because of a bioterrorism attack.
The Biden administration's top adviser on infectious diseases said that questions about the vaccine's resilience rose after an attack. He said that it was reasonable to assume that most people were still protected.
Dr. Fauci said that it was not certain if a person who was vaccined against smallpox would still be protected against monkeypox.
The monkeypox outbreak has grown to include 260 confirmed cases and scores more under investigation in 21 countries. The first symptom of the infection is a rash in the mouth, followed by the palms of the hand and soles of the feet, and then the rest of the body. The rash grows into blisters.
Close contacts can be at risk because of the live virus in each pustule, and a rupturing blisters that can affect bed linens and other items. People who have the virus should be careful about rubbing their eyes.
Mark Slifka, an immunologist at Oregon Health and Science University, said that before the vaccine was developed, the number one cause of blindness in the world was smallpox. He said that people with infectious diseases are contagious until they have healed their wounds.
The current outbreak of monkeypox is unlikely to cause a large epidemic, as emphasized by Dr. Slifka and other experts.
Anne Rimoin, an epidemiologist at the University of California, Los Angeles, who has studied monkeypox in Africa, said that they are lucky to have vaccines and therapies.
Doctors have a window of at least five days after exposure to vaccine and Monkeypox to treat the disease. The approach, called post-exposure prophylaxis, is not an option for Covid patients because the coronaviruses can start to ravage the body just a couple days after exposure.
In the absence of symptoms, the monkeypox virus does not spread. Dr. Rimoin said that the outbreak should be contained by careful monitoring, isolation, and contact tracing.
A majority of those who have been diagnosed are men under 50, and many of them identify as gay or bisexual, which may reflect the outbreak's possible origins at a Gay Pride event in the Canary Islands. Experts said that the outbreak could have started among heterosexual people at a large event.
There have been no deaths reported. Experts are concerned about close contacts who are children, older adults or have weak immune systems.
There are differing opinions on how long immunity from a vaccine lasts.
David Daigle, a spokesman for the Centers for Disease Control and Prevention, said in a statement that the agency only recommends boosters of the vaccine for people at risk of exposure.
Until we know more, we will use vaccine stocks for people who have had close contact with known cases, and people at highest risk for exposure through their jobs.
The United States and several European countries have begun immunizing patients with ring vaccinations.
Many of the most vulnerable groups are already protected. Some of the volunteers in the study had been immunized decades earlier, including one who had been immunized 75 years before. Most of them had high levels of immunity to the disease.
In a study, Dr. Slifka and his colleagues showed that after 92 years, even a single dose of the vaccine does not cure the disease.
Dr. Ferrucci and his colleagues at the N.I.H., as well as other teams, have found that antibody levels persist for decades after vaccination. Some studies have found that the immune system does not always work as it should, but that the immune system can still protect against monkeypox.
It would make sense to immunize anyone who has been exposed to the disease regardless of their previous vaccinations because of its high mortality rate, according to an expert.
She said that they wouldn't want to take the chance that someone was left protected.
She said that it is not necessary now.
What is the cause of monkeypox? There are parts of Central and West Africa where monkeypox is endemic. It is not as severe as smallpox. The Centers for Disease Control and Prevention says that it was discovered in 1958.
What are the symptoms? People who have been bitten by the monkeypox may have a rash that starts with a red mark and then gets raised and filled with saliva. Symptoms can take as long as three weeks after exposure to show, and can last as long as four weeks. Health officials say there are ways to control an outbreak.
How infectious is it? Body fluids, skin contact and respiratory droplets are some of the places where the virus can be spread. It has spread in unusual ways this year, and among populations that have not been at risk in the past.
Should I be concerned? There is a high chance that the virus will be spread during sexual contact, but there is a low chance that it will be transmitted in other ways. The virus can be fatal in a small percentage of cases, but most people recover within weeks.
There is no evidence that the vaccine can protect against monkeypox. The answer would require study participants to be deliberately exposed to a related virus, an unethical experiment.
The newer vaccines and drugs have been tested in animals.
Gathering evidence during an outbreak is one way to study the vaccine's effectiveness. Dr. Slifka's team did just that in 2003 when dozens of Americans were exposed to monkeypox after being exposed to prairie dogs.
28 people who had been exposed to the prairie dogs had their blood drawn by the researchers. Of the eight people who had previously beenvaccinated, five developed an average of three blisters, compared with 33 unvaccinated people.
The other three people had no symptoms at all.
A study found that the father of the family who was previously vaccine free developed two monkeypox scars compared with 200 for the unvaccinated mother. Their unvaccinated 6-year-old daughter was in a coma for 12 days and had about 90 lesions.
As the number of cases worldwide has risen, questions about vaccine protection against monkeypox have taken on more significance. There have been about 200 confirmed cases and 500 suspected cases of monkeypox in Nigeria.
There have been 58 deaths and over 1,300 suspected cases in the Democratic Republic of Congo since the beginning of the year.
The last few years have seen the emergence of monkeypox in African villages.
One of the greatest achievements in public health is the eradication of smallpox, which has left populations vulnerable to the virus and its cousins.
A rise in population and increased proximity to wild animals may result in more frequent monkeypox outbreaks according to Dr. Rimoin and her colleagues.
Unrestrained outbreaks would give the virus more chances to acquire new genes that would make it more resistant in people and animals.
If monkeypox were to establish itself outside of Africa, the public health risk would be enormous.
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