(CNN) — With nearly 9,000 confirmed monkeypox cases nationwide, there is growing concern that US college and university campuses could become monkeypox "hotspots" this fall.
Educators are working to reduce the public health risk while some students worry about how their campus experiences might be affected by the virus -- a virus that the nation is still trying to control and that was recently declared a national public health emergency.
"As we head into the fall, I'm concerned about outbreaks on college campuses as they are often a place where individuals engage in higher risk sexual activity and are in close contact with many different people," Dr. Rachel Cox, an assistant professor in the School of Nursing at the Mass General Health Institute of Health Professionals, said in an email to CNN. "We need to make sure we're prepared to allocate resources like tests, vaccines, and antivirals to places that may become hotspots."
Sydney Greenstein, an 18-year-old incoming freshman at New York University, said that while he's excited to begin his college experience, he has concerns about his risk of exposure in New York City, which has one of the highest numbers of monkeypox cases in the country. There are 1,937 confirmed or probable cases in New York City, according to the NYC Department of Health.
"It's definitely put a consideration into school and what my plans are and how I'm going to, you know, be social and interact with people and go out," Greenstein said.
Greenstein will be moving from Maryland to New York at the end of this month to start school and said he has not heard much from NYU about its monkeypox response plans. NYU did not immediately respond to CNN's request for comment.
But some universities told CNN that their response plans involve the infectious disease protocols they already have in place.
A continuation of work
Elon University in North Carolina sees the preparations for a potential response to monkeypox as an extension of work the school has been doing.
"We are aware that we may have cases of monkeypox. We have been working on preparing for it since May, so long before it was seen as a problem, and our focus is going to be very much on education, prevention, but we have plans should there be a case," said Dr. Ginette Archinal, medical director of student health and university physician. " 'Concerned' is overstating it, but we are prepared for cases of monkeypox on campus."
Elon's infectious disease response team "has been in preparation mode for many infectious diseases," for the past several years, said Jana Lynn Patterson, Elon's associate vice president for student life and dean of students.
Archinal and Patterson make up the leadership team of Elon's Infectious Disease Response Team.
The school had a mumps outbreak in fall 2019, which Patterson said made them better prepared for Covid, and they see the monkeypox response as "a continuation of our work."
"We have some basic infectious disease response protocols, and then we have refined them based on the current information we have around specific information or specific needs around a monkeypox case or an outbreak," she said.
The protocols cover several areas including isolation should it be needed, academic support, educational support and making sure clinical and health staff are up to date around assessments. Archinal and Patterson also stressed the importance of their relationship with the local health department and health system.
They were very intentional during Covid that any policies or protocols that were created could be applied to any infectious disease that came up in the future.
"Elon has protocols for this type of infectious disease that are deliberately designed to be tweaked based on what may be emerging," Archinal said. "Because why reinvent the wheel at the last minute every time there's an outbreak when you can have a solid, firm plan in place that you just tweak to make appropriate for each one, and that's really about the preparation."
According to the CDC, there are 111 monkeypox cases in North Carolina as of August 8.
Opportunities for monkeypox to spread
Elon is not the only school that intends to focus on education about the virus. At Florida A&M, there is some concern about monkeypox spreading on campus.
Students there "like engaging in a lot of different activities and socializing and everything, so I think there are certainly opportunities for monkeypox to be spread amongst the population," said Tanya Tatum, director of student health services at Florida A&M.
Tatum noted that monkeypox isn't like Covid-19, which primarily spreads through the air. But officials know that students engage in intimate activities. A recent study found that among 528 infections diagnosed during the current outbreak, 95% were suspected to have been transmitted during sexual activity.
The fact that the virus can be viable on inanimate objects such as bedsheets also adds to concerns.
"Some of our students aren't the best housekeepers, how often are bedsheets changed and things like that," she said. "So there is some concern."
The CDC says the most common way monkeypox spreads is from person to person through direct contact with the rash, scabs or body fluids of someone who's been infected. Such contact can happen during intimate activities such as sex. However, the virus can also spread if a person touches an object, fabric or surface that has been contaminated.
The plan at Florida A&M is to embark on an education campaign, Tatum said, so students are aware that the virus is spreading.
Florida A&M will have a website with information up at the end of the week, Tatum said. The plan also includes emails to employees and students, information on the student engagement platform and flyers posted in residence halls.
"Our students start moving back on campus Monday, August 15th. We will be pushing our information starting this week and will provide periodic messaging throughout the semester," Tatum said.
"We want people to understand how it spreads and ways which they can avoid that, either picking it up or spreading it further," she said. "We also want to make sure that they understand and are knowledgeable about what the treatment might be and what to do if they think they may have possibly been exposed."
The University of North Florida is also focusing on education, said Dr. Valerie Morrison, director of Student Health Services.
The university wants to make sure students know what to do when they think they might be sick from monkeypox or another infectious disease. This includes staying home and knowing how to reach student health services or a primary care provider.
The University of North Florida plans to reach students by including educational information on social media platforms like Instagram.
According to the CDC's count, Florida has the third-highest case count in the United States, with 936 cases as of August 8.
Texas A&M is also making efforts to educate its students.
"We have an active webpage and social media content ready to send to our students," Dr. Martha Dannenbaum, director of Student Health Services at Texas A&M, told CNN in an email. "We have well established processes for pushing out educational content to our students which we will continue to follow.
"University Health Centers are intimately involved with public health efforts on their campuses so managing potential outbreaks of monkey pox or other new infectious diseases is part of the work we do," Dannenbaum wrote. "Most (including Texas A&M Student Health) were very involved in the planning and execution of the plans for their campus related to COVID. We can expect a similar response to monkeypox."
Texas has 702 monkeypox cases as of August 8, according to the CDC.
Testing and isolation plans for students
"I think that colleges should definitely have ways to test available and also have solutions and plans for if someone's infected. You know, like what surfaces do they come into contact with a lot? How can they clean that off to minimize the spread?" said Greenstein, the incoming NYU student.
Several universities said they were able to test for the virus, although it often involved an outside lab.
"Currently, tests can only be done at labs authorized to perform the tests," a spokesperson for the American College Health Association told CNN in an email. "College health professionals may collect specimens and send them to these labs if it is determined that a patient needs a test."
The association is working on developing resources to help campuses prevent and manage outbreaks.
Florida A&M, Texas A&M, North Florida and Elon said they can perform tests for monkeypox on campus. In some cases, the specimens will be sent to a partner lab.
When it comes to isolation, North Florida's Morrison said that because of how monkeypox spreads, developing isolation policies can be complicated and may need to happen on a case-by-case basis.
The ways monkeypox can spread -- including through contaminated objects, like laundry, clothing and towels -- affects the mechanics of how a person can effectively isolate in a campus setting.
"If we had to isolate someone on-campus, we would want a room that's a single room that has its own bathroom where a person would isolate, and my recommendation would be that there's no porous-type furniture in there. You wouldn't want an upholstery type of thing, no rugs, because it makes it easier to keep clean afterwards," Morrison said.
Elon's Archinal also said the university can isolate students with monkeypox, should the need arise.
"I have written protocols for my staff on what to look out for, how to manage it. We already have the ability to test for it. We know which lab we send the tests to. We have protocols already in place about when we isolate, who we isolate, what things we look out for and when we notify our health department," Archinal said.
She added that officials have an automated system in place for Covid that notifies the relevant people on campus of which students may need to be taken care of in isolation. The same process, if needed, will be used for monkeypox.
No recommendation for mass vaccination
Colleges have also been considering how monkeypox vaccination might come into play for students.
Archinal and Patterson said Elon is ready if there is a need for a vaccination clinic on campus, and its partnership with the local health department plays into this.
If the vaccine becomes more available, they will consult with the state, and if they and the local health department feel that the school is a good candidate for a clinic, that can be deployed in less than 24 hours, Patterson said, similar to what happened during the mumps outbreak. Many other schools also plan to follow local health department guidelines and policies concerning vaccine distribution.
The CDC has been sending states supply of monkeypox vaccine, called Jynneos, for people who have been exposed to or are at risk of exposure to the virus.
According to the CDC, those eligible for vaccination include confirmed contacts of someone with monkeypox, presumed contacts who had a sex partner in the past 14 days diagnosed with monkeypox, those who had multiple sex partners in the past 14 days in an area where monkeypox is spreading and those who may be exposed to the virus through their job.
Archinal stressed that there is no recommendation from the CDC for blanket vaccination and said Elon will not suggest such a strategy if there is no need. During the school mumps outbreak, although all students had received the standard two vaccines, the health department recommended a booster dose.
"Within 24 hours, they were on campus doing vaccine clinics, booster doses," Archinal said. "Our discussion with the health department is that should that same situation arise and the event there was expanded advice to get vaccines and they were available, our health department would be capable of doing the same thing."
Tatum, at Florida A&M, said that if vaccines become more available, officials there will follow health department guidance. Florida has the vaccine, she said, but it's being distributed and administered through the health department.
She said that if there is a time where there is enough vaccine, the university sees rising numbers of cases and the health department recommends vaccination, "it may be a possibility that we might offer it."
A call for communication
Greenstein, the incoming NYU student, said he hopes that universities proactively communicate with students about their plans to mitigate spread and how they expect monkeypox might affect the school year.
"I would just ask that there's some form of communication," Greenstein said. "This doesn't have to be your top priority -- I completely understand the rush of getting everything ready in time -- but some form of communication would be nice."
He also hopes that his school is mindful of how it communicates information about the virus and does not stigmatize men who have sex with men or imply that the outbreak should only concern this community, which has seen a large majority of the cases in this outbreak.
"I think they should definitely keep in mind that their words have power," Greenstein said. "What they say can definitely be taken in the wrong way."
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