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Students pass infront of Royce Hall on the campus of the University of California, Los Angeles (UCLA)

Students have been returning to campus at US universities during the past few weeks.Credit: Al Seib/Los Angeles Times via Getty

For more than two years, universities worldwide have been trying to prevent COVID-19 transmission among their students, faculty and staff. But now another health emergency must be grappled with: monkeypox.

Students are heading back to campus in countries such as the United Kingdom and the United States. In other places, such as Brazil, classes have been in session throughout the global outbreak. Although monkeypox case counts are declining in some locales, university officials are steadfastly putting plans in place to curb the disease. The virus hasn’t been widely circulating among students, and academic institutions aim to keep it that way.

University campuses, in particular, can be hotspots for disease transmission. “Students tend to have a much higher number of social contacts,” says Lior Rennert, the lead public-health strategist at Clemson University in South Carolina. Therefore, mitigation measures are crucial.

At universities starting their term, “you might have a big influx of students from other counties, other cities, other states, other countries”, says Lindsey Mortenson, a physician and chair of the Emerging Public Health Threats and Emergency Response Coalition at the American College Health Association in Silver Spring, Maryland. “A lot of viruses may be mixing and transferring between individuals.”

Many officials are exhausted from dealing with COVID-19. And some universities don’t have any monkeypox-response plans. Nature spoke to officials and researchers at a few that do, about their strategies, lessons from the COVID-19 pandemic and whether those lessons will help to combat monkeypox.

No time to rest

Managing both monkeypox and COVID-19 on campus is like extinguishing fires, says Alexandre Bello, a biologist and the health-vigilance coordinator at Rio de Janeiro State University in Brazil. “We don’t have time to rest,” he says. “All the time, there are surprises.”

Many of the tools for curbing monkeypox are the same as those used against COVID-19, such as frequent hand washing and reducing some social activities. But the diseases are distinct. Monkeypox doesn’t spread as easily as COVID-19; rather than being transmitted primarily through airborne particles, monkeypox mainly spreads through prolonged skin-to-skin contact. That’s because an infected person can develop fluid-filled lesions on their skin, which contain an especially high viral load1.

People wait in line to recieve the Monkeypox vaccine at a mass vaccination site in Brooklyn, New York City.

Monkeypox vaccine clinics in cities can be visited by students from local universities.Credit: Kena Betancur/AFP via Getty

Scientists have debated whether monkeypox is technically a sexually transmitted disease — an infection passed through blood, semen or other bodily fluids — but there is no doubt that the disease can spread during sex, when people are in close contact. During the global outbreak, infections have occurred mostly in men who have sex with men (MSM) and have been linked to intercourse. So, in addition to COVID-19 precautions, universities are providing guidance that having sex with multiple, anonymous or same-sex partners could increase the risk for monkeypox exposure.

This is important knowledge for university students, because dense sexual networks can be common on campus. Messaging about the risks of attending packed gatherings, such as parties, where people might come in close contact, is being disseminated, too — although this route of transmission is rare. And officials warn against sharing clothing, bedding and towels in co-living spaces, such as dormitories and apartments. One study suggests2 that the monkeypox virus can be transferred among people close together in a communal space through such materials, although this is rare too.

Universities say a top priority is keeping students informed about symptoms — which can vary widely3. In addition to lesions, infected people can display flu-like symptoms such as fever, muscle aches and chills. University officials encourage anyone experiencing signs of illness, no matter how minor, to get tested, whether at their campus’s health centre or local health department. And because the MSM community, a historically marginalized group, is vulnerable to monkeypox, university administrators are working carefully with LGBT+ and other diversity, equity and inclusion organizations to ensure that resources are distributed without stigmatization.

Making sure people don’t shy away from testing is crucial. “We don’t want any student to feel like they can’t declare possible monkeypox,” says John de Pury, the assistant director of policy at Universities UK in London, an organization that represents UK academic institutions.

Resource-limited plans

At the University of Illinois at Urbana-Champaign (UIUC), which has yet to have a monkeypox case, the on-campus health centre will collect swabs from students and send them to an outside reference laboratory, which will return results in a few days. The university has isolation rooms for students to stay in if they test positive.

Awais Vaid, the director of the McKinley Health Center at UIUC, says by the end of August, the university had nearly 500 vaccine doses available to students and community members. Many people who meet criteria set by the Illinois Department of Public Health, including the MSM community, have already come in for the jab.

A reactive to test suspected monkeypox samples inside a fridge at the microbiology laboratory of La Paz Hospital in Spa

Some universities are sending samples to outside laboratories to test them for monkeypox. Here, samples are seen inside a fridge at La Paz Hospital in Madrid, Spain.Credit: Pablo Blazquez Dominguez/Getty

Rio de Janeiro State University, which has reported three employee cases but none among students, is also prepared. Students with suspected infections can be swabbed at a university-affiliated clinic, and the samples are sent to a neighbouring academic institution for testing. Test results should come back in about a day. Those who test positive and need isolated housing accommodations can stay at the university’s hospitals.

But Brazil doesn’t have all the treatment options readily available that US universities do. Only late last month did the country approve the import and use of monkeypox vaccines, and it will receive a small number of doses that are primarily for post-exposure treatment and research studies, according to Bello.

Many universities in the United Kingdom have yet to announce monkeypox protocols because their academic terms do not begin for another few weeks. Universities UK plans to publish its monkeypox guidelines later this month, says de Pury. These are being developed in collaboration with the UK Health Security Agency and will emphasize effective and de-stigmatized communication about the disease.

Neglected disease

Although many universities are grappling with monkeypox for the first time, the disease is nothing new for institutions in the Democratic Republic of the Congo (DRC). Monkeypox outbreaks have occurred there for decades, and the DRC is where monkeypox was first identified in humans in 1970.

The University of Kinshasa, in the DRC, has no explicit policy regarding the disease and follows the national guidelines that are used in hospitals, says Placide Mbala, a virologist at the university. Cases in the DRC have risen since the global outbreak began, largely because of heightened awareness of the disease, Mbala says, but most diagnoses have been made solely on the basis of symptoms. That’s because the country has little capacity for lab testing. The city of Kinshasa has no reported cases at the moment, Mbala says, so officials are on low alert.

However, it could be difficult for the university to deal with a monkeypox case if one arises, he adds.

The DRC has medications to ease symptoms, but lacks approved monkeypox vaccines or treatments, so the country relies on preventative messaging, spread through seminaries and conferences. Further, the DRC does not have funding for adequate monkeypox surveillance.

Despite its prevalence in Central and West Africa for more than 50 years, monkeypox has been neglected there, Mbala says.



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