NEW YORK - When Pennsylvania State University junior Nick Ribaudo got an email last month saying that a fellow student had tested positive for monkeypox, his first thought was: "Oh boy, here we go again."
Several US colleges have confirmed cases of the virus, raising concerns as students return to campus for the fall semester.
That's especially so as many students, like 22-year-old Mr Ribaudo, saw earlier school years cut short or moved online due to Covid-19.
With about 20,000 cases, the United States outbreak of monkeypox is the world's biggest, spreading through intimate contact mainly among men who have sex with men.
While global rates have shown signs of cooling, dropping 21 per cent in the week ended Aug 21, concerns about the US outbreak are cresting as students return to school, ready to meet and form new relationships.
Two other Pennsylvania schools - the University of Pittsburgh and West Chester University - reported cases in students, while Bucknell University in Lewisburg reported an infection without specifying whether it was a student, faculty or staff.
The West Chester student was identified during the summer term and finished those courses online, a university spokesman said in an email.
Monkeypox doesn't spread like infections that are harboured in sexual fluids, yet it's often transmitted though close, intimate contact with lesions.
Sexual activity is relatively common on college campuses, as are close gatherings in communal spaces like bars and parties.
Bavarian Nordic A/S makes the only monkeypox vaccine. The shots still aren't widely available at schools, said Dr Rebecca Wurtz, an associate professor of health policy and management at the University of Minnesota School of Public Health.
"Monkeypox is here to stay," Dr Wurtz said in an interview. "I think this is one more sexually transmitted infection to be added to the list that people need to be educated about."
While the disease isn't usually life-threatening, there have been deaths reported in other countries.
In the US, Texas late last month reported a possible monkeypox-related death in a person who was severely immunocompromised with other chronic health issues.
Los Angeles County health officials said Friday that they were conducting an autopsy to see if monkeypox infection contributed to the death of a resident.
Mounting, widespread cases are creating anxiety. Washington-based Georgetown University, American University and George Washington University all reported cases of monkeypox within their communities over the summer.
Nearby, the University of Maryland reported a suspected infection. The University of Texas at Austin and Texas State University, some of the state's largest institutions, also confirmed infections. The University of Delaware reported a case in an employee last month, and said its health center has testing and is working to acquire vaccine supply.
Earlier this month, the Biden administration requested US$4.5 billion (S$6.3 billion) in funding to quell monkeypox, with US$1.6 billion of that to pay for vaccines and therapies.
White House health officials met with college administrators across the country to discuss measures to control the spread of monkeypox on campus.
On Sept 1, the US Department of Health and Human Services (HHS) hosted another call with more than 100 university presidents and top health officials from the Centres for Disease Control and Prevention (CDC) and HHS. The CDC also launched a new web page with monkeypox resources applicable to universities and students in August.
The department, which is in charge of vaccine distribution, is not aware of any requests for Bavarian Nordic's vaccine from US universities or colleges, according to an HHS spokesperson.
For now, colleges say education is key to keeping monkeypox at bay. They're advising students to protect themselves by frequently washing their hands, avoiding contact with others who might have the disease, and to self isolate at home if they're showing symptoms.
"Educating the campus community on prevention of monkeypox infection will continue to be the focus of our efforts," said Mr Emilio Carranco, director of the Student Health Centre at Texas State University in San Marcos.
"Information on prevention, testing and isolation has been provided to all students living on campus."
However, there's still uncertainty about how the semester will unfold, and easing the worries of college students will be difficult for colleges and universities, Dr Wurtz said, in part because of the limited supplies of vaccines available to them.
"Are they doing enough? Well, no," she said. "But they're doing as much as they can." BLOOMBERG