Monkeypox reported in four states

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Monkeypox has been reported among five men in four locations: Massachusetts, New York City, Florida and Utah, where two individuals were reported to be infected. All of the cases reported in the United States involve recent travel outside of the United States. In the case in Massachusetts, the man traveled to Canada. 

President Joe Biden said Sunday, "it is something that everybody should be concerned about."

As of May 21, the World Health Organization said 92 cases have been confirmed globally and there are 28 suspected cases of monkeypox.

The concern, according to WHO, is that cases are being reported in countries not previously known for the virus, and these cases have no established travel links to such areas. Cases have been reported in Portugal, Spain and the United Kingdom. 

WHO called this a "highly unusual event."

"The virus is endemic in some animal populations in a number of countries, leading to occasional outbreaks among local people and travelers," WHO said on Friday. "The recent outbreaks reported across 11 countries so far are atypical, as they are occurring in non-endemic countries. More cases are likely to be reported as surveillance expands."

Genome sequence from a swab sample from a confirmed case in Portugal does show a close match to exported cases from Nigeria to the United Kingdom, Israel and Singapore in 2018 and 2019, WHO said.

The virus does not appear to have changed or mutated, according to the Centers for Disease Control and Prevention. All of the evidence suggests that current cases are closely related to the monkeypox found in West Africa over the last couple of years, CDC officials said during a briefing on Monday.

Most infected individuals recover on their own within a few weeks, according to the CDC. Some people with pre-existing skin conditions such as atopic dermatitis or eczema are more at risk.

"The risk is, we have a strong concern of monkeypox spreading," said Dr. Jennifer McQuiston, deputy director, Division of High Consequence Pathogens and Pathology for the CDC. The best way to stop the outbreak is to isolate infected individuals, McQuiston said.

"There's only a handful of cases in the United States right now. I don't think there's a great risk to the general community in the United States. There is a risk in the community where it is spreading." said Dr.  John Brooks, medical epidemiologist, Division of HIV/AIDS Prevention. 

Monkeypox is currently identified as being spread among gay or bisexual men, Brooks said, but it is not a sexually transmitted disease, nor is it limited to the gay community. Anyone can develop and spread monkeypox, but it spreads differently than COVID-19, requiring close contact with someone who has the virus through respiratory droplets or lesions on the skin. The lesions can appear as a rash or resemble herpes. 

The CDC identifies monkeypox as a rare but potentially serious viral illness that typically begins with flu-like illness and swelling of the lymph nodes and progresses to a widespread rash on the face and body. Symptoms are more flu-like than the coronavirus, Brooks said. 

Anyone with these symptoms should seek medical attention, the CDC said. The presence of the virus can be identified in about two hours and monkeypox can be managed in a regular physician's office.

Vaccines are being given to people who have come in close contact with infected individuals to prevent the virus from spreading.

The CDC has a stock of vaccines for the possibility of needing it for smallpox. Monkeypox symptoms are similar to that of smallpox, although it is reportedly clinically less severe.

There are two vaccines: About 1,000 doses of Jynneos and over 100 million doses of ACAM2000 are available, McQuiston said. The latter is an older generation smallpox vaccine that has side effects, the CDC said.

WHY THIS MATTERS

The CDC is working to give healthcare providers information on identifying monkeypox to manage the virus that seems to have come out of nowhere on the heels of the COVID-19 pandemic.

The current monkeypox outbreak has been circulating for a couple of weeks, possibly months, McQuiston said.

THE LARGER TREND

Monkeypox is believed to have originated in West Africa as a virus transmitted by animals, specifically rodents, to humans, McQuiston said.

Monkeypox reemerged in Nigeria in 2017 after more than 40 years with no reported cases, according to the CDC. Since then, there have been more than 450 reported cases in Nigeria and at least eight known exported cases internationally.

Monkeypox is not new to this country. There was an outbreak of monkeypox in 2003 in imported exotic pets, McQuiston said. A case of monkeypox was confirmed in a U.S. resident who had traveled from Nigeria to the United States, the CDC said in July 2021.

That same month, the American Hospital Association said the CDC recommended clinicians consider monkeypox in patients who had symptoms and who had recently traveled. 

ON THE RECORD

"Many of these global reports of monkeypox cases are occurring within sexual networks," said Dr. Inger Damon, director of CDC's Division of High-Consequence Pathogens and Pathology. "However, healthcare providers should be alert to any rash that has features typical of monkeypox. We're asking the public to contact their healthcare provider if they have a new rash and are concerned about monkeypox."  

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com