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Experts warn of continued monkeypox spread as hundreds of cases found worldwide

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Enlarge / A negative stain electron micrograph of a monkeypox virus virion in human vesicular fluid.

The multinational monkeypox outbreak continues to pose a low risk to the general public, and, for now, it seems unlikely that cases will mushroom into a global pandemic, according to the World Health Organization and the US Centers for Disease Control and Prevention.

But, experts are concerned that the virus could continue to spread and that transmission may escape containment without an urgent and thorough public health response.

The outbreak tally continues to increase rapidly, with hundreds of cases now reported across at least 23 countries. In an update released Sunday, May 29, WHO reported 257 confirmed cases and around 120 suspected cases from 23 countries. Those figures are already significantly outdated. As of Monday, Our World in Data reported 555 confirmed cases worldwide. On Tuesday, the United Kingdom reported 190 cases, up from the 106 that WHO reported Sunday. Likewise, the US total has increased to 15 cases, up from 10 reported last week.

In a press briefing last Thursday, CDC Director Rochelle Walensky said the agency presumes that there is some community spread of the virus in the US.

Still, in a public presentation guiding clinicians last week, Agam Rao, a CDC infectious disease specialist and poxvirus expert, highlighted that the monkeypox virus is not easily spread. The virus is related to smallpox but causes a relatively mild disease with a telltale rash and is usually accompanied by flu-like symptoms. Transmission requires close and prolonged contact, with the highest risk of spread to health care workers and the family members and sexual partners of infected people. “Monkeypox virus does not have the potential to be a pandemic,” Rao said succinctly.

So far, many of the cases appear to be in men who have sex with men (MSM), and the virus appears to be spreading through sexual networks. But health officials are cautious to avoid spurring stigma or a false sense of security. The virus can spread to anyone, and it is not a sexually transmitted infection specifically.

Moderate risk and continued spread

In its risk assessment Sunday, WHO said the “risk for the general public appears to be low,” and the “overall public health risk at global level is assessed as moderate,” given widespread cases clustering in countries outside West and Central Africa, where the virus is endemic in animals.

“The public health risk could become high if this virus exploits the opportunity to establish itself as a human pathogen and spreads to groups at higher risk of severe disease such as young children and immunosuppressed persons,” WHO said.

In a public webinar Monday, WHO’s technical lead for monkeypox, Rosamund Lewis, elaborated on that assessment, saying: “At the moment, we are not concerned of a global pandemic… We are concerned that individuals may acquire this infection through high-risk exposure if they don’t have the information they need to protect themselves,” she added. “And we are concerned that because the global population is not immune to orthopoxviruses since the end of smallpox eradication that the virus may attempt to exploit a niche and spread more easily between people.”

Health officials are now racing to raise awareness and step up outreach programs ahead of Pride Month celebrations in June. Already spread of the virus has been linked to large events and parties in Europe as pandemic restrictions eased, Hans Henri Kluge, WHO Regional Director for Europe, noted in a statement Tuesday. The virus is suspected to have circulated unrecognized for weeks or longer. Upcoming festivals and large parties could provide further opportunities for the outbreak to amplify.

“We do not yet know if we will be able to contain its spread completely,” Kluge said. “For that, we need a significant and urgent reduction in exposures through clear communication, community-led action, case isolation during the infectious period, and effective contact tracing and monitoring.”

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What’s really at risk with monkeypox?

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Is monkeypox a diversion from the persistent pressures of COVID or is it real? The answer is both.

Unfortunately, the media lens is very wide right now, meaning that we hear about an emerging infectious disease and jump quickly to the worst-case scenario. But unlike COVID-19, monkeypox is neither new nor is it widespread. It is also not a single-stranded RNA virus, which makes it less prone to rapid mutations like flu or SARS-CoV-2.

This particular strain of monkeypox that is capturing the media’s negative imagination traces to an outbreak in Nigeria in 2017-18. It is less virulent or deadly than another kind of monkeypox, which is itself much less virulent or deadly than smallpox. Yet it is smallpox that we think about when we talk about monkeypox, it is smallpox that we have stockpiled hundreds of millions of doses of a vaccine against, smallpox which killed more than 300 million people worldwide in the 20th century alone before the powerful vaccine eradicated it in 1977. Monkeypox is a poor cousin by contrast, though you can still get pretty sick from it with fever, fatigue, body aches and lymph node swelling, followed by a characteristic pustular rash.

But the traditional live virus smallpox vaccines are readily available — in fact, a Department of Health and Human Services spokesperson stated to me we have enough vaccine for all Americans. But actually giving it would be a huge overreaction at this point, with only sporadic cases and limited outbreaks in Europe, the U.S., and the U.K., many of which are still linked to travel or tracing to two big raves among gay and bisexual men in Spain and Belgium. Monkeypox can apparently be spread by sexual contact as well as by close contact with secretions.

It is hardly another COVID, and shouldn’t be thought of the same way, as COVID, by contrast, is approaching the easy airborne transmissibility of measles, with each subvariant being about 30 percent more transmissible than the last.

By contrast, with all the attention it is receiving, monkeypox still has 257 total cases in 23 countries worldwide and only a handful of cases here in the U.S.   

Don’t get me wrong, the real case number is clearly higher when you factor in community spread with milder cases that may be mistaken for flu or another virus, but still, this is not and likely never will be another pandemic. Since its main source of spread is among symptomatic patients it is much easier to follow a standard effective public health protocol than with COVID. Namely, identify, isolate, treat (there are effective anti-virals – TPOXX and TEMBEXA, as well as potentially cidofovir) and ring vaccination of all close contacts.

The Centers for Disease Control and Prevention is closely monitoring the situation here in the U.S., and there is an abundant and growing availability of PCR testing for monkeypox. This is crucial because if we don’t know who has it, we won’t be able to contain and control it. 

Back in early 2020, when I traveled to Dulles airport and the University of Nebraska Medical Center where the first U.S. COVID patients from the Diamond Princess cruise ship were being quarantined, I was among the first to warn that SARS-CoV-2 was a dangerous virus already spreading widely throughout our communities that we had no vaccine or treatment for. What followed defied even the most draconian predictions.  But there is no reason to automatically apply the model of what happened and what went wrong in trying to contain COVID to all emerging infectious diseases.

Monkeypox is a problem, but it is no COVID, and it can be managed by applying the tried and true science and public health we have at our disposal. Hysteria magnifies the problem and helps no one.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”

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Britain urges people with monkeypox to abstain from sex as cases rise

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Test tubes labelled “Monkeypox virus positive and negative” are seen in this illustration taken May 23, 2022. 

Dado Ruvic | Reuters

U.K. health authorities have urged anyone who tests positive for the monkeypox virus to abstain from sex until their symptoms have cleared.

In new guidance released Monday, the U.K. Health Security Agency also recommended that previously infected persons continue to use condoms for a period of eight weeks after the virus has passed, as a precautionary measure.

The health agency said the risks to the general public remain low, but encouraged people to contact a health professional if they notice any unusual rashes or lesions.

The advice comes after Britain recorded an additional 71 cases of the virus over the weekend, bringing the U.K. total to 179 less than a month after its first case was on May 7.

The U.K. now has the highest monkeypox case count among non-endemic countries, followed by Spain with 120 and Portugal with 96.

As of Monday, there were 555 confirmed and suspected cases of monkeypox in countries outside of Africa, according to Our World in Data.

Rising risks of sexual transmission

Monkeypox is a rare infectious disease typically found in Central and West African countries. Symptoms include rashes, fever, headaches, muscle ache, swelling and backpain. 

While the virus is generally mild, usually clearing up on its own within two to four weeks, health experts have voiced concern over the recent spike in cases in countries where monkeypox does not usually spread, and the growing risks of community transmission.

The majority of cases so far have been spread through sex, with a particular concentration of cases occurring within the gay and bisexual communities and men who have sex with men, according to the World Health Organization.

A section of skin tissue, harvested from a lesion on the skin of a monkey, that had been infected with monkeypox virus, is seen at 50X magnification on day four of rash development in 1968. 

CDC | Reuters

The public health body said Monday that it was not yet clear whether the recent outbreak could lead to a global pandemic but said that there is currently a window of opportunity to curb rising cases.

“Collectively, the world has an opportunity to stop this outbreak. There is a window,” Rosamund Lewis, the WHO’s technical lead for monkeypox, said during a briefing.

The WHO also said it is currently considering whether the outbreak should be assessed as a “potential public health emergency of international concern.” Such a declaration was done for the Covid-19 and Ebola outbreaks, and would enable additional research and funding to contain the disease, it noted.

What to do if you catch monkeypox

If you suspect that you may have contracted monkeypox, you should isolate yourself from physical contact with others and seek medical advice immediately.

Initial symptoms of monkeypox include fever, headaches, muscle ache, swelling and backpain. Rashes and lesions then typically emerge on the face, hands, feet, eyes, mouth or genitals within one to five days. Those rashes turn into raised bumps and then blisters, which may fill with white fluid before breaking and scabbing over.

Many of the symptoms of the virus can be easily confused with other diseases, such as chickenpox, herpes or syphilis, however, so medical confirmation is important.

If you are diagnosed with monkeypox, the U.K. guidance is that you will need to isolate until the virus has passed. Close contacts of someone with monkeypox may also be risk assessed and asked to isolate for 21 days.

The illness is typically mild and most people recover within two to four weeks. While medical advice currently varies across countries, the U.K.’s National Health Service notes that you may need to stay in a specialist hospital to prevent infection spreading to other people.

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Pride parades should go on despite monkeypox concerns: WHO

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A World Health Organization (WHO) adviser said on Monday that people should not change their plans to attend pride parades next month amid the increased circulation of monkeypox.

“It’s important that people who want to go out and celebrate gay pride, LGBTQ+ pride, to continue to go and plan to do so,” said Andy Seale, a strategies adviser in the WHO Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes.

WHO experts have pointed to sex at two recent raves in Europe as the leading theory for the spread of the virus, which is endemic in areas of Africa. The agency has said several cases have been reported among men who have sex with men, but cautioned it may be a reflection of “positive health seeking behavior” in that demographic, given that the cases were identified at sexual health clinics.

Seale said at Monday’s public briefing that the organization has linked cases to a number of “social events” in European countries.

“There is no specific transmission route that we need to be worried about,” he said. “It really is connected to the fact there have been a couple of events that have perhaps amplified the current outbreak.”

WHO released public health guidance on monkeypox last week specifically for men who have sex with men. Asked about similarities between the focus on LGBT people in the recent monkeypox outbreak and the HIV epidemic, Seale said WHO has a “lot of lessons learned” from dealing with HIV messaging for years.  

“Given this is not a gay disease, the transmission routes are common to everybody,” Seale said. “The advice is pretty much the same for all people.”

UNAIDS earlier this month denounced monkeypox reporting that included “homophobic and racist stereotyping.”

“It’s challenging to calibrate this, to balance the risk messaging and not unintentionally contributing to stigma,” Seale said.

Seale said close bodily contact is the main risk factor for monkeypox, so condoms will not provide protection. Seale noted that pride parades were not a particular concern because they happen outdoors, while monkeypox has recently been linked to nightclubs and other indoor settings.

“We don’t see any real reason to be concerned about enhanced likelihood of transmission in those contexts, because the parties that we’ve been referring to have perhaps been more in enclosed spaces,” he said.

WHO has reported 257 confirmed monkeypox cases and about 120 suspected cases from 23 countries where the virus is not endemic. The international health group said it was not aware of any deaths caused by the virus’ increased spread.

The virus, which first presents symptoms like swollen lymph nodes and fever but later causes lesions, is related to but less deadly than smallpox. The Centers for Disease Control and Prevention (CDC) suggests the smallpox vaccine is at least 85 percent effective against monkeypox, and the agency has released some doses in response to the outbreak.

Monkeypox spreads through close contact with an infected animal or person, generally through lesions, body fluids, contaminated materials and respiratory droplets, which can only travel a few feet.



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Monkeypox patient in Massachusetts suffered fluid-filled blisters on scalp, palms and feet

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America’s first monkeypox patient this year had ‘smallpox-like’ fluid-filled blisters erupting on his scalp, palms and soles of his feet, doctors say.

The man — who has not been named — was admitted to Massachusetts General Hospital on May 12 with a fever and rash after antibiotics failed to stave off his illness.

Doctors initially believed the patient had chickenpox, a sexually transmitted disease like herpes or even an allergic reaction. But skin and blood tests for these illnesses in the hospital’s specialist lab repeatedly came back negative.

Medics were stumped until the tell-tale blisters burst through his skin five days later, which looked just like those in smallpox.

Dr. Nesli Basgoz at the hospital spotted the similarity immediately, and ordered tests for pox viruses — which eventually led to the monkeypox diagnosis.

The man was the first confirmed case of the virus in the U.S. this year, and the first sign the Europe’s outbreak had crossed the Atlantic to America.

A total of 14 cases of the illness – mostly among gay and bisexual men – have been spotted in the U.S. so far, and there are now signs it is spreading within the country.

Today the World Health Organization (WHO) ratcheted up its threat level from the virus to ‘moderate’ warning if it continues to spread it could reach children and older people who are more vulnerable to the disease.

Doctors only decided to test the patient in Massachusetts for monkeypox after blisters emerged on their skin with an indentation in the middle. (This is a stock image of the symptoms, and does not show the patient)

Monkeypox has now been detected in eight states, with signs that there is human-to-human transmission now happening in the United States

Dr Nesli Basgoz decided to check the patient for monkeypox

Basgoz said the light-bulb moment came when the patient’s blisters formed an umbilication, or dent in their center, which is characteristic of smallpox.

She told the Boston Globe that — despite recognizing this from previous training — she knew it could not be the specific small pox virus because it had been eradicated.

But the blisters led her to check whether any pox viruses were spreading outside of West Africa, where they are native.

Searching the internet early on May 17 she stumbled across an advisory issued by UK health authorities a day before warning they had spotted four cases of monkeypox not linked to travel to West Africa.

‘It was one of those a-ha moments’, she said.

Within two hours of contacting infectious diseases experts at the hospitals about the theory a conference call was held with state health officials.

WHO raises risk from monkeypox outbreak to ‘moderate’ 

Monkeypox’s threat to the world has been upgraded to ‘moderate’ by the World Health Organization (WHO), as the tropical virus spreads to dozens of countries.

The WHO said the explosion of cases with no links to each other or Africa means the current figure is ‘likely to be an underestimate’.

It has warned that if infections continue to happen then vulnerable people and children — who are more likely to die from the virus — could start to catch it.

So far the outbreak, which was first detected in early May, has spread to 24 countries and been diagnosed in 106 Britons, the majority of whom are men who have sex with men.

There are also growing concerns the virus will spill into wild animals and become endemic around the world, as is the case in parts of central and western Africa.

Passing between humans and animals would also raise the risk of monkeypox mutating. At the moment the risk to public health is moderate, but the WHO said it had the potential to ‘become high’.

Tests were launched and later that same day they revealed the patient was infected with a family of viruses that included monkeypox. It was announced to the nation the next day.

The man — who was identified by the state as gay or bisexual — had returned to the U.S. from Canada by car when he was struck by the virus.

But health chiefs still considered it possible he had monkeypox because of the extensive travel links between the continent and America.

Currently, the patient is said to be in a good condition but it can take up to four weeks to recover from the illness.

Since America’s first case was spotted almost two weeks ago another 13 have been detected across seven more states.

They are mostly among gay and bisexual men, the outbreak in Europe — which has now topped 300 cases — likely sparked by unsafe sex at two mass gatherings in Spain and Belgium.

Cases in America were initially linked to international travel, with health chiefs saying there was a ‘very low risk’ of onward transmission.

But over the weekend two infections have emerged that are in ‘close contacts’ of previously detected infections — with no signs of international travel.

This suggests that human-to-human transmission is now taking place in the United States.

Monkeypox is primarily spread through contact with infectious lesions in the skin, although in rare cases it can also be transmitted through the air.

Patients initially suffer a fever up to 21 days after infection, but this later develops into a rash that starts on the face before spreading to the rest of the body.

Most cases are mild and clear up within four weeks. But about one in ten people who catch the virus die, estimates suggest. However, the strain currently circulating is thought to be less lethal with a fatality rate of about one in 100. 

The virus is endemic to West Africa, but in the latest outbreak it has spread beyond the region.

There are concerns it could become established in these areas should it spread into the animal population, which would act as an infection reservoir.

Medics also fear it may spread widely in people because few now have immunity against smallpox — which also protects against monkeypox — with mass vaccination drives abandoned in the 1970s when the virus was eradicated.

It comes as the WHO raised its threat level over the virus to ‘moderate’ today as cases are detected in 24 countries where it is not endemic.

In a risk assessment published on Sunday, they warned that its ‘moderate’ grading could be pushed to ‘high’ if the virus ‘exploits the opportunity to establish itself as a human pathogen’ and spreads to vulnerable groups.

The ‘sudden appearance’ and ‘wide geographic scope’ of cases suggests widespread human transmission of the virus — which spreads through skin-to-skin contact and an infected persons’ droplets — is underway, the WHO said.

It also warned the surge in monkeypox infections suggests the virus ‘may have been circulating unrecognized for several weeks or longer’.

Reported cases have so far been mild but there is a risk the virus has a ‘greater health impact’ if it spreads to at-risk people, including children and immunocompromised people, such as some HIV patients, who ‘may be especially at risk of more severe disease’.

Monkeypox can kill up to 10 per cent of people it infects. The milder strain causing the current outbreak kills one in 100 — similar to when Covid first hit. The virus death rate has been higher among children in previous outbreaks.

The WHO warned there is a ‘high risk’ of further spread of the virus though skin-to-skin contact between families and sexual partners, as well as due to contact with contaminated materials, such as utensils, bedding and clothing.

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First potential human-to-human transmission of monkeypox detected in the United States

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The first potential cases of human-to-human transmission of monkeypox in the United States this year have been detected.

This weekend four cases have been spotted overall — with two in California and one each in Colorado and New York. 

It brings the U.S. tally to 14 infections across eight states, with most of the infections among gay and bisexual men. 

Health officials in California said their second case identified this weekend was a ‘close contact’ of an initial patient diagnosed three days earlier.

In Colorado, another individual being probed for the virus is a ‘close contact’ of a young gay or bisexual man who was found to be infected a day beforehand.

The first patients in each state fell ill shortly after returning from trips abroad to Europe and Canada respectively, which are facing outbreaks of the virus endemic to West Africa.

The explosion of cases across 24 countries prompted the World Health Organization (WHO) to upgrade the threat level from the virus to ‘moderate’.

They warned that should infections continue to increase then vulnerable people and children — who are more likely to die from the virus — could start to catch it.

There are also growing concerns that the disease will spill into wild animals allowing it to become endemic across the world.

In California, the case was detected in Sacramento — a city of 500,000 — and traced back to the initial infection spotted three days earlier.

Health chiefs in the state insisted the risk to the public was ‘very low’, although contact tracing was still ongoing.

On May 24, they revealed a suspected case in an individual who had returned from Europe — which is experiencing an outbreak — a day earlier.

WHO raises risk from monkeypox outbreak to ‘moderate’ 

Monkeypox’s threat to the world has been upgraded to ‘moderate’ by the World Health Organization (WHO), as the tropical virus spreads to dozens of countries.

The WHO said the explosion of cases with no links to each other or Africa means the current figure is ‘likely to be an underestimate’.

It has warned that if infections continue to happen then vulnerable people and children — who are more likely to die from the virus — could start to catch it.

So far the outbreak, which was first detected in early May, has spread to 24 countries and been diagnosed in 106 Britons, the majority of whom are men who have sex with men.

There are also growing concerns the virus will spill into wild animals and become endemic around the world, as is the case in parts of central and western Africa.

Passing between humans and animals would also raise the risk of monkeypox mutating. At the moment the risk to public health is moderate, but the WHO said it had the potential to ‘become high’.

In Colorado, officials said their new case was in Denver and a ‘close contact’ of the case spotted just a day beforehand.

They also said the risk to the public ‘remains low’.

It was not revealed how the other two cases in California and New York may have become infected.

Testing is underway at the Centers for Disease Control and Prevention (CDC) to confirm that these are monkeypox infections.

Most of the infections are among men, but in Virginia the case is in a woman who recently returned from West Africa.

The virus has been spotted in California, Colorado, Florida, Massachusetts, New York, Utah, Virginia and Washington.

Only symptomatic people can spread the virus, usually through physical contact with infectious skin lesions.

Although not a sexually transmitted infection, health chiefs say the virus may be spreading through touching in the genital area.

More than 650 cases across 24 countries where the virus is not endemic have so far being spotted, prompting the WHO to raise its threat level. 

In a risk assessment published on Sunday, they warned that its ‘moderate’ grading could be pushed to ‘high’ if the virus ‘exploits the opportunity to establish itself as a human pathogen’ and spreads to vulnerable groups.

The ‘sudden appearance’ and ‘wide geographic scope’ of cases suggests widespread human transmission of the virus — which spreads through skin-to-skin contact and an infected persons’ droplets — is underway, the WHO said.

It also warned the surge in monkeypox infections suggests the virus ‘may have been circulating unrecognized for several weeks or longer’.

Reported cases have so far been mild but there is a risk the virus has a ‘greater health impact’ if it spreads to at-risk people, including children and immunocompromised people, such as some HIV patients, who ‘may be especially at risk of more severe disease’.

Monkeypox can kill up to 10 per cent of people it infects. The milder strain causing the current outbreak kills one in 100 — similar to when Covid first hit. The virus death rate has been higher among children in previous outbreaks.

The WHO warned there is a ‘high risk’ of further spread of the virus though skin-to-skin contact between families and sexual partners, as well as due to contact with contaminated materials, such as utensils, bedding and clothing.

Health chiefs have warned monkeypox, a virus endemic in parts of Africa and is known for its rare and unusual rashes, bumps and lesions, could also spread to some pets and become endemic in Europe. Undated handout file image issued by the UK Health Security Agency of the stages of Monkeypox

‘However, at present, the risk for the general public appears to be low,’ the agency said.

It cautioned that a ‘large part’ of the population is vulnerable to monkeypox due to the discontinuation of the smallpox vaccination scheme.

Very few people under the age of forty have been vaccinated. In the U.S., youngsters were routinely offered this jab until four decades ago, around the point at which the virus was eradicated.

Because smallpox and monkeypox are so similar, those who received the jab are thought to have up to 85 percent immunity against the circulating strain.

No monkeypox cases have been logged among medics in the current outbreak, it noted, but an NHS worker became infected in 2018 after treating a patient who had returned from NIgeria.

In its report, the WHO also warned that people who have recently had multiple sexual partners — either where they live or abroad — ‘may be at risk’ of having monkeypox.

It said health chiefs should reach out to at risk communities, which ‘at the present time’ includes men who have sex with men and their close contacts.

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Unlikely monkeypox outbreak will lead to pandemic, WHO says

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LONDON, May 30 (Reuters) – The World Health Organization does not believe the monkeypox outbreak outside Africa will lead to a pandemic, an official said on Monday, adding it remains unclear if infected people who are not displaying symptoms can transmit the disease.

More than 300 suspected and confirmed cases of monkeypox – a usually mild illness that spreads through close contact and can cause flu-like symptoms and pus-filled skin lesions – have been reported in May, mostly in Europe.

The WHO is considering whether the outbreak should be assessed as a “potential public health emergency of international concern” or PHEIC. Such a declaration, as was done for COVID-19 and Ebola, would help accelerate research and funding to contain the disease. read more

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Asked whether this monkeypox outbreak has the potential to grow into a pandemic, Rosamund Lewis, technical lead for monkeypox from the WHO Health Emergencies Programme said: “We don’t know but we don’t think so.”

“At the moment, we are not concerned of a global pandemic,” she said.

Test tubes labelled “Monkeypox virus positive” are seen in this illustration taken May 22, 2022. REUTERS/Dado Ruvic/Illustration/File Photo

Once monkeypox has been contracted, the duration of the rash emerging and scabs falling off is recognised as the infectious period, but there is limited information on whether there is any spread of the virus by people who are not symptomatic, she added.

“We really don’t actually yet know whether there’s asymptomatic transmission of monkeypox – the indications in the past have been that this is not a major feature – but this remains to be determined, she said.

The strain of virus implicated in the outbreak is understood to kill a small fraction of those infected, but no deaths have been reported so far.

Most cases have cropped up in Europe rather than in the Central and West African countries where the virus is endemic, and are predominantly not linked to travel.

Scientists are therefore looking into what might explain this unusual surge of cases, while public health authorities suspect there is some degree of community transmission.

Some countries have begun to offer vaccines to close contacts of confirmed cases. read more

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Reporting by Natalie Grover in London; Editing by Toby Chopra, David Holmes and Alison Williams

Our Standards: The Thomson Reuters Trust Principles.

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Monkeypox: CDC identifies 9 cases in 7 states

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The CDC has identified nine monkeypox cases in seven states as of Wednesday, Director Dr. Rochelle Walensky said Thursday.

Cases have been identified in Massachusetts, Florida, Utah, Washington, California, Virginia and New York.

Most of the cases “are within gay [and] bisexual men and other men who have sex with men,” she said. Virginia announced Thursday that the case in its state is a woman.

“This is a community that has the strength and has demonstrated the ability to address challenges to their health by focusing on compassion and science,” she said in an apparent reference to the AIDS epidemic.

“While some groups may have a greater chance of exposure right now, infectious diseases do not care about state or international borders. They’re not contained within social networks, and the risk of exposure is not limited to any one particular group,” she warned.

Walensky implored Americans “to approach this outbreak without stigma and without discrimination.”

‘We shouldn’t be surprised to see more cases’

The CDC is working to learn more about the outbreak: Samples from the nine identified cases were sent to the agency for additional confirmatory testing and genomic investigation, Walensky noted, and there are efforts to learn how each person contracted the virus.

Some of the nine cases have a recent history of international travel to areas with active monkeypox outbreaks, she said, but others do not.

Officials expect more cases to be diagnosed as the CDC has urged doctors and Americans to be on the lookout for symptoms.

“We shouldn’t be surprised to see more cases reported in the US in the upcoming days. It’s actually a sign that Americans are remaining vigilant, and health care providers and public health workers are doing their job,” said Dr. Raj Panjabi, White House senior director for health security and biodefense.

As part of this outbreak, the CDC has been tracking multiple clusters of monkeypox that have been reported in early- to mid-May in several countries that don’t normally report such infections, including regions in Europe and North America.

Monkeypox is rare in the United States, and the virus does not occur naturally in the country, according to the CDC. After the virus jumps from an animal to a human, human-to-human transmission can happen through close direct contact, such as via large respiratory droplets or lesions on the skin.

Monkeypox symptoms can include fever, headache, muscle aches and swollen lymph nodes. A characteristic of the disease is that it can cause lesions or pustules and a rash on the body, including the palms of the hands and the soles of the feet.

US plans to move vaccine to states that need it most

The US has mobilized vaccine for monkeypox to states that have reported cases and plans to move the vaccine where it may be needed, Walensky said Thursday.

“The US has the resources we need to help us respond to monkeypox in this country right now. We’ve been preparing for this type of outbreak for decades,” she said.

The US has two preventive vaccines and two antiviral treatments that can be used for orthopox, the family of viruses that includes monkeypox.

“One of these vaccines, with the trade name of Jynneos, is approved for the prevention of monkeypox disease in adults 18 years of age and older,” Walensky said. “CDC has mechanisms in place to move these products around the country so that they can be used for prevention or treatment for people who may benefit, wherever they may be.”

Panjabi said that vaccination against monkeypox has been offered to health care workers in Massachusetts, where the first US case in this outbreak was identified last week.

“In Massachusetts, they got it as the Jynneos vaccine as of Sunday, and we’re offering it to health care providers who’ve had high-risk exposure or are eligible according to the state and CDC guidance,” Panjabi said.

CDC officials are recommending vaccination for people at highest risk of infection due to direct contact with someone who has monkeypox.

“Right now, while we are in the early phase of investigating this, we know that those at highest risk for infection are those who had contact with a known monkeypox patient, with the kind of contact that would facilitate spread. So those are the individuals we’re really focusing on recommending vaccination for right now: post-exposure vaccination,” said Dr. Jennifer McQuiston, deputy director of the CDC’s Division of High Consequence Pathogens and Pathology.

“We continue to watch what is happening and think about whether wider vaccination recommendations would make sense, but at this time, we only have nine known cases, and we have contacts that we’ve identified associated with those cases that would likely most benefit from vaccines,” McQuiston said. “And so that’s where we’re focusing our energies right now.”

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Monkeypox: Plans underway to ramp up testing if outbreak grows quickly

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Dozens of public health labs across the country now use a more generalized test for orthopoxvirus, a larger category that includes monkeypox, smallpox and other viruses. Two biotechnology companies, Roche and Abbott, have announced plans to roll out monkeypox PCR tests, although right now, their test kits are for research only.

The US Centers for Disease Control and Prevention says it’s exploring ways to get monkeypox-specific testing out to states.

There are already 74 labs across 46 states — part of a network known as the Laboratory Response Network — that are “using an FDA-cleared test for orthopoxviruses,” CDC Director Dr. Rochelle Walensky said Thursday.

Current capacity is around 7,000 of these tests weekly, with the potential to expand if needed.

Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, said a lot of that capacity “was set up in response to the threat of biological weapons, and smallpox is the most worrisome orthopoxvirus.”

The testing that CDC does is more specific to the monkeypox virus, and the agency can genetically sequence samples, as well. For example, it was by looking at the viral genetic code of the first US patient — a man in Massachusetts who had recently traveled to Canada — that researchers were able to see that his case of monkeypox closely matched that of a case in Portugal.

However, Dr. Jennifer McQuiston, a veterinarian and deputy director of the CDC’s Division of High Consequence Pathogens and Pathology, underscored that the testing that goes on at CDC isn’t really necessary for patient care.

“The orthopox test that’s in place is an actionable test,” she said.

Experts say that action may include isolating patients, making treatments and vaccines available, and contact tracing to determine who else might have been exposed to the virus.

Because other orthopoxviruses aren’t spreading in countries where they aren’t endemic like the US, one can assume that a positive orthopox test here is indeed monkeypox, according to Adalja.

Countries like Spain have shifted to include orthopox-positive cases as confirmed monkeypox cases in their counts. The CDC’s tracker of US cases lists “total confirmed monkeypox/orthopoxvirus cases.”

“I think that more diagnostic tests closer to patients is better. Commercial assays are even better,” Adalja said. “But the fact is, there are no other orthopoxviruses out there right now.”

He doesn’t believe that a lack of monkeypox-specific testing is hindering the public health response “because an orthopox-positive [case] is going to be monkeypox until proven otherwise in this scenario that we’re in right now.”

He added that this is a very different situation from the Covid-19 testing stumbles of 2020, when the world was dealing with a novel coronavirus without a major testing alternative, meaning it was often difficult to tell Covid-19 apart from other respiratory viruses like the flu. Monkeypox, on the other hand, we’ve known about for decades, and there’s a plan in place.

“It’s not the same as Covid,” Adalja said.

Identifying monkeypox

Monkeypox is rare outside endemic countries, and it isn’t as transmissible as a virus like Covid-19, according to the CDC. Humans may be infected by animals, but people can also infect each other through skin-to-skin contact; large respiratory droplets, which tend to travel no more than a few feet; or contact with things contaminated by skin lesions, such as bedding.

Monkeypox symptoms can include fever, headache, muscle aches and swollen lymph nodes. A characteristic of the disease is a rash that results in lesions or pustules. This can happen anywhere on the body, often on places like the face, hands and feet. In the current outbreak, some cases have caused lesions in the genital or groin area, according to health officials.

The process for identifying a monkeypox case in the United States begins with a person noticing possible symptoms and seeking medical care. Their provider can contact a local or state health department to collect a specimen for orthopox testing, said Chris Mangal, director of public health preparedness and response at the Association of Public Health Laboratories.

At this time, the CDC is recommending the collection of two specimens — swabs of lesions.

“When they run that test, and if that test comes back positive, they will report presumptive positive for non-variola orthopoxvirus. And that presumptive positive is actually good enough — that, combined with what you’re seeing in terms of the patient presentation — to give them a sense that ‘we should take public health actions here,’ ” Mangal said.

The second specimen and the test result are sent to the CDC for its own testing.

“The CDC and the public health labs actually work closely, hand-in-hand, on this testing,” Mangal said.

During the monkeypox outbreak, the process for confirmatory testing has been “good enough for the phase we’re in right now” because there has not been a high number of cases, she said.

“If we get into the scenario where we’re seeing a significantly higher number of cases of monkeypox, it is my belief that CDC will then work with the [US Food and Drug Administration] and the public health labs to ensure they have this confirmatory capability,” she said, adding that there are a few scenarios that could play out if that happens.

“We can have public health labs developing their own lab-developed tests,” Mangal said. “If this rose to an emergency scenario, similar to Covid, laboratories could work through the FDA to obtain an emergency use authorization for confirmatory tests.”

But overall, Mangal said, she does not see the current outbreak developing into a major emergency. For the general public, “it’s my opinion that they should not be overly concerned,” she said.

The current capacity for monkeypox testing is “not a major public health concern” in general, Adalja said, but there is still room for it to move faster or be more widely available.

“It would be great if Quest and LabCorp could do it. It’d be great if there were kits that people could put in sexually transmitted infection clinics to definitively diagnose,” he said. “But I don’t think right now you’re hampering the public health response, just because there’s no other orthopoxvirus circulating.”

Even if the CDC shifts monkeypox-specific testing to state public health labs, getting confirmatory results could take time, Adalja added.

“Even though we’re talking about state public health labs and members of the CDC’s Laboratory Response Network being able to do orthodox PCR, it’s still a step — it still involves paperwork, it still involves making phone calls, that dissuades people from doing it, that has a lag built into it,” Adalja said.

“If you work in an STD clinic in some city and you have that kit there, or you have a lab that’s right in your town that does it, that makes it so much easier,” he said.

Plans for monkeypox PCR tests

Roche and Abbott’s planned monkeypox PCR tests are separate from the CDC’s plans.

None has received a green light from the FDA, and both companies said last week that their tests are intended for “research use” — though they are leaving the door open to tackle future testing needs.

Even if it doesn’t become necessary to expand testing in countries like the US, these moves could benefit other countries, including those in Western and Central Africa where the monkeypox virus has long been endemic.

“Some of the resource-poor countries where these diseases are endemic sometimes have a clearer path to getting these tests in people’s hands than in the United States, where there’s so much regulation and it’s so hard to do a point-of-care test,” Adalja said.

“I do think there’s an advantage to having these tests in endemic countries so that people can get diagnoses quickly,” he added. “You can find outbreaks much faster. You can deploy the smallpox vaccine faster for monkeypox.”

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Health

Monkeypox Is Spreading During Sex — and That Is Actually a Relief

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We’re starting to get a handle on how monkeypox is spreading in this latest outbreak of the deadly disease.

The pox spreads through close physical contact. Especially during sex.

Believe it or not, that’s actually a relief. Because one possible alternative—the pox spreading through the air—is much, much more dangerous.

The World Health Organization recently confirmed the transmission methods driving the three-week-old outbreak in Europe, Australia, and the United States. “Based on currently available information, cases have mainly but not exclusively been identified amongst men who have sex with men seeking care in primary care and sexual health clinics,” the WHO stated last week.

That doesn’t mean monkeypox—a pathogen that is endemic in rodent and monkey populations in West and Central Africa and causes flu-like symptoms and a rash in people (and can be fatal in up to 10 percent of cases, depending on the precise strain)—is a sexually transmitted disease.

In fact, experts are clear that it’s not. Instead, it’s an opportunistic disease that prefers to jump from an infected person to an uninfected one via tiny cuts in the skin or the mucus membranes of the nose, mouth, and anus. “Any close contact will allow for spread,” Blossom Damania, a virologist at the University of North Carolina at Chapel Hill, told The Daily Beast.

So it should come as no surprise, then, that men having sex with other men is a significant factor in the pox’s spread. David Heymann, who formerly headed the WHO’s emergencies department, told The Associated Press that men attending raves in Spain and Belgium—and getting frisky with each other—“amplified” the outbreak.

“What’s happened is, it’s gotten into a population which is amplifying transmission because of behavior,” Heymann told The Daily Beast.

Mateo Prochazka, an infectious disease epidemiologist at the U.K. Health and Security Agency, said he was worried that these discoveries would be misconstrued in a way that could be used to attack the gay community, of which he is a member.

“It does not mean that gay or bisexual men are doing anything inherently wrong, or that the virus has changed or that it’s sexually transmitted, it just means that this behaviour facilitates transmission in these networks,” he told PinkNews. “We wanted to make sure people understand that transmission is not exclusive to gay and bisexual men, it just happens that it has entered this network.”

There was widespread concern, early in the outbreak, that this strain of the pox might spread the way COVID spreads—in the air when we breathe, cough, speak, laugh.

So, the sexual aspect of the viral transmission is actually a cause for relief among epidemiologists as the number of confirmed cases—around 100 in a dozen countries outside of Africa, as of Monday—slowly climbs. (No deaths have been reported.)

“We still don’t fully understand the extent of the outbreaks or the modes of transmission,” Lawrence Gostin, a Georgetown University global health expert, told The Daily Beast last week.

COVID of course likes to travel in the very fine “aerosol” mist that everyone exhales every few seconds. Those aerosols can travel across rooms and linger in the air for minutes at a time. That’s part of what makes COVID so contagious.

Experts suspected that monkeypox tends to favor larger droplets that don’t travel as far or linger as long. “Monkeypox is not airborne, but transmits via droplets after prolonged contact,” the European Center for Disease Prevention and Control—Europe’s version of the U.S. Centers for Disease Control and Prevention—told The Daily Beast in a statement. In other words, it seemed unlikely the pox would spread like COVID and potentially trigger its own pandemic.

But viruses are unpredictable. The idea that the pox might have mutated in order to ride on aerosols kept a lot of epidemiologists awake at night earlier this month even though this is a DNA virus so cannot mutate as readily as an RNA virus like COVID. The world is barely managing to handle one pandemic. The last thing we need is a second global disease on top of the first.

We can relax… somewhat. Inasmuch as the pox is mostly spreading through very close contact—kissing, fondling, sex—it’s fairly straightforward to keep from passing it along. “This disease can be contained by behavior-change,” Heymann said.

It starts with education. Know what the pox looks like—hard, circular blisters—and don’t touch anyone showing signs of infection. But there’s no need for paranoia. You’re probably not going to catch the pox by simply sharing air with an infected person.

And even if you do catch it, you’ve got options for swift treatment. Monkeypox is related to smallpox and the same vaccines work against both. The CDC alone stockpiles more than 100 million doses of the pox vaccines.

Not only can the latest and best pox vaccine, Jynneos, prevent infection—it also works as a therapy after infection, Heymann pointed out. “It changes the virus.” The catch is, you have to take a dose within a few days of getting sick.

Between contact-tracing, vaccines, and therapies, we’ve got the tools to contain monkeypox and prevent most of the possible deaths from the virus. And now that we’re zeroing in on the major transmission pathways, we can begin to rule out the likelihood of a pox pandemic. “I expect it to be contained in high-income countries,” Gostin said.

To stand a good chance of spreading the pox, you’ve got to get up close and real personal with someone else. That doesn’t lend itself to out-of-control spread.

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