Officials from the U.S. Centers for Disease Control and Prevention warned the public and medical providers Monday to be on alert for possible cases of monkeypox as it counts up to five cases of the normally rare disease around the nation.
But the officials say the threat to the general public remains low, as it’s just not as easily spread as other diseases such as COVID-19. Rather, it takes touching or sharing fluids with someone with the characteristic monkeypox rash.
“What we’re talking about here is close contact,” said Capt. Jennifer McQuiston, CDC’s deputy director of the Division of High Consequence Pathogens and Pathology, during a news conference Monday. “Someone passing someone in the grocery store wouldn’t be at risk for monkeypox.”
But the officials said global cases are rising. A tally by Johns Hopkins Center for Health Security put it at 240 confirmed for suspected cases in 15 countries.
The CDC says many of the newest cases of transmission have been in gay men, though it is not typically considered a sexually transmitted disease because it can spread through close, but nonsexual activities.
That led the CDC officials to specifically say members of the LGBTQ community, and their providers, ought to be especially vigilant looking out for flu-like symptoms and the rash, which can resemble those caused by other disease including some sexually transmitted diseases.
“They think it could be a STD, but we’d like the provider to consider it could be monekypox,” said Dr. John Brooks, a medical epidemiologist in the CDC’s Division of HIV/AIDS Prevention.
The first case from these outbreaks was reported this month in the United Kingdom, and cases began to spread. But not all cases involve travel and some don’t involve travel to countries where monkeypox is endemic, or regularly found.
Earlier this month, the first U.S. case was confirmed in Massachusetts in a man who had traveled to Canada.
There are now four more cases being investigated by the CDC but assumed to be monkeypox. They are one each in New York and Florida and two in Utah.
While still relatively low in number, such cases are normally rare and there isn’t much community transmission in Western countries, including the United States.
There have not been cases reported in Maryland linked to the current infections. The last reported case in the state was in November in a man who had traveled to Nigeria.
Health officials are urging people and providers to be on the lookout for the rash that can develop before or after flu-like symptoms. It can resemble rashes caused by chickenpox, measles and syphilis and is often found on the face, hands and feet.
“We are monitoring the situation and encourage Marylanders to be vigilant,” said Chase Cook, a spokesman for the Maryland Department of Health, in a statement. “We released a letter to clinicians informing them of best practices if they encounter the disease.”
In the May 19 letter, Dr. Jinlene Chan, deputy health secretary for public health services, advises providers to screen for the disease, isolate people with potential cases and report the cases to the CDC. The providers should not assume if patients have not traveled that it is not monkeypox.
The CDC officials said they are working with states, where labs do the initial testing for a range of similar diseases. The CDC performs the genetic sequencing to confirm monkeypox.
Officials say they are working to do this quickly so contacts can be traced and warned. The information is also being shared globally so officials can determine how the disease is spreading and if there are unusual or new patterns requiring different interventions.
Monkeypox is a zoonotic disease, meaning it jumped to humans from primates and rodents, according to the Johns Hopkins Center for Health Security.
Hopkins reports the virus can incubate for up to 21 days but the disease usually develops in about five days, starting with fever and chills, headache, muscle aches, back pain, fatigue and swollen lymph nodes. That differentiates it from chickenpox and smallpox, which doesn’t lead to swollen nodes. They usually resolve in two or three weeks.
There is no vaccine for monkeypox, though the U.S. Food and Drug Administration has licensed two for smallpox that are considered effective and are stored in the U.S. strategic reserves. Smallpox vaccine have not been routinely given in the United States for decades, but the CDC officials are considering whether it’s necessary to give a vaccine to some health care workers and close contacts of those infected.
There also are antiviral therapies available.
The CDC reported that the cases appear to be from a West African strain that is more mild, with infections resolving on their own in a few weeks. There are no reported deaths from recent cases.
Experts are investigating, however, why there are so many cases in unusual places and what should be done if the cases grow exponentially.
The Morning Sun
The Global Virus Network, an international coalition of virologists that work to improve detection and management of viral diseases, announced Monday that its latest task force would center on monkeypox.
The task forces were created about a decade ago by the co-founder of the network, Dr. Robert Gallo, who is the director of the Institute of Human Virology at the University of Maryland School of Medicine.
He, like the CDC officials, said cases could grow but, because of the lower level of transmissibility, their numbers were unlikely to explode. But experts need to ask if there isn’t a new factor making monkeypox more contagious or dangerous.
For now, he said, “It doesn’t appear so.”
The most likely reason there are cases in so many places is that people travel more now.
“There are still unknowns, but the world is smaller and everything that was very unusual before is less so as we progress and have global contact,” Gallo said.
“Why today and not last year?” he asked. “We didn’t travel so much last year. Things take time.”