Update June 5, 2022: WHO update on Monkeypox:
To date, the clinical presentation of confirmed cases has been variable. Many cases in this outbreak are not presenting with the classical clinical picture for monkeypox.
In cases described thus far in this outbreak, common presenting symptoms include genital and peri-anal lesions, fever, swollen lymph nodes, and pain when swallowing. While oral sores remain a common feature in combination with fever and swollen lymph nodes, the local anogenital distribution of rash (with vesicular, pustular, or ulcerated lesions) sometimes appears first without consistently spreading to other parts of the body.
In many cases, this initial presentation of a genital or peri-anal rash suggests close physical contact as the likely route of transmission during sexual contact.
Some cases have also been described as having pustules appear before constitutional symptoms (e.g., fever) and having lesions at different stages of development, both atypical of how monkeypox has presented historically.
Monkeypox cases continue to rise. For June 3, 2022, there are 915 confirmed and 71 suspected cases, with zero deaths. The seven-day average continues to increase.
Why is monkeypox spreading?
Monkeypox is spread from fluids coming from a rash. Typically, people would stay away from someone who looks sick, especially if they have skin lesions, so why is monkeypox spreading?
An article from the Journal of the American Medical Association may explain why. Monkeypox from new cases appears to be presented differently. According to Dr. Agam Rao, MD, an infectious disease physician, and medical officer of the CDC’s Poxvirus and Rabies Branch,
We're hearing that those prodromal symptoms might be mild or not even noticed in these new cases.
Another thing is that monkeypox symptoms often start from the head area and spread to the patient’s arms, legs, palms, and soles. In the current cases, the rash starts in the genital or perianal region before going to the person’s extremities. Some patients have presented with rectal inflammation or proctitis, said Rao.
The new presentation contrasts the person infected with smallpox covered with pustular rashes from head to toe. The image below shows the different stages of monkeypox skin lesions.
Monkeypox from two separate outbreaks
A CBS News quotes a CDC official who said that the monkeypox cases that have been genetically sequenced in Massachusetts, Florida, Virginia, and Utah are genetically similar to the patients in Europe. Those appear identical to the virus spotted from an infected traveler to Maryland from Nigeria last year.
However, at least two U.S. cases looked similar to a virus sample from a traveler to Texas last year.
In a CDC media briefing, Dr. Jennifer McQuiston, head of the CDC's monkeypox response, said,
"It's not clear what all this means, but it's likely that within the last couple of years, there have been at least two different instances where monkeypox virus spilled over to people in Nigeria from the animal that maintains it.
"That virus likely began to spread through close person-to-person contact, possibly intimate or sexual contact."
Not all cases have a history of travel
Most monkeypox cases have been in men who have sex with men (MSM) with links to recent travel abroad. However, Dr. McQuiston said during the briefing that at least one U.S. case "does not have a travel link or know how they acquired their infection."
It could be that the atypical presentation of monkeypox is the cause of its rapid spread.
Widespread transmission
The Morbidity and Mortality Weekly Report (MMWR) of the CDC reports that
The ongoing investigation suggests person-to-person community transmission.
Two days ago, I reported that the World Health Organization said that Widespread human-to-human monkeypox transmission is now underway.
Vaccines deployed
Dr. Raj Panjabi, the White House's senior director for global health security and biodefense, said that the Biden administration had deployed about 1,200 doses of vaccine and 100 treatment courses to at-risk contacts and patients in the outbreak. Most have been of the recently-approved Jynneos vaccine, produced by Bavarian Nordic.
The table below from BNO News lists the number of monkeypox cases from all countries affected.
CDC Recommendations for travelers
- Avoid close contact with sick people, including those with skin lesions or genital lesions.
- Avoid contact with dead or live wild animals such as small mammals, including rodents (rats, squirrels) and non-human primates (monkeys, apes).
- Avoid eating or preparing meat from wild game (bushmeat) or using products derived from wild animals from Africa (creams, lotions, powders).
- Avoid contact with contaminated materials used by sick people (such as clothing, bedding, or materials used in healthcare settings) or that came into contact with infected animals.
- Wear a mask. Wearing a mask can help protect you from many diseases, including monkeypox.
The risk to the general public is low. Still, you should seek medical care immediately if you develop new, unexplained skin rash (lesions on any part of the body), with or without fever and chills, and avoid contact with others.
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- Know more about Monkeypox
Sources:
- Harris E. What to Know About Monkeypox. JAMA. Published online May 27, 2022. doi:10.1001/jama.2022.9499
- Morbidity and Mortality Weekly Report (MMWR) Monkeypox Outbreak — Nine States, May 2022
- CDC Media Telebriefing: Update on 2022 U.S. Monkeypox Investigation
Image credit:
Monkeypox - https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates#seven-may, OGL 3, https://commons.wikimedia.org/w/index.php?curid=118186900
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