CDC: up to five cases of monkeypox are now suspected in the United States

With one confirmed and four suspected cases of monkeypox in the United States, clinicians should continue to be on high alert if their patients report a new rash, particularly in the genital or perianal area, staff at the clinic said Monday. CDC.

The single confirmed case in Massachusetts had more than 200 close contacts, the majority of whom were healthcare workers, said Capt. Jennifer McQuiston, DVM, deputy director of the CDC’s Division of High-Consequence Pathogens and Pathologies. Currently, contacts of known cases, including health care providers, are vaccinated “if they fall into a high-risk category and warrant” vaccination, she said.

The other four suspected cases – one in New York, one in Florida and two in Utah – tested positive for the orthopox virus, but McQuiston explained that only the CDC can verify if the sample is monkeypox. (or, as one journalist put it, “monkey pox until proven otherwise”). All are men with a history of international travel, she added.

The Massachusetts man’s strain is genetically similar to a strain from Portugal, where cases of monkeypox have been reported, which is similar to the West African strain of the virus, McQuiston said. Some patients reported onset in early May, but traveled in early April.

Monkeypox is spread by large respiratory droplets and “prolonged” close contact. “Many” patients in the current global epidemic identify as men who have sex with men (MSM). Patients tend to recover in 2-4 weeks.

McQuiston said the CDC is working to provide images of the monkeypox rash on its website to help healthcare providers because it could be confused with other sexually transmitted infections.

John Brooks, MD, of the CDC’s Division of HIV/AIDS Prevention, noted that one case of monkeypox was mistaken for severe herpes. He urged patients with an unusual rash on the genital or anal areas to contact their primary care provider or, if they don’t have one, a sexual health clinic for testing.

“We’re concerned enough about the rate at which new cases are growing around the world to get everyone’s attention,” he said, adding that the lesions were “a bit atypical compared to what we expected.” .

Brooks urged MSM to withdraw from socializing if they are not feeling well and to get assessed by a provider as soon as possible. The virus can show “flu-like symptoms” and sores can start in the throat or mouth in the “pre-rash” period, when people can already be contagious, he noted.

“Louis Pasteur said, ‘chance favors the prepared mind'”, he added.

More unusual symptoms include swollen lymph nodes that impair breathing or eye damage, which could affect sight, but McQuiston said researchers have seen mild and “mostly self-limiting” symptoms in this outbreak. Immunosuppressed people are likely to face a more severe clinical course, such as prolonged illness, larger lesions and more bacterial infections, she added.

CDC staff said there are two live-virus smallpox vaccines available, which appear to work on monkeypox: the new Jynneos vaccine, which is a non-replicating vaccine with fewer adverse events, and ACAM2000, a replicative vaccine with a higher risk of adverse events. , particularly in immunocompromised individuals and those with atopic dermatitis.

Brooks added that while the data on people with HIV and monkeypox is very limited, those with well-controlled HIV are likely to do as well as “anyone else” with the vaccine. Antivirals are also available for people at risk of serious illness.

There are around a thousand doses of Jynneos available, but production is expected to ramp up rapidly in the coming weeks, McQuiston noted. There are approximately 100 million doses of ACAM2000 available.

The CDC is undertaking a proven strategy used to deal with infectious disease outbreaks around the world: isolate, test, and contact tracing. Brooks emphasized that contact tracing is effective in limiting the spread of this monkeypox outbreak.

“We want to encourage people to come forward and urge them to seek treatment,” he said.

  • Molly Walker is associate editor and covers infectious diseases for MedPage Today. She is the winner of the J2 Achievement Award 2020 for her COVID-19 coverage. To follow

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