The first potential cases of human-to-human transmission of monkeypox in the United States this year have been detected.
This weekend, four cases were spotted in total – including two in California and one each in Colorado and New York.
That brings the US tally to 14 infections in eight states, with most infections in gay and bisexual men.
California health officials said their second case identified over the weekend was “close contact” with a first patient diagnosed three days earlier.
In Colorado, another person being probed for the virus is a “close contact” of a young gay or bisexual man who was found to be infected the day before.
The first patients in each state fell ill shortly after returning from overseas trips to Europe and Canada respectively, which are dealing with endemic virus outbreaks in West Africa.
The explosion of cases in 24 countries prompted the World Health Organization (WHO) to raise the threat level of the virus to “moderate”.
They warned that if infections continue to rise, vulnerable people and children – who are more likely to die from the virus – could start to catch it.
There are also growing fears that the disease could spread to wild animals, which would allow it to become endemic across the world.
In California, the case was detected in Sacramento – a city of 500,000 people – and dates back to the initial infection spotted three days earlier.
State health chiefs have insisted the risk to the public is “very low”, although contact tracing is still underway.
On May 24, they disclosed a suspected case in a person who had returned from Europe – which is experiencing an outbreak – a day earlier.
WHO raises risk of monkeypox outbreak to ‘moderate’
The global threat of monkeypox has been rated as ‘moderate’ by the World Health Organization (WHO), as the tropical virus spreads to dozens of countries.
The WHO said the explosion of cases unrelated to each other or to Africa means the current figure is “probably underestimated”.
He warned that if infections continue to occur, 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 has been diagnosed in 106 Britons, the majority of whom are men who have sex with men.
There are also growing fears that the virus could spread among wild animals and become endemic around the world, as it is in parts of central and western Africa.
Crossing between humans and animals would also increase the risk of monkeypox mutation. At the moment the public health risk is moderate, but the WHO has said it has the potential to “become high”.
In Colorado, officials said their new case was in Denver and a “close contact” of the case was spotted a day in advance.
They also said the risk to the public “remains low”.
It has not been revealed how the other two cases in California and New York could have been infected.
Testing is underway at the Centers for Disease Control and Prevention (CDC) to confirm these are monkeypox infections.
Most of the infections are in men, but in Virginia the case involves 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 it is not a sexually transmitted infection, health chiefs say the virus can be spread through touch in the genital area.
More than 400 cases in 24 countries where the virus is not endemic have so far been spotted, prompting the WHO to raise its threat level.
In a risk assessment published on Sunday, they warned that its “moderate” rating 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 onset” and “wide geographic spread” of cases suggest widespread human transmission of the virus – which is spread through skin-to-skin contact and droplets from an infected person – is underway, the WHO said.
He also warned that the spike 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 that the virus could have a ‘greater health impact’ if it spreads to those at risk, including children and immunocompromised people, such as some HIV patients, who “may be at particular risk for more severe disease”.
Monkeypox can kill up to 10% of the people it infects. The milder strain behind the current epidemic kills one in 100 people – like when Covid first hit. The virus death rate has been higher among children in previous outbreaks.
The WHO has warned that there is a “high risk” of the virus spreading through skin-to-skin contact between families and sexual partners, as well as through contact with contaminated materials, such as utensils, bedding and clothing.
Health chiefs have warned that monkeypox, a virus endemic to parts of Africa and known for causing rare and unusual rashes, bumps and sores, could also spread to some pets and become endemic in Europe. Undated handout file image issued by the UK Health Safety Agency of the stages of Monkeypox
“However, at this time, the risk to the general public appears to be low,” the agency said.
He warned that a “large part” of the population is vulnerable to monkeypox due to the halt in the smallpox vaccination programme.
Very few people under forty have been vaccinated. In the United States, young people were regularly offered this shot until four decades ago, around the time the virus was eradicated.
Because smallpox and monkeypox are so similar, those who have received the vaccine are thought to have up to 85% immunity to the circulating strain.
No cases of monkeypox have been recorded among doctors during the current outbreak, he noted, but an NHS worker was 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 – regardless of where they live or abroad – “may be at risk” of having monkeypox.
He said health chiefs should reach out to at-risk communities, which “at this time” include men who have sex with men and their close contacts.
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