The United States has recorded 45 cases of monkeypox since early May, the Centers for Disease Control and Prevention announced Friday.
The agency is asking healthcare providers to monitor patients for rashes, but the nature of monkeypox rashes in recent cases has differed from what doctors have observed in the past in Africa – where the virus is endemic in 11 countries – the CDC said.
In some of the new cases, monkeypox caused people to develop what looks like a pimple or blister, rather than a generalized rash, CDC Director Rochelle Walensky said during a briefing. In other cases, tiny bumps on the skin are the first or only indication of an infection, she said.
“We have seen presentations of monkeypox that are mild and sometimes only [in] limited areas of the body, which differs from the classic presentations seen in endemic countries in West and Central Africa,” said Walensky. “This has raised concerns that some cases may go unrecognized or undiagnosed.
Walensky said that historically patients have reported flu-like symptoms such as fever, body aches and swollen glands. After that, “a characteristic rash, often diffuse, appears on several sides of the body, often on the face, arms and hands.”
But in recent cases, Walensky continued, “some patients have developed a localized rash, often around the genitals or anus, before experiencing any flu-like symptoms, and some have not even developed any such flu-like symptoms”.
CDC officials said some US patients have also reported proctitisor painful inflammation of the lining of the rectum, a symptom rarely associated with monkeypox.
“If you notice a new rash or a new skin condition that you’re just not sure about anywhere on your body, including in your mouth, go get it checked out,” said Demetre Daskalakis, director of the CDC HIV/AIDS Prevention Division. during a media call on Thursday. “Now is not the time to hold back, even if you don’t think it’s that bad.”
Why monkeypox symptoms may differ from previous outbreaks
The type of monkeypox currently circulating in the United States and other countries outside of Africa is known as the West African clade. The World Health Organization estimates that about 1% of people who have contracted this strain have died in the past, compared to up to 10% of people who contract the Congo Basin strain.
A monkeypox rash can look like chickenpox, herpes, or syphilis. In some cases, the lesions are extremely painful and may leave scars. Some patients in the current outbreak have needed prescription drugs or even hospital care to manage the pain.
But in other cases, the rash did not cause much discomfort. Dr Stuart Isaacs, associate professor of medicine at the University of Pennsylvania, said there may be something in the West African strain itself that produces milder disease than its counterpart.
“You have these local lesions and very little of the generalized rash that you see in photos historically,” Isaacs said.
How a person is exposed to monkeypox could also affect the presentation of their symptoms, he theorized.
Monkeypox appears to be spread by close physical contact, either through exposure to bodily fluids, respiratory droplets, rashes, or lesions that form during an infection, or through contaminated objects like clothing or bedding. Most US patients are men who have sex with men, leading experts to believe that exposure can occur during sexual activity.
“It’s almost impossible to separate skin-to-skin contact from sexual contact from face-to-face contact as the reason for transmission,” Walensky said, adding, “We don’t know yet if the virus can be spread through contact with the semen or vaginal secretions.”
But she said there was no evidence to date that the virus spreads through the air or from interactions such as casual conversations at the grocery store or by touching the same doorknob.
Vaccines can protect against monkeypox Existing smallpox vaccines work well against monkeypox, Isaacs said. Vaccines can even prevent people from getting the disease or developing symptoms if given soon after exposure.
The United States has enough stockpiled doses to vaccinate millions of Americans against monkeypox, said Dawn O’Connell, assistant secretary for preparedness and response at the Department of Health and Human Services. This includes more than 100 million doses of ACAM2000, an older generation smallpox vaccine, and 72,000 doses of Jynneos, the US government’s preferred vaccine. shotwhich is specifically approved for use against monkeypox.
The CDC and HHS have conducted more than 1,400 vaccination classes in 16 states since the outbreak began, O’Connell said.
The United States is expected to receive an additional 300,000 doses of Jynneos over the next few weeks, and vaccine maker Bavarian Nordic has reserved another million doses ready to ship for the United States, O’Connell said. On Friday, US officials also announced that the country had ordered an additional 500,000 frozen doses of Jynneos, which will be delivered later this year.
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