Two men who eventually became the first two cases of monkeypox in America had sought treatment for rashes and warts repeatedly before doctors finally tested them for the virus in mid-May, after the onset of an epidemic in Europe, reveals the CDC.
A report released Friday by the Centers for Disease Control and Prevention (CDC) lays out a timeline of how these early cases were initially missed by local doctors, and the gap between patients noticing the symptoms and ultimately being told they were infected.
The first patient, in the Boston, Massachusetts area, first developed a rash around his anus and genitals on May 4, days before cases of the virus first emerged in Europe . He was not tested for monkeypox until he was hospitalized with severe pain.
A New York man also had a rash on May 4. Doctors believed it was a sexually transmitted infection (STI) and did not consider the rare virus until the Massachusetts case was announced.
The CDC report released on Friday takes into account the most recent data as of May 31. This includes 17 confirmed cases of the virus, including 16 in men who have sex with men.
Officials said at a Friday briefing that they had now confirmed 20 cases in America and more than 700 worldwide. There have also been no deaths from the virus linked to this outbreak.
All US patients are recovering or have already fully recovered. Patients who have the virus are told to stay in isolation until their scabs from the lesion fall off and are replaced by new skin.
The outlier case that does not involve a gay or bisexual man comes from the Northern Virginia area, where authorities confirmed a case in a woman who had recently traveled overseas.
Two different strains have been found in the United States, with the vast majority of cases matching the same strain that has been found across Europe in recent weeks.
Both strains are of the less severe West African variant. However, two different strains imply that there were several animal-to-human transfers of the virus that ultimately led to cases in the United States.
Last year, two cases of monkeypox were detected in the United States – one in Texas and one in Maryland – were also of different strains, and the same two strains that are currently circulating in America.
A case in the United States has not been linked to international travel or known human-to-human transmission. The CDC has not disclosed where this case was detected.
Monkeypox will show up as small lesions that appear on a person’s body, although officials warn they could be subtle and easy to miss (file photo)
CDC officials assured the public that the country has a sufficient supply of monkeypox vaccine to deal with an impending surge of the rare virus (file photo)
Monkeypox was first detected outside West and Central Africa – regions where it is endemic – on May 7 in a person in the UK who had recently traveled to Nigeria.
A few days earlier, on May 4, a Massachusetts man who had just returned from an international trip developed an anogenital rash.
This rash eventually spread to her face. Over the next week, he will see a doctor four times, and each time the common causes of these types of lesions will be ruled out.
On May 12, the man was hospitalized due to unbearable pain caused by his rash. Shortly after, on May 17, local officials informed the CDC of the man’s condition – after seeing coverage of a similar case in the UK.
He tested positive for the orthopox family of viruses on May 17 and a day later the CDC confirmed he had monkeypox.
Also on May 4, a New York man who had recently traveled abroad developed a sore mouth and a painful rash.
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Dr Hans Kluge, head of the WHO’s European division, has warned that the current outbreak of the tropical disease “may not be under control”.
He warned Europe had become the new epicenter of the virus, with the outbreak linked to sexual transmission at raves and festivals on the continent.
Dr Kluge insisted the virus “will not require the same wide-ranging demographic measures” as Covid, but said “significant and urgent” action was needed to prevent more cases.
He added that although the cases have been concentrated in men who have sex with men, there is nothing to prevent it from spreading to other groups.
When he sought medical care, he was tested for STIs and sent home. The rash started to spread and other STI tests kept coming back negative.
After hearing about the case in Massachusetts, New York City officials informed the CDC about the case. In the coming days, he would test positive for monkeypox and go into solitary confinement.
In the following days, cases of the virus would break out across America, including at least three more in New York, three in Sacramento County and others spread across eleven US states.
At least one of these patients was treated with tecovirimat, an antiviral agent developed to fight smallpox but also effective against monkeypox, outside the country’s strategic stock.
Since smallpox – a virus eradicated for decades – and monkeypox are both orthopox viruses, many treatments for the former also work against the latter.
Contact tracing efforts have begun in order to control the spread of the virus, and authorities have detected hundreds of people exposed in areas where confirmed cases have been found.
These include 56 people considered to be at high risk of catching the virus, 117 at moderate risk and 235 at low risk based on potential exposure levels.
There are two vaccines available against the virus, which are distributed to close contacts of infected people and to people working in the health sector who may be exposed to the virus.
One is JYNNEOS, a vaccine that can be given both before and after exposure to the virus to be effective. Last week, CDC officials laid out plans to distribute the vaccines to health workers and those exposed.
America is believed to have around 1,000 doses of the two-dose vaccine, although CDC officials say that figure has changed since the figures were last revealed last week, implying the country has purchased more of vaccines. It is the preferred vaccine to combat the rare virus.
ACAM2000 is an older vaccine that was designed to prevent smallpox – just like JYNNEOS – and is only effective after exposure to the virus. The United States is said to be sitting on a stockpile of more than 100 million injection doses, a figure which may also have changed according to the CDC.
It also has a higher risk of adverse events related to it.
The CDC reports that a state with detected cases of the virus chose to request ACAM2000 instead of the preferred JYNNEOS to treat its close contacts.
Officials reiterated that the country has “more than enough” vaccine doses to deal with the current outbreak.