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As part of that effort, about 1,200 doses of monkeypox vaccine have been made available in the United States, said Dr. Raj Panjabi, senior director for global health security and biodefense at the White House.
“We want to ensure that people at high risk have access to vaccines quickly and can receive appropriate treatment if they become ill. To date, we have delivered around 1,200 vaccines,” Panjabi said. “And 100 treatment courses in eight jurisdictions, and we have states more to offer.”
Health care workers in Massachusetts treating monkeypox patients were among the first to receive vaccinations to protect against the virus.
In the United States, the two-dose vaccine Jynneos is approved for the prevention of smallpox, specifically monkeypox. Another smallpox vaccine approved in the United States, ACAM2000, can also be used against monkeypox.
To date, more than 120 PCR orthopox tests have been performed as part of the outbreak surveillance effort in the United States.
“This is just a fraction of what’s available,” Panjabi said, adding that 67 labs in 46 states — part of a network known as the Laboratory Response Network — have the “collective ability” to run more than 1,000 tests per carry out day.
“So we’re now working to make sure that testing capacity is used,” he said. People with monkeypox symptoms are encouraged to see a doctor, and providers are urged to run tests if they suspect someone has monkeypox.
“Community-level” spread could occur, a CDC official warns
Officials at the US Centers for Disease Control and Prevention on Friday urged clinicians to be on the lookout for possible cases of monkeypox because the virus could spread at the community level.
Twenty cases of monkeypox have been identified in 11 states, plus one other case in the United States that has been infected and tested elsewhere, said Dr. Jennifer McQuiston, associate director of the CDC Division of Pathogens and Serious Consequence Pathology.
All patients are recovering or have recovered, and those who still have a rash are advised to stay home and isolate from others until they have fully recovered.
“I want to emphasize that this could happen in other parts of the United States as well. There could be community-level transmission, and so we really want to step up our surveillance efforts,” McQuiston said. “We really want to encourage doctors that if they see a rash and are concerned it might be monkeypox, they go ahead and test for it.”
She added that the rashes seen in this outbreak as a result of monkeypox infections are subtle and can easily be mistaken for other types of infections, particularly sexually transmitted infections — and there could be co-infections of monkeypox with STIs.
McQuiston said the rash from monkeypox infection typically presents as “deep-seated” and “roundish” lesions that develop into raised or fluid-filled pustules. It could be confused with other infectious diseases like herpes or syphilis, she added.
“Nevertheless, we do not want to minimize this situation. The rash caused by the monkeypox virus can spread widely across the body or appear in sensitive areas like the genitals,” McQuiston said. “It can be very painful, and some patients have reported needing prescription pain medication to relieve this pain. The wounds can also cause long-term scarring on the skin.”
Analysis of genetic sequencing data from cases in the United States suggests there may be two genetically distinct variants of monkeypox circulating, McQuiston said.
The genetic sequence data is “certainly interesting from a scientific point of view,” but “to determine how long the monkeypox virus has been circulating will require the analysis of many more sequences from many more patients to piece this puzzle together more clearly,” she said. “It’s certainly possible that there have been cases of monkeypox in the United States that have previously gone under the radar, but not on a large scale.”
She added that the risk to the public was still low and that finding cases with different lineages was a “positive sign” that the country’s surveillance network was working.
Among the 17 cases detailed in the report in nine states, all patients had a rash, 14 of whom said they had traveled internationally in the 21 days prior to their symptoms, and all but one identified as a man who having sex with men (MSM). Three were immunocompromised. All patients were adults.
“The high proportion of first-time cases diagnosed in this outbreak among people who identify as gay, bisexual or other MSM may simply reflect an early introduction of monkeypox into interconnected social networks; this finding may also reflect a bias in the finding due to strong, established relationships between some MSM and clinical providers with robust STI services and broad knowledge of infectious diseases, including uncommon conditions,” CDC researchers wrote in the report.
“However, infections are often not confined to specific regions or population groups; because close physical contact with infected individuals can spread monkeypox, anyone, regardless of gender or sexual orientation, can contract and spread monkeypox.”
Around the world, World Health Organization officials say, more and more countries are reporting cases of monkeypox that have never seen the virus before.
“Cases have been reported in 26 countries” where the virus is not endemic, Maria Van Kerkhove, WHO’s head of emerging diseases and zoonoses and technical lead for Covid-19, said during a news conference on Thursday. She added that more than 600 cases have been identified in these countries.
“As surveillance and attention increases, we expect more cases to be identified,” she said. “Many investigations into public health outbreaks are ongoing.”
“What we’re seeing now started out as a small cluster of cases and then the investigation quickly led to the discovery of infections in a group of men who have sex with men and that prompted further investigation and we don’t know yet , which is the source of the actual outbreak,” Lewis said. “The most important thing now is not to stigmatize.”
