CDC: Monkeypox likely transmitted through male sex act

580
Lesions

Monkeypox is a rare viral infection spread by wild animals and is generally found in forested areas of western and central Africa. It is spread via contact and droplet exposure via exhalation.

It is a zoonotic disease, meaning it spreads from animals to humans. The first person in the US since last November to test positive for Monkeypox was diagnosed in Massachusetts this week. He is said to have contracted it on a trip to Canada. Last year’s cases contracted the disease in Nigeria.

Scientists at the Centers for Disease Control and Prevention (CDC) are collaborating with the Massachusetts Department of Public Health to investigate a case of monkeypox in a Massachusetts resident who had recently traveled to Canada by private transportation. Testing in Massachusetts found orthopox virus infection Tuesday night, and CDC labs confirmed as monkeypox this afternoon.

In humans, the symptoms of monkeypox are similar to but milder than the symptoms of smallpox. Monkeypox begins with fever, headache, muscle aches, and exhaustion. The main difference between symptoms of smallpox and monkeypox is that monkeypox causes lymph nodes to swell (lymphadenopathy) while smallpox does not. The incubation period (time from infection to symptoms) for monkeypox is usually 7−14 days but can range from 5−21 days.

Signs

The illness begins with:

  • Fever
  • Headache
  • Muscle aches
  • Backache
  • Swollen lymph nodes
  • Chills
  • Exhaustion

Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body.

Lesions progress through the following stages before falling off:

  • Macules
  • Papules
  • Vesicles
  • Pustules
  • Scabs

The illness typically lasts for 2−4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease.

CDC is also tracking multiple clusters of monkeypox that have been reported within the past two weeks in several countries that don’t normally report monkeypox, including Portugal, Spain, and the United Kingdom. It’s not clear how people in those clusters were exposed to monkeypox but cases include individuals who self-identify as men who have sex with men.  CDC is urging healthcare providers in the U.S. to be alert for patients who have rash illnesses consistent with monkeypox, regardless of whether they have travel or specific risk factors for monkeypox.

Anyone, regardless of sexual orientation, can spread monkeypox through contact with body fluids, monkeypox sores, or shared items (such as clothing and bedding) that have been contaminated with fluids or sores of a person with monkeypox. Monkeypox virus can also spread between people through respiratory droplets typically in a close setting, such as the same household or a healthcare setting. Common household disinfectants can kill the monkeypox virus.

Last week Portuguese health authorities confirmed five cases of monkeypox in young men while United Kingdom officials announced two. British health authorities said neither person had previously traveled to Africa and that it was possible they were infected in the U.K. The cases had no known links to other previously confirmed patients.

“Many of these global reports of monkeypox cases are occurring within sexual networks.  However, healthcare providers should be alert to any rash that has features typical of monkeypox. We’re asking the public to contact their healthcare provider if they have a new rash and are concerned about monkeypox,” said Inger Damon, MD, PhD, a poxvirus expert with more than 20 years’ experience and Director of CDC’s Division of High-Consequence Pathogens and Pathology, where the agency’s poxvirus research is based.

What people should do: 

  • People who may have symptoms of monkeypox, particularly men who report sex with other men, and those who have close contact with them, should be aware of any unusual rashes or lesions and contact their healthcare provider for a risk assessment.

What healthcare providers should do:

  • If healthcare providers identify patients with a rash that looks like monkeypox, consider monkeypox, regardless of whether the patient has a travel history to central or west African countries.
  • Do not limit concerns to men who report having sex with other men. Those who have any sort of close personal contact with people with monkeypox could potentially also be at risk for the disease.
  • Some patients have had genital lesions and the rash may be hard to distinguish from syphilis, herpes simplex virus (HSV) infection, chancroid, varicella zoster, and other more common infections.
  • Isolate any patients suspected of having monkeypox in a negative pressure room, and ensure staff understand the importance of wearing appropriate personal protective equipment (PPE) and that they wear it each time they are near suspected cases.
  • Consult the state health department or CDC’s monkeypox call center through the CDC Emergency Operations Center (770-488-7100) as soon as monkeypox is suspected.

Monkeypox is a rare but potentially serious viral illness that typically begins with flu-like illness and swelling of the lymph nodes and progresses to a widespread rash on the face and body. Monkeypox reemerged in Nigeria in 2017 after more than 40 years with no reported cases. Since then, there have been more than 450 reported cases in Nigeria and at least eight known exported cases internationally.