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Monkeypox Outbreak in Nine US States
TAKE-HOME MESSAGE
- This report summarizes the CDC's effort to control the outbreak of monkey pox in the United States. As of May 31, 2022, 17 cases have been identified in nine states in the United States. All the patients developed rashes within 27 days, and 12 had prodromal symptoms such as headache, fever, and malaise. Patients were diagnosed with an orthopoxvirus infection within an average of 11 days, with person-to-person transmission being implicated in the spread of this infection. All the patients are well and are being monitored. During this period, the CDC has released guidance for testing, developed interim public health and clinical recommendations, and facilitated the availability of vaccine postexposure prophylaxis. Furthermore, contact tracing is ongoing.
- The CDC encourages healthcare providers to have a high index of suspicion for patients with rash illnesses and urges the general public to observe principles of infection prevention and control to curtail this outbreak.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOn May 17, 2022, the Massachusetts Department of Public Health (MDPH) Laboratory Response Network (LRN) laboratory confirmed the presence of orthopoxvirus DNA via real-time polymerase chain reaction (PCR) from lesion swabs obtained from a Massachusetts resident. Orthopoxviruses include Monkeypox virus, the causative agent of monkeypox. Subsequent real-time PCR testing at CDC on May 18 confirmed that the patient was infected with the West African clade of Monkeypox virus. Since then, confirmed cases have been reported by nine states. In addition, 28 countries and territories, none of which has endemic monkeypox, have reported laboratory-confirmed cases. On May 17, CDC, in coordination with state and local jurisdictions, initiated an emergency response to identify, monitor, and investigate additional monkeypox cases in the United States. This response has included releasing a Health Alert Network (HAN) Health Advisory, developing interim public health and clinical recommendations, releasing guidance for LRN testing, hosting clinician and public health partner outreach calls, disseminating health communication messages to the public, developing protocols for use and release of medical countermeasures, and facilitating delivery of vaccine postexposure prophylaxis (PEP) and antivirals that have been stockpiled by the U.S. government for preparedness and response purposes. On May 19, a call center was established to provide guidance to states for the evaluation of possible cases of monkeypox, including recommendations for clinical diagnosis and orthopoxvirus testing. The call center also gathers information about possible cases to identify interjurisdictional linkages. As of May 31, this investigation has identified 17 cases in the United States; most cases (16) were diagnosed in persons who identify as gay, bisexual, or men who have sex with men (MSM). Ongoing investigation suggests person-to-person community transmission, and CDC urges health departments, clinicians, and the public to remain vigilant, institute appropriate infection prevention and control measures, and notify public health authorities of suspected cases to reduce disease spread. Public health authorities are identifying cases and conducting investigations to determine possible sources and prevent further spread. This activity was reviewed by CDC and conducted consistent with applicable federal law and CDC policy.
Additional Info
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Monkeypox Outbreak - Nine States, May 2022
MMWR Morb. Mortal. Wkly. Rep. 2022 Jun 10;71(23)764-769, FS Minhaj, YP Ogale, F Whitehill, J Schultz, M Foote, W Davidson, CM Hughes, K Wilkins, L Bachmann, R Chatelain, MAP Donnelly, R Mendoza, BL Downes, M Roskosky, M Barnes, GR Gallagher, N Basgoz, V Ruiz, NTT Kyaw, A Feldpausch, A Valderrama, F Alvarado-Ramy, CH Dowell, CC Chow, Y Li, L Quilter, J Brooks, DC Daskalakis, RP McClung, BW Petersen, I Damon, C Hutson, J McQuiston, AK Rao, E Belay, AM McCollumFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Monkeypox extends
To signal its concern surrounding the global expansion of monkeypox, the World Health Organization (WHO) is holding an emergency session to determine if monkeypox should be declared an international public health emergency. If monkeypox is declared, it would join polio and COVID-19 as the third public health emergency of international concern. As of June 10, the WHO has recorded cases in 28 nations across the Americas, Europe, Eastern Mediterranean, and Western Pacific Regions.
Closer to home, a recent report in MMWR1 details the first 17 US cases. The first case, confirmed in Massachusetts on May 17th, was identified as belonging to the West African clade, which is usually less virulent than the Congo Basin clade. Since that time, 72 cases have been identified across 18 states. As many of the affected individuals have not traveled internationally, there is compelling evidence of person-to-person community spread of this virus. A preponderance of cases in men who have sex with men (MSM; 94%) may explain the high rate (47%) of initial rash starting in the genital or perianal area.
I have previously provided PracticeUpdate readers with the basics of monkeypox epidemiology2and case recognition, which are echoed in this report. The key features are: 1) prodrome of fever, lymphadenopathy, malaise, headache and/or myalgia occurring 5 to 13 days post exposure; (2) emergence of deep-seated, well-circumscribed vesicles or pustules 1 to 4 days later; 3) progression of skin lesions to scabbing.
The four most important considerations at this time for primary care clinicians are:
Up-to-date guidance for clinicians, including excellent photos of the characteristic rash, can be found on the CDC website.3 Clinical vigilance, early reporting of suspect cases, and public health measures may be able to contain this newly emerging infections disease.
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