The United States has reported 72 cases of monkeypox in 18 states in the past month, making it the largest outbreak of monkeypox ever recorded in the country.
That total has increased significantly since early June, when just 19 cases were confirmed.
The Centers for Disease Control and Prevention released new guidelines on Tuesday on how to identify monkeypox during this outbreak, based on symptoms seen by doctors so far. Some recent infections have presented differently from past cases in Africa, where monkeypox is endemic in 11 countries.
Traditionally, people with monkeypox have developed a fever, swollen lymph nodes, headache, and muscle aches, followed by a rash that starts on their face or in their mouth and then spreads to others parts of their body, especially the hands and feet.
But in many recent cases in the United States, patients first presented with a rash in the mouth or around the genitals or anus. And instead of generalized rashes, some patients saw scattered or localized lesions in areas other than the face, hands, or feet. In some cases, flu-like symptoms developed after the rash, but other people did not have these symptoms at all.
The rash also seems to progress differently than in previous cases. Monkeypox lesions usually start out flat and then lift, after which they progress to fluid blisters, followed by pus-filled blisters that crust over and fall off. But the CDC said Tuesday that among recent patients, lesions appeared at different stages in the same area of the body. Blisters filled with fluid and pus, for example, may exist side by side.
Additionally, some US patients have reported pain in or around the anus and rectum, rectal bleeding, proctitis (painful inflammation of the lining of the rectum), or the feeling of needing to have a bowel movement even if the intestines are empty. None of these symptoms were commonly associated with monkeypox before.
The World Health Organization said on Tuesday it had also identified a unique pattern of symptoms among recent cases outside Africa, including rashes limited to certain areas of the body such as the genitals or mouth. .
“It is now clear that there is an unusual situation, which means that even the virus is behaving in an unusual way compared to the way it behaved in the past,” said WHO Director General Tedros. Adhanom Ghebreyesus, during a briefing.
Tedros warned last week that the window to contain the global outbreak could be shrinking, noting that “the risk of monkeypox establishing itself in non-endemic countries is real.”
On Friday, CDC Director Rochelle Walensky said the United States needed to step up testing to track the spread of the virus.
“We need to increase testing for those with a characteristic rash, looking like pimples or blisters, so we can make rapid diagnoses,” she told a briefing.
No deaths have been reported outside of Africa in connection with the recent outbreak. The spreading version of monkeypox, the West African strain, has a 1% mortality rate, according to the CDC.
The agency says the risk to the public is low, but asked travelers to exercise extra caution and avoid close contact with sick people and wildlife, dead or alive.
People who develop rashes or abnormal lesions should contact their healthcare provider, the CDC said, especially if they meet the following criteria:
- Contact with a suspected or confirmed case of monkeypox.
- Contact with someone with a similar rash.
- Recent travel to countries where cases of monkeypox have been reported.
- Close in-person contact with men who have sex with men who meet partners through an online website, app, or social event.
- Contact with live or dead wild animals or exotic pets endemic to Africa, or a product derived from these animals.
People with flu-like symptoms and one or more of these risk factors should self-quarantine, the CDC said. If a rash does not appear within five days, monkeypox can probably be ruled out.
Because the cases can resemble chickenpox, herpes or syphilis, anyone who develops lesions associated with these illnesses should also be checked for monkeypox, the CDC said. If a doctor prescribes treatment for a sexually transmitted infection and the patient is unresponsive, that’s another indicator that a test is warranted, the agency added.
The CDC advises people who test positive for orthopoxvirus, a category of virus that includes monkeypox, to self-isolate until their scabs have fallen off and a new layer of skin has formed. Symptoms of monkeypox usually last two to four weeks.
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