What is monkeypox, the rare virus now confirmed in the U.S. and Europe?

Massachusetts health authorities said Wednesday that they confirmed a case of a rare and sometimes serious viral illness called monkeypox — the first infection identified in the United States this year amid a rash of cases outside the disease’s typical territory.

Monkeypox, which can be passed to animals and humans, is usually found in Central and West Africa. But health authorities in Europe have confirmed more than a dozen cases this month and are investigating dozens more. Some infections confirmed in the United Kingdom “have no travel links” to a place where monkeypox is regularly found, officials said, suggesting the virus may be spreading through the community.

Monkeypox is not known to spread easily between humans. The fact that cases are emerging in several countries at once — with signs of “sustained” transmission in people — is striking, said Aris Katzourakis, a professor of evolution and genomics at the University of Oxford.

“It’s either a lot of bad luck or something quite unusual happening here,” Katzourakis said.

WHAT TO KNOW

  • What is monkeypox?
  • How worried should we be? How does this compare to covid-19?
  • Has monkeypox made it to the United States before?
  • Where else has monkeypox been identified this month?
  • What do we know about the U.S. case?
  • What now?

Rare monkeypox outbreak in U.K., Europe and the U.S.: What is it and should we worry?

There’s a monkeypox outbreak in the United Kingdom, Portugal, Spain and other European countries. The outbreak is small — so far 68 suspected cases, including eight in England and 20 in Portugal. Cases in Canada and a case in the U.S. have also been reported.

But health officials have little clue where people caught the monkeypox virus. And there’s concern the virus may be spreading through the community — undetected — and possibly through a new route of transmission.

“This [outbreak] is rare and unusual,” epidemiologist Susan Hopkins, who’s the chief medical adviser of the U.K. Health Security Agency (UKHSA), said in a statement on Monday.

“Exactly where and how they [the people] acquired their infections remains under urgent investigation,” the agency said in the statement.

Monkeypox can be a nasty illness; it causes fever, body aches, enlarged lymph nodes and eventually “pox,” or painful, fluid-filled blisters on the face, hands and feet. One version of monkeypox is quite deadly and kills up to 10% of people infected. The version currently in England is milder. Its fatality rate is less than 1%. A case generally resolves in two to four weeks.

Typically, people catch monkeypox from animals in West Africa or central Africa and import the virus to other countries. Person-to-person transmission isn’t common, as it requires close contact with bodily fluids, such as saliva from coughing or pus from the lesions. So the risk to the general population is low, the U.K. health agency notes.

But in England, 7 of the 8 cases don’t involve recent travel to Africa, suggesting the patients involved in those cases caught the virus in England. On top of that, those individuals haven’t had contact with the one patient known to have traveled to Nigeria, the UKHSA reported Tuesday. Together, this data suggests the virus is spreading in the community undetected.

“Presumably this is cryptic spread from an imported case(s),” virologist Angie Rasmussen of the Vaccine and Infectious Disease Organization tweeted on Monday.

In the U.S., the patient in Massachusetts had not recently traveled to countries where the disease occurs but had visited Canada.

In addition, there’s evidence the virus could be spreading through a new route: sexual contact. “What is even more bizarre is finding cases that appear to have acquired the infection via sexual contact,” epidemiologist Mateo Prochazka at the UKHSA tweeted. “This is a novel route of transmission that will have implications for outbreak response and control.”

“We are particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay,” epidemiologist Hopkins said in the UKHSA’s statement.

Scientists at the U.S. Centers for Disease Control and Prevention are watching the outbreak in Europe closely. “We do have a level of concern that this is very different than what we typically think of from monkeypox,” Jennifer McQuiston, a senior CDC official, told health news site STAT on Tuesday.

In 2019, the U.S. Food and Drug Administration approved the first vaccine for monkeypox, which also protects against smallpox. “This vaccine is also part of the Strategic National Stockpile (SNS), the nation’s largest supply of potentially life-saving pharmaceuticals and medical supplies for use in a public health emergency that is severe enough to cause local supplies to be depleted,” the agency said in a news release.

A primer on monkeypox

So just what is known about monkeypox? And how threatening is it compared with other emerging viruses?

In 2017, Goats and Soda interviewed two monkeypox experts — Anne Rimoin of the University of California, Los Angeles, and Jay Hooper of the U.S. Army Medical Research Institute of Infectious Diseases — to find out.

Here are some of the questions we asked and some of their surprising answers, updated in light of the current cases.

Where does it come from? Monkeys?

No!

“The name is actually a little bit of a misnomer,” Rimoin says. Perhaps it should be called “rodentpox” instead.

The name “monkeypox” comes from the first documented cases of the illness, in 1958, when two outbreaks occurred in colonies of monkeys kept for research, the CDC says on its website.

But monkeys aren’t major carriers. Instead, the virus likely persists in squirrels, pouched rats, dormice or another rodent.

How do you catch it?

Primarily, from an animal bite, scratch or contact with the animal’s bodily fluid. Then the virus can spread to other people through coughing and sneezing or contact with pus from the lesions.

The lesions from monkeypox are similar to those from a smallpox infection.

“But it doesn’t spread very well between people,” Hooper says. “Its infection rate is much lower than that of smallpox.” In many cases, people don’t spread the virus to anyone else.

Up until this current outbreak, a person sick with monkeypox spread the virus to between zero and one person, on average. So all previous outbreaks (up until now) burned themselves out quickly.

“You have primary cases, in which people get monkeypox from an animal, and they may transmit the disease a few generations — but then that’s it,” she says. “The outbreaks tend to be self-limiting.”

“There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population,” the World Health Organization’s website says.

Scientists don’t know yet if the rate of transmission has increased in this current outbreak. If there is enhanced transmission, that could be one reason the current outbreak appears to have spread through the community in three cities.

Has there ever been an outbreak in the U.S.?

“There already was!” Hooper says. “But it was quickly contained.”

In 2003, monkeypox hitched a ride with a shipment of animals from Ghana to Illinois. Several giant pouched rats and squirrels tested positive for the virus and eventually spread it to prairie dogs being sold as pets in multiple Midwestern states, the CDC says on its website.

Forty-seven people caught the disease from the prairie dogs. Everyone recovered. And no one spread the disease to another person.

Is monkeypox a “new” virus?

No. The virus has likely been infecting people for centuries, even millennia, Rimoin says. But for a long time, doctors missed the cases.

Monkeypox is closely related to smallpox. “They are clinically indistinguishable,” Rimoin says. “So for centuries, doctors have likely mistaken monkeypox for smallpox.”

Then in the 1970s, the world was close to eradicating smallpox. Cases plummeted. And doctors in central Africa started noticing another disease that looked like smallpox but didn’t spread as well between people. It was monkeypox.

There are several other viruses related to smallpox, including cowpox and camelpox. “I would be more worried about camelpox than monkeypox,” Rimoin says, “because that’s closer on the genetic tree to smallpox.”

Is the disease actually a rising threat? Or are we just better at detecting it?

A little bit of both, Rimoin says.

Back in 2010, Rimoin and her colleagues reported that monkeypox had increased 14-fold in the Democratic Republic of Congo since the 1980s. Incidence rose from less than 1 case per 10,000 people to about 14 cases per 10,000 people.

And the reason for this bump is ironic: the eradication of smallpox.

The smallpox vaccine actually works quite well to protect people against monkeypox. It’s about 85% effective (although the smallpox vaccine does have some safety concerns, Hooper points out: “It’s a live virus and can cause a deadly infection in people with severely compromised immune systems”).

But after the world eradicated smallpox, countries stopped vaccinating kids. And for those who were vaccinated years earlier, their protection has likely waned over time, Hooper says.

“So now there’s this growing population of people who don’t have immunity to monkeypox,” he says. “And when you do have a outbreak, it’s likely to be bigger because less people in the community are protected.”

That means small monkeypox outbreaks in West Africa and central Africa now involve dozens of cases instead of just one or two, Hooper says.

And in the Democratic Republic of Congo, annual cases have shot up into the thousands. In 2020, there were nearly 4,600 suspected cases, according to a study published in February.

Could the virus become more transmissible and thus more of a global threat?

“Oh, yes,” Hooper says. “Every time there’s an outbreak — and the more people get infected — the more chances monkeypox has to adapt to people,” he says.

In other words, the more time the virus spends inside people, the more time it has to evolve. It could possibly figure out how to spread more quickly among people.

So scientists are keeping a close eye on the virus and outbreaks that occur — especially if the virus appears to change its route of transmission, as may be happening in the current outbreak.

“We didn’t think Ebola spread very easily between people,” Hooper adds. “And we were all surprised that health care workers could catch it even though they were wearing protective gear.”

And of course, many scientists didn’t think SARS-CoV-2, the coronavirus that causes the disease COVID-19, would mutate to become more contagious, but that’s exactly what has happened in the past two years. SARS-CoV-2 evolved from a virus just about as contagious as the flu virus into one that’s almost as contagious as the far more transmissible chickenpox virus.

“With viruses that spill over from animals, you just never know what’s going to happen,” Hooper says.

And indeed, this new outbreak in Europe may be a sign that the virus has changed — even if just a bit — and may be increasing its ability to spread among people.

So, Have You Heard About Monkeypox?

A new viral outbreak is testing whether the world has learned anything from COVID.

Yesterday afternoon, i called the UCLA epidemiologist Anne Rimoin to ask about the European outbreak of monkeypox—a rare but potentially severe viral illness with dozens of confirmed or suspected cases in the United Kingdom, Spain, and Portugal. “If we see those clusters, given the amount of travel between the United States and Europe, I wouldn’t be surprised to see cases here,” Rimoin, who studies the disease, told me. Ten minutes later, she stopped mid-sentence to say that a colleague had just texted her a press release: “Massachusetts Public Health Officials Confirm Case of Monkeypox.

The virus behind monkeypox is a close relative of the one that caused smallpox but is less deadly and less transmissible, causing symptoms that include fever and a rash. Endemic to western and central Africa, it was first discovered in laboratory monkeys in 1958—hence the name—but the wild animals that harbor the virus are probably rodents. The virus occasionally spills over into humans, and such infections have become more common in recent decades. Rarely, monkeypox makes it to other continents, and when it does, outbreaks “are so small, they’re measured in single digits,” Thomas Inglesby, the director of the Johns Hopkins Center for Health Security, told me. The only significant American outbreak occurred in 2003, when a shipment of Ghanaian rodents spread the virus to prairie dogs in Illinois, which were sold as pets and infected up to 47 people, none fatally. Just last year, two travelers independently carried the virus to the U.S. from Nigeria but infected no one else.

The current outbreaks in Europe and the U.S. are different and very concerning. The first case, which was identified in the United Kingdom on May 7, fit the traditional pattern: The individual had recently traveled to Nigeria. But several others hadn’t recently been to endemic countries, and some had had no obvious contact with people known to be infected. This suggests that the monkeypox virus may be surreptitiously spreading from person to person, with some number of undetected cases. (The incubation period between infection and symptoms is long, ranging from 5 to 21 days.) “It’s uncommon to see this number of cases in four countries at the same time,” Inglesby said. (The count may soon be seven: Since we spoke yesterday, monkeypox has been confirmed in Sweden and Italy, while Canada is investigating suspected cases.)

These monkeypox outbreaks are also unique because … well … they’re occurring in the third year of a pandemic“when the public is primed to be more acutely aware of outbreaks,” Boghuma Kabisen Titanji, a physician at Emory University, told me. “I don’t think that’s necessarily a good thing.” When it comes to epidemics, people tend to fight the last war. During the West African Ebola outbreak of 2014, American experts had to quell waves of undue paranoia, which likely contributed to the initial downplaying of the coronavirus. Now, because the U.S. catastrophically underestimated COVID, many Americans are panicking about monkeypox and reflexively distrusting any reassuring official statements. “I don’t think people should be freaking out at this stage,” Carl Bergstrom of the University of Washington told me, “but I don’t trust my own gut feelings anymore, because I’m so sick of all this shit that I tend to be optimistic.”

Monkeypox, then, is a test of the lessons that the world has (or hasn’t) learned from COVID. Can we better thread the needle between panic and laxity, or will we once again eschew uncertainty in a frantic quest for answers that later prove to be wrong?


To be clear, monkeypox isn’t COVID—they’re different diseases caused by different viruses with markedly different properties. COVID was completely unfamiliar when it first appeared, but monkeypox is a known quantity, and experts on the virus actually exist. One of them, Andrea McCollum of the CDC, told me that based on existing studies, monkeypox doesn’t spread easily, and not over long distances through the air. It transmits via contaminated surfaces or prolonged proximity with other people, which is why most outbreaks have been small, and why people have mostly transmitted the disease to either household members or health-care workers. “This isn’t a virus that, as far as we’re aware, would really take off in a population like COVID,” she said. “It really requires close contact for human-to-human transmission.”

Of course, we have heard that before. In early 2020, many experts claimed that COVID spread only via contaminated surfaces or close-splashing droplets—hence the six-feet rules and hygiene theater. Now it is widely accepted that the disease spreads through smaller and farther-reaching aerosol particles—hence the importance of ventilation and masks. But that doesn’t mean history is repeating with monkeypox. A 2012 study suggested that the virus can persist in aerosols for several days—but that was under artificial laboratory conditions, and persistence is just one small part of the infection process. The fact remains that past monkeypox outbreaks have been inconsistent with a virus that travels as easily as the coronavirus. “Monkeypox does not scream ‘airborne’ at me; COVID-19 did,” Linsey Marr, an aerosol expert at Virginia Tech, told me.

Then again, Marr is less certain about monkeypox than she was about COVID. And Titanji notes that our knowledge of monkeypox is based on just 1,500 or so recorded cases, as of 2018. “I’ve seen a lot of people writing as if everything we know about monkeypox is definitive and finalized, but the reality is that it is still a rare zoonotic infection,” she said. For that reason, “I’m in Team Cautious,” she said. “We can’t use what happened with previous monkeypox outbreaks to make sweeping statements. If we’ve learned anything from COVID, it’s to have humility.”

For decades, a few scientists have voiced concerns that the monkeypox virus could have become better at infecting people—ironically because we eradicated its relative, smallpox, in the late 1970s. The smallpox vaccine incidentally protected against monkeypox. And when new generations were born into a world without either smallpox or smallpox-vaccination campaigns, they grew up vulnerable to monkeypox. In the Democratic Republic of Congo, this dwindling immunity meant that monkeypox infections increased 20-fold in the three decades after smallpox vanished, as Rimoin showed in 2010. That gives the virus more chances to evolve into a more transmissible pathogen in humans. To date, its R0—the average number of people who catch the disease from one infected person—has been less than 1, which means that outbreaks naturally peter out. But it could eventually evolve above that threshold, and cause more protracted epidemics, as Bergstrom simulated in 2003. “We saw monkeypox as a ticking time bomb,” he told me.

This possibility casts a cloud of uncertainty over the current unusual outbreaks, which everyone I spoke with is concerned about. Are they the work of a new and more transmissible strain of monkeypox? Or are they simply the result of people traveling more after global COVID restrictions were lifted? Or could they be due to something else entirely? So far, the cases are more numerous than a normal monkeypox outbreak, but not so numerous as to suggest a radically different virus, Inglesby told me. But he also doesn’t have a clear explanation for the outbreak’s unusual patterns—nor does anyone else.

Answers should come quickly, though. Within days, scientists should have sequenced the viruses from the current outbreaks, which will show whether they harbor mutations that might have changed their properties. Within weeks, European epidemiologists should have a clearer idea of how the existing cases began, and whether there are connections between them. As for the U.S., “there are currently no additional suspected cases” beyond the individual in Massachusetts, McCollum told me. But given the numbers in Europe, she’s standing by for more.


The u.s. is, of course, in a better position with monkeypox than with COVID. Although the nation hadn’t planned for a coronavirus pandemic, it has spent decades thinking about how to handle smallpox bioterrorism. The two cases of monkeypox in 2021 provided handy test runs for those plans, which are now unfolding smoothly. For example, the case in Massachusetts was identified when the patient’s physician, having reviewed reports from the U.K., called the state’s public-health department on Tuesday. Within 12 hours, the department had collected and tested the patient’s samples. The next day, more samples arrived at the CDC, which confirmed monkeypox. “All of that worked really well,” McCollum said. “We’re a fairly well-oiled machine.”

Also, there’s already a vaccine. One smallpox vaccine is 85 percent effective at preventing monkeypox and has already been licensed for use against the virus. And as another bioterrorism precaution, stockpiles of three smallpox vaccines are large enough “to vaccinate basically everyone in the U.S.” Inglesby said. And though monkeypox patients usually get just supportive care, a possible treatment does exist and has also been stockpiled: Tecovirimat, or TPOXX, was developed to treat smallpox but would likely work for monkeypox too.

Monkeypox may also be less deadly than is frequently claimed. The oft-cited fatality rate of about 10 percent applies to a strain that infected people in the Congo Basin. The West African strain, which several of the current cases have been linked to, has a fatality rate closer to 1 percent—and that’s in poor, rural populations. “We haven’t seen fatalities in people who’ve had monkeypox in high-resource settings,” Rimoin said.

Still, as COVID has shown, even when a disease doesn’t kill you, it can hardly count as “mild.” Monkeypox might not take off in the way that COVID did, but for those who get it, it remains a “substantial illness,” McCollum said. “If individuals are sick, they’re often sick for two to four weeks. It’s urgent to identify people early, get them treatment, and identify contacts.” It helps that one common symptom is an obvious rash, which looks like an extreme version of chickenpox. But unlike chickenpox, the monkeypox rash is usually preceded by a fever, the lesions are initially more painful than itchy, and the lymph nodes are often inflamed. “The constructive thing to do is to make sure that the public is aware of what monkeypox looks like,” Titanji said.

For that reason, she added, it’s important to avoid stigmatizing infected people. Many of the current cases are in men who identify as gay, bisexual, or men who have sex with men—an unusual pattern not seen in previous monkeypox outbreaks. That has raised questions about a new route of transmission, but sex obviously involves prolonged close contact, which is how the virus normally spreads. As COVID showed, early narratives about a disease can rapidly and prematurely harden into accepted lore. And if those narratives turn into stigma, they could stop people from coming forward with symptoms.

Communication might prove to be one of monkeypox’s hardest challenges, as it has been with COVID. “We need leaders who are saying, ‘Here’s what we know; here’s what we don’t know; we’ll find out; and we’ll be back tomorrow,’” Inglesby said. But some leaders have lost credibility during the recent pandemic, while others are being drowned out by armchair experts who have amassed large followings. “All of a sudden, everyone’s an expert in monkeypox,” Titanji said.

What is monkeypox? Everything you need to know about the virus outbreak baffling scientists

The arms and legs of a four-year-old girl infected with monkeypox in Liberia.
The arms and legs of a four-year-old girl infected with monkeypox in Liberia.

Health authorities confirmed Wednesday that monkeypox—an infectious disease that’s usually found in parts of Africa—has arrived in the U.S. after several cases were reported across Europe.

The first case associated with the current outbreak was reported in the U.K. on May 7 in a person who had recently traveled to Nigeria, where they are believed to have contracted the disease.

Five cases of monkeypox have since been confirmed in Portugal, while Spain has seven cases.

Canada is investigating 13 suspected cases of the disease, with the U.S. patient reported to have recently traveled to the country.

What is monkeypox, and where did it come from?

Monkeypox is a rare zoonotic disease—meaning it’s caused by germs that spread between animals and people.https://b58008410c97c41ab8294128a159762f.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

It’s a virus that is mainly spread by wild animals in parts of west and central Africa, according to the WHO—but human-to-human transmission can also occur, and it is occasionally exported to other parts of the world when an infected person travels.  

There are two variants of the virus: the West African strain and the Central African strain.

The cases identified in the U.K. have all been the West African strain of the virus, which is thought to be milder than the Central African strain.

What are the symptoms?

According to Britain’s National Health Service, the first symptoms of monkeypox include fever, headaches, muscle aches, exhaustion, and swollen glands.

A rash appears one to five days after the first symptoms, often beginning on the face before spreading to other parts of the body.

The rash, which starts as raised spots that turn into blisters before falling off, is often confused with chicken pox, the NHS says.

Monkeypox lesions are shown on a patient’s hand in a CDC handout from 2003, when there was an outbreak of the virus in Wisconsin, Illinois, and Indiana.

In countries like the U.K. or the U.S., symptoms are typically mild, Professor Neil Mabbott, personal chair of immunopathology at the University of Edinburgh’s Roslin Institute, told Fortune in a phone call on Thursday.

However, he said there is currently not enough data to determine whether certain demographics are at heightened risk of developing more severe symptoms.

How do you catch the disease?

The disease is usually caught from an infected animal if a person is bitten or comes into contact with its blood or other bodily fluids, or they consume or touch infected animal products like meat, skin, or fur.  

While the human-to-human transmission is rare, it is possible.

The U.K. Health Security Agency (UKHSA) has identified nine cases of monkeypox in Britain since the country first detected a single case of the virus on May 7.

Two cases of the virus were identified in London a week after the first case was reported, but authorities said the individuals had no connection to the previously confirmed case, and “where and how they acquired their infection remains under investigation.”

The UKHSA detected four additional cases on May 16, and a further two on May 18.

Common contacts were only identified for less than half of the new infections.

As the latest two patients had no travel links to a country where monkeypox is endemic, the UKHSA said it was possible that they had contracted the disease through community transmission.

Despite this possibility, health authorities have emphasized that the risk to the general public remains low.

“As a whole, we shouldn’t be panicking—this is not a disease that spreads like COVID-19 within the general population,” Mabbott told Fortune. “Monkeypox isn’t very transmissible in humans. It needs very, very close contact with an infected person to be able to transmit.”

He explained that the virus transmits via large droplets that can only travel a short distance, but it can also be spread through direct contact with skin lesions or, sometimes, contaminated bedsheets or clothes.

Andrew Preston, a professor of microbial pathogenicity at the University of Bath, also told Fortune on Thursday that human-to-human spread is thought to be relatively rare and difficult.

“So these current cases that we’re discussing are somewhat surprising,” he said.

“There have been cases of people [picking it up from] contaminated bedding or fluid from the skin of an infected person, so there are various different opportunities to get the virus, but it’s [generally through] pretty close contact, we think, with an infected person.”

Preston said it was still unclear whether the amount of time spent with an infected person made someone more or less likely to catch the virus.

“It’s still somewhat of a mystery as to how this is spreading. The chances are it’s just not being recognized—it’s not the first thing you think of, and some people say the rash is a bit like shingles,” he said.

He added that it was concerning to see that some of the cases identified in the U.K. had no links to one another.

“That would suggest there are other contacts forming the connections between those cases,” he explained. “That’s the worrying thing: The epidemiology would suggest there are other unrecognized cases at the moment. There have to be other cases in the community.”

Is monkeypox sexually transmitted?

The U.K.’s most recent cases of monkeypox were predominantly found in gay or bisexual men, or men who have sex with men, according to health officials.

Monkeypox has not previously been described as a sexually transmitted infection, but British health officials said on Wednesday that the virus can be passed by direct contact during sex.

“We are particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay if they have concerns,” Dr Susan Hopkins, the UKHSA’s chief medical adviser, said in a statement on Wednesday.

However, according to Mabbott, any transmission of monkeypox between sexual partners is likely to be down to close contact, rather than the virus spreading in the same way as other sexually transmitted infections.

We can’t rule that out, but it is most likely due to the very close contact,” he said.

Preston added: “Monkeypox is not recognized as a sexually transmitted disease—that is, something that’s hugely dependent on being spread through sexual contact. There’s nothing to suggest that here, but if you’ve got a rash on your skin that’s potentially infectious, or you’re breathing contaminated droplets, then if you’re up close with someone [it can spread]. That doesn’t necessarily mean it is a sexually transmitted disease like gonorrhea or chlamydia.”

Can you die from monkeypox?

Fatality rates differ between the two strains, Mabbott said on Thursday.

The West African variety, the strain currently circulating in Europe and the U.S., has a recorded fatality rate of around 1%, while the Central African strain’s recorded fatality rate is around 10%.

“It can be fatal, and it’s most likely to be fatal somewhere where there is [poor] health care,” Mabbott told Fortune.

Is there a cure?

Mabbott noted that while there was currently no cure for monkeypox, smallpox vaccines have been used in Africa in the past to provide protection against monkeypox, as the viruses are related.

However, a successful widespread vaccination campaign eradicated smallpox from circulation decades ago, meaning the majority of the population hasn’t been given a vaccine for the virus.

“Most of the world hasn’t been vaccinated against smallpox, so most people would be completely susceptible to [monkeypox],”

“We haven’t been using that vaccine for about 40, 50 years, so there are very few people walking around now that have smallpox-vaccine-induced immunity,” Mabbott agreed.

“Likewise, I’m not aware of any antiviral treatments which have been approved for use against monkeypox. So we don’t have those tools.”

17 suspected monkeypox cases seen in Montreal, as European tally increases

Health officials in Montreal on Thursday said they were investigating 17 suspected cases of monkeypox in the area, likely adding Canada to the list of countries in the Americas and Europe that are reporting recent infections.

Most of the cases were in men in their 30s to 50s.

The Montreal officials also said they had found links between some of their suspected cases and the first infection found in the United States, a Massachusetts man who had recently traveled to Canada by car.

The current outbreak has raised alarms for several reasons. For one, as countries up their surveillance efforts, more are reporting cases of the virus, which is rarely seen outside Central and West Africa. The pattern of infections indicates that the virus has been spreading undetected. It’s also not clear, for example, if the U.S. case is related to the cases in Europe. Genomic sequencing can help answer that question.Related: A CDC expert answers questions on monkeypox

“This is the first time that chains of transmission are reported in Europe without known epidemiological links to West and Central Africa,” the European Centre for Disease Prevention and Control wrote in a report Thursday.

Other countries that have reported monkeypox cases include the United Kingdom, Spain, and Portugal. Sweden and Italy said Thursday they had identified their first cases, with the Italian case in a person who had reportedly traveled to the Canary Islands. U.K. officials said Wednesday they had identified nine cases thus far in the outbreak. Until now, the country had only ever detected seven cases.

Cases outside of Africa are typically imported infections that don’t start transmission chains, though there was a large outbreak in the United States in 2003 that involved 47 confirmed and probable cases and was traced back to the importation of small mammals from Ghana.

Many of the cases in the current outbreak have been identified in men who have sex with men. Health authorities have stressed cases are likely not limited to this population, both to try to avoid stigmatization, and to ensure that clinicians remain on the lookout for infections in other groups of people.

MonkeyPox infection symptoms

A monkeypox infection results in flu-like symptoms — fever, body aches, chills — and also swollen lymph nodes. It’s characterized by a rash that often starts on the face, and unlike other rashes, it often includes vesicles that form on people’s palms. One possible explanation for why so many cases in the current outbreak have been identified at STI clinics is that people have turned up with “a preponderance of lesions in the genital area,” the ECDC wrote. The health officials in Montreal said the suspected cases there have included painful lesions in the mouth and on the penis.

Most people recover from the infection within a few weeks. The cases diagnosed in Europe have been caused by the West African clade of the virus, which is typically less dangerous than the Congo Basin clade. In Africa, monkeypox has been fatal in about 1 in 10 cases, with severe disease and death more likely among children, young adults, and people with compromised immune systems, though the ECDC said in its report that the case fatality rate for the West African clade has been 3.6%.

The monkeypox virus spreads among people through respiratory droplets that can infect the membranes of the eyes, nose, and throat, or through exposures with lesions or bodily fluids. It can also be picked up through contact with clothing or linens contaminated with pus or other material from lesions.

Monkeypox has not been known to be sexually transmitted, and a leading hypothesis is that whatever transmission is occurring between sex partners isn’t being spread through sex itself. Rather, it could be contracted during the close contact that comes with sex.

Massachusetts public health officials confirm case of monkeypox

BOSTON — The Massachusetts Department of Public Health (DPH) today confirmed a single case of monkeypox virus infection in an adult male with recent travel to Canada. Initial testing was completed late Tuesday at the State Public Health Laboratory in Jamaica Plain and confirmatory testing was completed today at the US Centers for Disease Control and Prevention (CDC). DPH is working closely with the CDC, relevant local boards of health, and the patient’s health care providers to identify individuals who may have been in contact with the patient while he was infectious. This contact tracing approach is the most appropriate given the nature and transmission of the virus. The case poses no risk to the public, and the individual is hospitalized and in good condition.

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 rash on the face and body. Most infections last 2-to-4 weeks. In parts of central and west Africa where monkeypox occurs, people can be exposed through bites or scratches from rodents and small mammals, preparing wild game, or having contact with an infected animal or possibly animal products. The virus does not spread easily between people; transmission can occur through contact with body fluids, monkeypox sores, items that have been contaminated with fluids or sores (clothing, bedding, etc.), or through respiratory droplets following prolonged face-to-face contact.

No monkeypox cases have previously been identified in the United States in 2022; Texas and Maryland each reported a case in 2021 in people with recent travel to Nigeria. Since early May 2022, the United Kingdom has identified 9 cases of monkeypox; the first case had recently traveled to Nigeria. None of the other cases have reported recent travel. UK health officials report that the most recent cases in the UK are in men who have sex with men.

Based on findings of the Massachusetts case and the recent cases in the UK, clinicians should consider a diagnosis of monkeypox in people who present with an otherwise unexplained rash and 1) traveled, in the last 30 days, to a country that has recently had confirmed or suspected cases of monkeypox 2) report contact with a person or people with confirmed or suspected monkeypox, or 3) is a man who reports sexual contact with other men. This clinical guidance is consistent with recommendations from UK health officials and US federal health officials, based on identified cases.

Suspected cases may present with early flu-like symptoms and progress to lesions that may begin on one site on the body and spread to other parts. Illness could be clinically confused with a sexually transmitted infection like syphilis or herpes, or with varicella zoster virus. The CDC plans to issue public information soon on poxvirus infections which, when available, will be found here.

For more about this virus, visit https://www.cdc.gov/poxvirus/monkeypox/.

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