Monkeypox ▪ Rare, sometimes life-threatening zoonotic infection ▪ Endemic in west and central Africa ▪ Caused by Monkeypox virus (which is an orthopoxvirus) ▪ Specific animal reservoir unknown, but likely small mammals ▪ Can spread from infected animals to humans and person-to-person – Respiratory secretions – Skin-to-skin contact with infected body fluids (e.g., fluid from vesicles and pustules) – Fomites (e.g., shared towels, contaminated bedding) Pre-2022 U.S. cases ▪ 2003: Outbreak linked to small mammals imported from Ghana – Cases: 47, multistate involving upper Midwest United States – Cause was traced to spread of Monkeypox virus from: imported African rodents → pet prairie dogs → people who had contact with pet prairie dogs ▪ 2021: 2 unrelated cases in travelers from Nigeria – July (Texas) and November (Maryland) – Similar to imported cases during 2018-2021 reported in travelers to United Kingdom (U.K.) (4), Singapore (1), Israel (1) Classic lesions: Firm, deep-seated, well circumscribed, painful, itchy, sometimes umbilicated Reed KD, Melski JW, Graham MB, Regnery RL, Sotir MJ, Wegner MV, Kazmierczak JJ, Stratman EJ, Li Y, Fairley JA, Swain GR, Olson VA, Sargent EK, Kehl SC, Frace MA, Kline R, Foldy SL, Davis JP, Damon IK. The detection of monkeypox in humans in the Western Hemisphere. N Engl J Med. 2004 Jan 22;350(4):342-50. Lesions observed in endemic countries Lesions observed during 2003 U.S. monkeypox outbreak May 2022 ▪ United Kingdom: cases in 3 distinct clusters announced May 7, 14, and 16 – Travel-associated: 1 – Family cluster of unknown etiology: 3 – Cases identified at sexual health clinics among gay, bisexual, or other men who have sex with men (MSM): 4 ▪ United States: first suspected case identified on May 17 – Resident of Massachusetts who had traveled to Canada – Began as anogenital rash (vesicles, pustules) and spread to face and trunk – Tested positive by the OPX generic test at Massachusetts Laboratory Response Network laboratory Probable and confirmed cases* by U.S. state Total: As of 2pm ET on Tuesday June 28, 305 cases diagnosed in the United States† among residents of 28 states and the District of Columbia *A probable case is presence of orthopoxvirus DNA by PCR of a clinical specimen OR orthopoxvirus using immunohistochemical or electron miscroscopy testing methods OR demonstration of detectable levels of anti-orthopoxvirus IgM antibody during the period of 4 to 56 days after rash onset in a person in whom there is no suspicion of other recent orthopoxvirus exposure (e.g., Vaccinia virus in ACAM2000 vaccination) Confirmed case is demonstration of Monkeypox virus DNA by polymerase chain reaction testing or Next-Generation sequencing of a clinical specimen OR isolation of Monkeypox virus in culture from a clinical specimen †One patient is currently being monitored in Florida, but laboratory confirmation occurred in another country. This case is not included in some U.S. case counts including this one Cases by date of lab report, N=305 Demographics of U.S. cases*, N=305 ▪ Median age: 36 years (range 20-76 years) ▪ Male sex at birth: 271 – All for whom gender identity was reported, are cisgender men ▪ Female sex at birth: 5 – Some cisgender women – Some transgender men MMSC† : 193/195(99%) Unknown: 76 ▪ No cases in children ▪ No deaths; some hospitalizations primarily for pain control Data will change pending ongoing investigations and additional cases* †male to male sexual contact Any person, regardless of gender identity or sexual orientation, can acquire and spread monkeypox Clinical symptoms ▪ Skin rash or