Outbreak Summary and Epidemiologic Updates

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Current Epidemiologic Update

To date, over 98% of global cases have been in males with 36 years as the median age. Of those reporting sexual orientation, 95.8% self-identified as men who have sex with men. The most common transmission type was a sexual encounter  and the majority of those were at a party setting. Some cases (5.2%) have been reported in healthcare workers, although it seems most were infected in the community instead of at work.

While the trend of cases globally is decreasing, the number of cases within the United States is still increasing. Almost all cases have been reported in men and the median age is 37 years old. A very small percentage (<1%) of cases has been reported within American Indians/Alaska Natives; however, race information is only reported for less than half of cases.

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Historical Epidemiologic Updates

Epidemiologic Update: August 3, 2022

The World Health Organization publishes biweekly status reports. As of August 3, 2022, 98.8% (N=16,517/16,721) of cases are male and 97.5% (N=7,328/11,812) of cases were reported as Men who have Sex with Men (MSM). Males aged eighteen to forty-four years old account for 76.7% of cases and seem to be disproportionately impacted. The data shows that 91.5% (N=4,808/5,255) of transmission events were through a sexual encounter. There have only been two cases of a health worker infected that was not also a MSM, indicating clinical protocols are adequate. Only five deaths have been reported from this outbreak worldwide.

This epidemiological data is vital in effectively stopping this outbreak, we are at a critical turning point. The current monkeypox outbreak is reminiscent of the beginning of the HIV epidemic. Monkeypox is spread by direct contact, and anyone can get it; however, using the lessons learned and the networks created through controlling HIV, these can be used to effectively distribute monkeypox information to inform and protect our communities.

Epidemiologic Update: July 22, 2022

As of July 22, 2022, there were 2,891 cases in the United States, and there are cases in almost all states and territories. There are currently 900 cases in New York, followed by 356 cases in California, 247 cases in Florida, and 238 cases in Illinois. Currently, this outbreak is concentrated among men who have sex with men, especially those with multiple sexual partners; however, it is spreading rapidly. This outbreak can be contained through cooperation and a strong public health response.

Sources for Epidemiologic Data

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Outbreak Summary

Monkeypox is caused by infection with the monkeypox virus, which is an Orthopoxvirus. The Orthopoxvirus genus also includes variola virus (smallpox), vaccinia virus (smallpox vaccine), and cowpox virus. The virus gets its name from the first two outbreaks in 1958, in which monkeys kept for research developed this pox-like disease. The source of the disease remains unknown.

Monkeypox is rare in the United States but is endemic in several countries in Central and West Africa. The first time monkeypox was reported outside of Africa was during the 2003 outbreak in the United States. The 2003 outbreak was traced back to a shipment of small rodents imported from Ghana. These rodents were then housed near prairie dogs. The prairie dogs were sold as pets before they developed clinical signs. People who contracted monkeypox in this outbreak had direct contact, a bite or scratch, or contact with bedding from these infected animals. Due to this, the importation of African rodents was restricted by the CDC and still is to this day. Up until the current outbreak, monkeypox has been linked to international travel to endemic countries or imported animals.

In May 2022, a resident of Massachusetts returning home from Canada was the first known monkeypox case in the United States during the current outbreak. Monkeypox is rarely fatal, especially the West African strain in the current outbreak, and milder than smallpox. Clinicians providing services connected to primary care or sexually transmitted diseases, especially to populations with multiple sexual partners, need to remain vigilant. Groups at highest risk for serious illness or death are people with a weakened immune system, pregnant or breastfeeding, children under 8 years old, and those with a history of eczema.

Transmission

This monkeypox outbreak is different than previous outbreaks as it seems to be spread through close contact, sustained skin-to-skin contact (including sexual contact) with a person with monkeypox rash or lesions or contaminated fomites (surfaces), such as bedding. Many of the reported cases are among gay, bisexual, or other men who have sex with men. Any person, regardless of gender or sexual orientation, can get and transmit monkeypox. The current threat level in the United States currently is low.

Possible methods for person-to-person transmission include:

  • Direct contact with infectious rash, scabs, or body fluids
  • Respiratory secretions during prolonged face-to-face contact
  • Intimate physical contact (kissing, cuddling, sex, etc.)
  • Touching items that were in contact with infectious rash or body fluids
  • Pregnant people to fetus through placenta

Monkeypox can spread from the time symptoms begin until the rash is fully healed with a fresh layer of skin. People without symptoms cannot spread the virus. It is currently unknown if monkeypox can spread through semen or vaginal fluid.

Learn more about prevention measures and get answers to frequently asked questions.

Symptoms, Treatment, and Vaccines

Symptoms in this outbreak also seem to be slightly different than previous outbreaks. General symptoms include fever, headache, muscle and backache, swollen lymph nodes, chills, exhaustion, and rash. There have been cases of co-infections of similarly presenting infections such as chickenpox, syphilis, and herpes.

Testing is vital in identifying cases. Antivirals used for smallpox treatment, such as tecovirimat (TPOXX), may be recommended for those with a weakened immune system. For clinicians, laboratory staff, or anyone with a higher risk of transmission of monkeypox, The Advisory Committee on Immunization Practices (ACIP), recommends getting vaccinated with ACAM2000 or JYNNEOS.

Learn more about treatment and vaccines and access information for medical providers.

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Historical Developments

WHO Declares Monkeypox a Public Health Emergency of International Concern – July 23, 2022

In a press conference on July 23, 2022, the World Health Organization (WHO) announced that monkeypox is now classified as a Public Health Emergency of International Concern (PHEIC). Since the first Emergency Committee meeting at the end of June 2022, monkeypox cases have risen from 3,040 cases in 47 countries to over 16,000 cases in 75 countries.The committee was split in this decision and additional information is linked outlining both perspectives as well as the criteria for declaring an outbreak as a PHEIC.

US HHS Declares Monkeypox a Public Health Emergency – August 4, 2022

On August 4, 2022, the U.S. Department of Health and Human Services Secretary declared monkeypox virus a Public Health Emergency in the United States. This announcement aims to strengthen the response effort of the Biden-Harris Administration. The White House’s strategy “includes significantly scaling the production and availability of vaccines, expanding testing capacity and making testing more convenient, reducing burdens in accessing treatments, and conducting robust outreach to stakeholders and members of the LGBTQI+ communities.” The full response details can be found here.

FDA Authorizes Emergency Use of JYNNEOS vaccine – August 9, 2022

On August 9, 2022, the FDA authorized emergency use of JYNNEOS vaccine to help increase vaccine availably. This new authorization will allow clinicians to use the vaccine intradermally for those aged eighteen and older. This is expected to increase the number of vaccines up to five times as the intradermal vaccine dose is about one-fifth of the amount required for the subcutaneous vaccine dose. Additionally, this EUA will allow individuals younger than 18 years old to receive the vaccine subcutaneously. Research has shown that both routes of administration produce similar immune responses.