The Washington PostDemocracy Dies in Darkness

CDC tells doctors to be on alert for monkeypox as global cases rise

The U.S. Centers for Disease Control and Prevention (CDC) headquarters in Atlanta. (Tami Chappell/Reuters)
6 min

The Centers for Disease Control and Prevention issued an alert Friday urging doctors and state health departments to be vigilant for cases of monkeypox as an unprecedented global spread of the virus raises alarm among public health authorities.

The alert comes two days after the agency confirmed a monkeypox case in Massachusetts, where a patient with skin lesions associated with the rare virus was treated. New York City officials said Thursday they are investigating a potential case. Federal officials say they expect to identify additional infections in the coming days.

Authorities have confirmed more than 70 cases of monkeypox across Europe as of Friday. Other infections were identified in Canada, where the Massachusetts patient had recently traveled, and Australia.

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

The World Health Organization held an emergency meeting Friday to look into the spread of the virus beyond western and central Africa, where it is typically seen. A team of academics tracking cases, working with data initiative Global.Health, showed the majority of confirmed infections had been reported in Spain, followed by England and Portugal.

As monkeypox cases rise in Europe and other parts of the globe, health authorities are expressing concern about the unusual uptick. (Video: Alexa Juliana Ard, Meryl Kornfield/The Washington Post)

Globally, there were more than 50 suspected cases that had not yet been confirmed.

Experts say the latest cases are unusual because of the level of spread among patients with no known travel history to Africa.

Monkeypox was first reported in the United States in 2003 in an outbreak linked to prairie dogs infected by rodents from Ghana. Two cases were detected in the United States last year in patients who recently traveled to Nigeria.

“We are seeing the virus emerging in new ways we have not seen it emerge before,” said Brett Petersen, deputy chief of the CDC’s pox virus and rabies branch. “That is where a lot of the concern comes from.”

Petersen said the agency issued the alert so public health officials could get a better handle on the scope and potential trajectory of the outbreak “so we are prepared to handle what may be coming.”

But the risk to the public remains low, health officials said. Monkeypox is easier to contain than the coronavirus because it is harder to transmit, and current cases have been identified as the West African strain associated with milder illness that lasts two to four weeks.

Symptoms usually start with fever, aches and exhaustion, followed days later by a rash characterized by pus-filled bumps and lesions. In Africa, the fatality rate of the West African strain has been 1 percent, although experts say that may be lower in countries with better access to health care.

Health officials say Americans should be vigilant about seeking medical care if they develop rashes and avoiding prolonged contact with those who have them.

While there is no specific treatment for monkeypox, the CDC says antivirals used for smallpox could be effective against monkeypox. Patients exposed to monkeypox can also be given smallpox vaccines to reduce the severity of the disease because of its slow incubation period. Federal officials are preparing guidance for when to use these options.

Traveling with the CDC in search of monkeypox's source

“I very much believe there is not any threat to the general public and people do not need to be worrying about monkeypox,” said Paul Biddinger, an emergency preparedness executive at Massachusetts General Hospital where the first confirmed U.S. patient is being treated and in good condition.

The CDC says clinicians should be on the lookout for rashes associated with monkeypox that can sometimes be confused as symptoms of syphilis or herpes. The agency says close attention should be paid to patients who recently traveled to countries with confirmed infections or had exposure to others with similar rashes, as well as men who have sex with men.

Public health authorities in Europe and Montreal have seen cases concentrated among gay and bisexual men.

The proliferation of cases linked to men who have sex with men has surprised experts because monkeypox has historically not been associated with those groups. The virus, while spread through close contact including sex, is not seen as a sexually transmitted illness. Experts say this trend could be a coincidental result of the virus first circulating in tightknit gay communities. Clinics serving LGBTQ communities are also on heightened alert for monkeypox.

European countries confirm more than 70 monkeypox cases

“What we are seeing here is not so much a disease that’s related to sex, as a community of men who may be having a lot of close contact,” a senior U.S. health official said Friday. The Biden administration organized the call with reporters under the condition that officials not be named.

Health care providers serving LGBTQ communities, including Fenway Health in Boston, are preparing clinicians to flag potential cases of monkeypox that have not previously been on their radar. They also cautioned against stigmatizing queer men as a vector for a virus spread through prolonged and direct contact.

“This is not something where people in the general public need to be fearing individuals who they know are gay,” said Kenneth Mayer, Fenway Health’s medical research director.

U.S. officials and experts say the nation has treatment and vaccines for smallpox that can be tapped for a monkeypox outbreak thanks to a stockpile accumulated out of concerns of bioterrorism after the Sept. 11, 2001, terrorist attacks.

Most patients with the West African strain of the virus will not require specialized care, experts said.

Because vaccines can be effective in the early days after exposure to the monkeypox virus, they can also be used as a tool to curb the spread. Some close contacts of British monkeypox patients have been provided vaccines, a spokesman for the U.K. Health Security Agency said.

“The incubation period for monkeypox is so slow and prolonged you had a chance to boost the immunity,” said Michael Skinner, a faculty member of the department of infectious diseases at the Imperial College London.

Public health officials emphasize that the rising monkeypox cases should not be a cause for panic because of the effective tools to contain and treat the virus. They are expecting to learn more in the coming weeks about why this latest outbreak is different.

“We’ve never seen this amount of person-to-person spread outside of Africa. So something new is going on,” said Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. “Whether that’s something new with the virus, or new behavior or whether it’s new surveillance ability, we don’t know yet.”

Adam Taylor, Timothy Bella and Amanda Coletta contributed to this report.