CDC director Rochelle Walensky said some patients with smallpox also had syphilis, herpes, gonorrhea or chlamydia infections. The monkey pox rash may look like herpes or syphilis, Walensky said. “It is important to know that smallpox cases in monkeys can be similar to some sexually transmitted infections and could be mistaken for other diagnoses,” Walensky told reporters on Friday. Patients who have symptoms should be evaluated for all sexually transmitted infections as well as for smallpox, he said. “Healthcare providers should not rule out monkey pox just because a patient has a different diagnosis or another STD,” Walensky told reporters. The United States has confirmed 45 cases of monkey pox in 15 states and Washington DC as of Thursday, according to the CDC. No deaths have been reported. The current outbreak is unusual because the virus is spreading outside of West and Central Africa, where the disease has been present for decades. More than 1,300 cases have been reported worldwide in 31 countries, according to the CDC. Smallpox usually starts with flu-like symptoms such as fever, headache, muscle aches, chills, exhaustion and swollen lymph nodes. The disease then progresses to a painful rash that can spread throughout the body. Most patients recover in two to four weeks without specific medical treatment, according to the CDC. However, some patients during the current epidemic developed a rash only on the genitals or anus before experiencing flu symptoms, Walensky said. In some cases, patients developed an asymptomatic rash similar to the flu, he said. In many cases, the localized rash has not spread to other parts of the body or to just a few areas, the CDC director said. People who have been diagnosed with smallpox during the current epidemic have reported close physical contact with other people who have been infected with the virus, Walensky said. The virus can be spread through direct contact with wounds, body fluids or materials such as clothing or sheets. Walensky said it was unclear whether the virus could be spread through semen or vaginal fluid as a sexually transmitted disease. The CDC also does not know if the virus can be transmitted from people who are infected but have no symptoms or mild symptoms. At least 75% of patients with smallpox in the United States have reported exposure to the virus during international travel, according to Dr. Jennifer McQuiston, a CDC official. The majority of cases have been reported among men who have sex with men, according to the CDC. Some patients are not sure how they contracted monkey pox, suggesting the virus may be spreading low within the United States, McQuiston said. However, the CDC has not identified any cities or areas in the United States where there is an outbreak, he said. “There are only these occasional, sparse cases that are not sure how they got the monkey pox,” McQuiston said. “They probably got it from someone who traveled recently, but they just aren’t sure,” he said. Montreal, Canada’s third largest city, reported an outbreak, McQuiston said. Montreal is located just across the border from the state of New York and New England. Monkey pox can also be spread through respiratory droplets when humans have close, constant face-to-face contact, Walensky said. The virus is not considered to remain in the air or transmitted through short periods of shared airspace, such as occasional grocery chats, Walensky said. Also, monkey pox is not thought to be transmitted by the brief touch of the same object as a door knob, he said. No airborne transmission has been reported, according to Dr. Raj Panjabi, who heads the White House pandemic preparedness office. The difference is that the airborne droplets fall quickly to the ground, while the aerosol particles are much smaller and can stay in the air for longer, Panjabi said. Covid-19, for example, spreads through aerosol particles, which is one of the reasons it is so contagious. The federal government has delivered 1,400 vaccine courses and 110 antiviral treatments for people who have had high-risk exposure or smallpox infections, according to Panjabi. The U.S. has also conducted 300 tests so far for orthopox, the family of viruses that includes apes. When people test positive for orthodoxy, they are supposed to have monkey pox until the CDC in Atlanta confirms the diagnosis. “We are working to make testing through public health labs more convenient and to extend testing beyond public health labs through business partners,” Punjabi told reporters on Friday. The U.S. currently has 72,000 doses of the Jynneos vaccine, a smallpox vaccine also approved for monkey pox, readily available in the National Strategic Reserve, according to Dawn O’Connell, who heads the Office of Health and Human Services. Services responsible for inventory. Bavarian manufacturer Nordic is also shipping another 300,000 doses to the US, O’Connell told reporters. Jynneos is a two-dose vaccine approved by the Food and Drug Administration to prevent monkeypox in people 18 years of age and older. The United States also has more than 100 million doses of an older generation smallpox vaccine, ACAM2000, which can also prevent monkeypox infection. Smallpox and aphids belong to the same family of viruses, although smallpox is much milder. The CDC generally recommends Jynneos over ACAM2000 because the latter vaccine can have serious side effects. The U.S. does not currently have enough doses of Jynneos in the supply chain to vaccinate everyone in the U.S. in the event of a public health emergency, McQuiston said. Therefore, the Jynneos vaccine is only given to people who will benefit most from it, he said. ACAM2000 may play a role in vaccinating people who are not at risk for side effects from the vaccine to help maintain an adequate supply of Jynneos for those who need it, he said.
