2022 monkeypox outbreak in the United States

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2022 monkeypox outbreak in the United States
Monkeypox Outbreak United States Cases by State.svg
Spread of monkeypox by US state as of August 12, 2022
DiseaseMonkeypox
Virus strainMonkeypox virus (West African clade)
LocationUnited States
Index caseBoston, Massachusetts[1]
Arrival dateMay 18, 2022 (2 months, 3 weeks and 5 days ago)
Confirmed cases11,177[2]
Deaths
0
Government website
www.usa.gov

The 2022 monkeypox outbreak in the United States is part of the larger outbreak of human monkeypox caused by the West African clade of the monkeypox virus. The United States was the fourth country, outside of the African countries with endemic monkeypox, to experience an outbreak in 2022. The first case was documented in Boston, Massachusetts, on May 19, 2022.[3] As of August 5, monkeypox had since spread to 49 states, as well as Washington, D.C., and Puerto Rico.[4]

On August 4, 2022, the U.S. Centers for Disease Control and Prevention declared monkeypox a public health emergency in the United States.[5]

Background[edit]

Monkeypox is an infectious viral disease that can occur in humans and some other animals.[6] Symptoms include fever, swollen lymph nodes, and a rash that forms blisters and then crusts over.[6] The time from exposure to onset of symptoms ranges from five to twenty-one days.[7][8] The duration of symptoms is typically two to four weeks.[8] There may be mild symptoms, and it may occur without any symptoms being known.[7][9] The classic presentation of fever and muscle pains, followed by swollen glands, with lesions all at the same stage, has not been found to be common to all outbreaks.[6][10] Cases may be severe, especially in children, pregnant women or people with suppressed immune systems.[11]

The disease is caused by the monkeypox virus, a zoonotic virus in the genus Orthopoxvirus. The variola virus, the causative agent of smallpox, is also in this genus.[12] Of the two types in humans, the West African type causes a less severe disease than the Central African (Congo basin) type.[13] It may spread from infected animals by handling infected meat or via bites or scratches.[14] Human-to-human transmission can occur through exposure to infected body fluids or contaminated objects, by small droplets, and possibly through the airborne route.[6][14] People can spread the virus from the onset of symptoms until all the lesions have scabbed and fallen off; with some evidence of spread for more than a week after lesions have crusted.[13] Diagnosis can be confirmed by testing a lesion for the virus's DNA.[15]

There is no known cure.[16] A study in 1988 found that the smallpox vaccine was around 85% protective in preventing infection in close contacts and in lessening the severity of the disease.[17] A newer smallpox and monkeypox vaccine based on modified vaccinia Ankara has been approved, but with limited availability.[7] Other measures include regular hand washing and avoiding sick people and animals.[18] Antiviral drugs, cidofovir and tecovirimat, vaccinia immune globulin and the smallpox vaccine may be used during outbreaks.[19][20] The illness is usually mild and most of those infected will recover within a few weeks without treatment.[20] Estimates of the risk of death vary from 1% to 10%, although few deaths as a consequence of monkeypox have been recorded since 2017.[21]

An ongoing outbreak of monkeypox was confirmed on May 6, 2022, beginning with a British resident who, after travelling to Nigeria (where the disease is endemic), presented symptoms consistent with monkeypox on April 29, 2022. The resident returned to the United Kingdom on May 4, creating the country's index case of the outbreak.[22] The origin of several of the cases of monkeypox in the United Kingdom is unknown. Some monitors saw community transmission taking place in the London area as of mid-May,[23] but it has been suggested that cases were already spreading in Europe in the previous months.[24]

Transmission[edit]

Stages of lesion development.

A large portion of those infected were believed to have not recently traveled to areas of Africa where monkeypox is normally found, such as Nigeria, the Democratic Republic of the Congo as well as central and western Africa. It is believed to be transmitted by close contact with sick people, with extra caution for those individuals with lesions on their skin or genitals, along with their bedding and clothing. The CDC has stated that, among monkeypox cases with available data, 99% occurred in men, 94% of whom reported recent male-to-male sexual or close intimate contact.[25] The CDC has also stated that individuals should avoid contact and consumption of dead animals such as rats, squirrels, monkeys and apes along with wild game or lotions derived from animals in Africa.[26]

In addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. CDC has also warned clinicians to not rule out monkeypox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.[27]

Timeline[edit]

Monkeypox cases in United States  ()
     Deaths        Confirmed cases
MayMayJunJunJulJulAugAug
Last 15 daysLast 15 days
Date
Cases (rise)
Deaths (rise)
2022-05-18
1(n.a.)
2022-05-19
1(=)
2022-05-20
2(+1)
2022-05-21
2(=)
2022-05-22
2(=)
2022-05-23
2(=)
2022-05-24
2(=)
2022-05-25
4(+2)
2022-05-26
9(+5)
2022-05-27
12(+3)
2022-05-28
12(=)
2022-05-29
14(+2)
2022-05-30
14(=)
2022-05-31
19(+5)
2022-06-01
19(=)
2022-06-02
23(+4)
2022-06-03
25(+2)
2022-06-04
25(=)
2022-06-05
25(=)
2022-06-06
26(+1)
2022-06-07
31(+5)
2022-06-08
35(+4)
2022-06-09
40(+5)
2022-06-10
47(+7)
2022-06-11
49(+2)
2022-06-12
49(=)
2022-06-13
65(+16)
2022-06-14
72(+7)
2022-06-15
84(+12)
2022-06-16
100(+16)
2022-06-17
113(+13)
2022-06-18
113(=)
2022-06-19
113(=)
2022-06-20
113(=)
2022-06-21
113(=)
2022-06-22
156(+43)
2022-06-23
181(+25)
2022-06-24
201(+20)
2022-06-25
201(=)
2022-06-26
201(=)
2022-06-27
244(+43)
2022-06-28
306(+62)
2022-06-29
351(+45)
2022-06-30
396(+45)
2022-07-01
460(+64)
2022-07-02
460(=)
2022-07-03
460(=)
2022-07-04
460(=)
2022-07-05
560(+100)
2022-07-06
605(+45)
2022-07-07
700(+95)
2022-07-08
767(+67)
2022-07-09
767(=)
2022-07-10
767(=)
2022-07-11
866(+99)
2022-07-12
929(+63)
2022-07-13
1,052(+123)
2022-07-14
1,470(+418)
2022-07-15
1,814(+344)
2022-07-16
1,814(=)
2022-07-17
1,814(=)
2022-07-18
1,972(+158)
2022-07-19
2,108(+136)
2022-07-20
2,323(+215)
2022-07-21
2,593(+270)
2022-07-22
2,891(+298)
2022-07-23
2,891(=)
2022-07-24
2,891(=)
2022-07-25
3,487(+596)
2022-07-26
3,591(+104)
2022-07-27
4,639(+1,048)
2022-07-28
4,907(+268)
2022-07-29
5,189(+282)
2022-07-30
5,189(=)
2022-07-31
5,189(=)
2022-08-01
5,811(+622)
2022-08-02
6,326(+515)
2022-08-03
6,617(+291)
2022-08-04
7,102(+485)
2022-08-05
7,510(+408)
2022-08-06
7,510(=)
2022-08-07
7,510(=)
2022-08-08
8,934(+1,424)
2022-08-09
9,492(+558)
2022-08-10
10,389(+897)
2022-08-11
10,768(+379)
2022-08-12
11,177(+409)

The first known case was detected on May 18, 2022, in a man from Boston, Massachusetts, who had traveled to Canada, where a case of the virus was reported the following day.[28][29] The person was hospitalized in Boston.[30] There, he tested positive for monkeypox, becoming the first case in the United States.[28]

Two days after the man tested positive for the virus, other states began reporting cases, with New York reporting its first case on May 21.[31] On May 22, President Biden gave a speech at Osan Air Base in South Korea during which he indicated the disease was "something that everybody should be concerned about".[32] On May 26, Virginia reported its first case in a woman who had traveled to Africa,[33] followed by California and Hawaii on June 4, 2022.[34][35] As of June 3, the United States had 21 confirmed cases,[36] a number which had risen to 460 as of July 1.[37]

On May 23, 2022, Florida reported a case of monkeypox. On the same day, the Tampa Bay Times reported that the Florida Department of Health had announced the case on a man that had been isolated since the day before.[38] WESH later on also confirmed the case, which was in Broward County.[39] The following day, WESH reported another monkeypox case as being "investigated".[40] The case was then confirmed to be in the same county as the first case, adding up the total in the county to two. Later, a third case was also investigated, this time being reported by CBS Miami to also be in the same county as the first and second case.[41] This case added up the total in the United States to 18. A fourth case was reported by the Sun-Sentinel, although the state of Florida did not disclose the county where it was detected.[42]

In early June 2022, a man in Washington, D.C., was reported to test positive for orthopox, potentially monkeypox.[43]

Cases by state[edit]

Data sourced from the CDC.[44] New York case count is from the New York State Department of Health.[45]

Cases of monkeypox
State Cases Change[note 1]
 Alabama 30 (+3)
 Alaska 2 (+0)
 Arizona 170 (+7)
 Arkansas 15 (+1)
 California 1,945 (+53)
 Colorado 111 (+0)
 Connecticut 59 (+2)
 Delaware 8 (+0)
 District of Columbia 328 (+9)
 Florida 1,085 (+32)
 Georgia 851 (+27)
 Hawaii 12 (+0)
 Idaho 9 (+0)
 Illinois 771 (+37)
 Indiana 78 (+1)
 Iowa 15 (+2)
 Kansas 3 (+0)
 Kentucky 11 (+0)
 Louisiana 103 (+6)
 Maine 3 (+0)
 Maryland 275 (+16)
 Massachusetts 202 (+0)
 Michigan 92 (+10)
 Minnesota 66 (+5)
 Mississippi 11 (+0)
 Missouri 20 (+1)
 Montana 2 (+0)
 Nebraska 15 (+1)
 Nevada 74 (+15)
 New Hampshire 15 (+0)
 New Jersey 293 (+0)
 New Mexico 16 (+0)
 New York 2,295 (+108)
 North Carolina 138 (+7)
 North Dakota 2 (+0)
 Ohio 89 (+11)
 Oklahoma 12 (+0)
 Oregon 95 (+0)
 Pennsylvania 298 (+16)
 Puerto Rico 48 (+5)
 Rhode Island 31 (+0)
 South Carolina 60 (+11)
 South Dakota 2 (+0)
 Tennessee 67 (+0)
 Texas 815 (+0)
 Utah 69 (+5)
 Vermont 2 (+1)
 Virginia 175 (+0)
 Washington 251 (+17)
 West Virginia 4 (+0)
 Wisconsin 31 (+0)
Total cases 11,117 (+409)
As of August 11, 2022 at 2:00 pm Eastern Time

Timeline of first confirmed cases by state[edit]

First confirmed monkeypox cases by state
Date States
18 May 2022  Massachusetts[46]
21 May 2022  New York[47]
23 May 2022  Florida[48]
25 May 2022  Utah[49]
26 May 2022  Virginia[50] Colorado[51]
27 May 2022  Washington[52] California[53]
2 June 2022  Pennsylvania[54] Illinois[55]
3 June 2022  Hawaii[56]
5 June 2022  District of Columbia[57]
6 June 2022  Georgia[58]
7 June 2022  Texas[59]
9 June 2022  Rhode Island[60]
14 June 2022  Ohio[61] Oklahoma[62]
15 June 2022  Nevada[63]
16 June 2022  Maryland[64] Oregon[65]
18 June 2022  Indiana[66]
20 June 2022  New Jersey[67]
22 June 2022  Missouri[68]
23 June 2022  North Carolina[69]
24 June 2022  Kentucky[70]
27 June 2022  Nebraska[71] Minnesota[72]
29 June 2022  New Hampshire[73] Michigan[74]
30 June 2022  Wisconsin[75]
1 July 2022  Iowa[76]
5 July 2022  Connecticut[77]
6 July 2022  Arkansas[78] Idaho[79]
7 July 2022  Louisiana[80] Tennessee[81]
8 July 2022  South Carolina[82] West Virginia[83]
9 July 2022  Kansas[84]
11 July 2022  New Mexico[85]
12 July 2022  Delaware[86] Arizona[87]
14 July 2022  South Dakota[88]
15 July 2022  Alabama[89]
20 July 2022  North Dakota[90]
22 July 2022  Maine[91]
25 July 2022  Mississippi[92]
29 July 2022  Alaska[93] Vermont[94]
5 August 2022  Montana[95]

Responses[edit]

Vaccination[edit]

On 18 May 2022, Bavarian Nordic announced that BARDA, part of the Department of Health and Human Services (HHS), exercised a $119 million option, under a $299 million contract, to supply a freeze-dried version of JYNNEOS vaccine, converting existing bulk vaccine.[96] The United States spent $119 million to purchase doses of the Modified vaccinia Ankara-based two-shot[97] Jynneos vaccine from Bavarian Nordic in May 2022.[98] The contract also allows the United States to purchase an additional $180 million worth of the vaccine at a later date.[99] The vaccine, JYNNEOS (also known by the brand names Imvamune and Imvanex), was approved by FDA in 2019 to prevent both smallpox and monkeypox. As of June 14, the United States had around 70,000 doses of JYNNEOS in its stockpile, and the federal government placed an order for 500,000 more on June 10, 2022. Dawn O'Connell, assistant secretary for preparedness and response at Department of Health and Human Services (HHS), said around 300,000 doses would be delivered in June-July 2022, and the remainder would be delivered later in that year.[100][101]

In addition, the Strategic National Stockpile (SNS) holds over 100 million doses of an older smallpox vaccine (ACAM2000).[102]

As of June 28, the Biden administration was allocating tens of thousands of vaccine doses from the Strategic National Stockpile to clinics nation-wide.[103][104] The rollout of vaccines and testing was criticized as too slow, as well as for having similar problems to the rollout of vaccines and tests during the COVID-19 pandemic in the United States.[105]

The United States government's response is coordinated by the National Security Council Directorate on Global Health Security and Biodefense – more commonly known as the White House Pandemic Office – in collaboration with the Department of Health and Human Services (HHS). The White House Pandemic Office had previously reinstated Dr. Beth Cameron to the executive position.[106][107] The HHS is overseen by Secretary of Health and Human Services Xavier Becerra.

As of June 29, HHS has received requests from 32 states and jurisdictions, deploying over 9,000 doses of JYNNEOS vaccine and 300 courses of ST-246 (tecovirimat)[108][109] antiviral smallpox treatments.[110] The United States expanded deployment of JYNNEOS vaccines, allocating 296,000[111][112] doses over the coming weeks, 56,000 of which will be allocated immediately. Over the coming months a combined 2.5 million[113][114][97] additional doses will become available.[115]

Precautionary measures[edit]

Hospitals have begun making their own preparations to help control the current monkeypox outbreak, including screening patients, increasing decontamination and cleaning procedures,[116][117][118] and wearing appropriate safety gear[119][120] when interacting with infected patients.

See also[edit]

Notes[edit]

  1. ^ This is the increase in cases over the previous day.

References[edit]

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  2. ^ "2022 U.S. Map & Case Count". USA CDC. Retrieved June 17, 2022.
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  73. ^ "First Probable Case of Monkeypox Identified in New Hampshire". New Hampshire Department of Health and Human Services. Retrieved June 29, 2022.
  74. ^ "MDHHS announces first probable monkeypox case in Michigan". Michigan Department of Health and Human Services. Retrieved June 29, 2022.
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  76. ^ "First Case of Monkeypox in Iowa". Iowa Department of Public Health. Retrieved July 1, 2022.
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