CDC: Monkeypox may have been circulating for 'months' before the raves in Europe

• The CDC said Monday that monkeypox cases may already have been spreading for "a couple months, or longer."
• US pox cases being investigated now traveled internationally in both April and May, but not to Africa, where the disease is endemic.

Monkeypox experts at the US Centers for Disease Control and Prevention said on Monday that it's possible this virus has "been circulating for a couple weeks, perhaps a couple months, or longer."

Veterinarian Jennifer McQuiston, deputy director of the CDC's division of high consequence pathogens, told reporters on a phone call that of the five confirmed and suspected US monkeypox cases currently being treated and tested, at least some were contracted as early as April of this year.

That puts the emergence of the virus on the global scene (outside of the countries where monkeypox is endemic in West Africa) well before some of the European parties and festivals that officials at the World Health Organization recently suggested were the primary source of the outbreak. Gay Pride Maspalomas in the Canary Islands, for example, didn't kick off until May 5, while the Belgian pride parade took place on May 21. Health authorities in Madrid have also been tracing many cases in this outbreak back to a single unnamed "sauna" location, which was recently shut down, Reuters reported.

"Some of those individuals reported onset in early May and travel at the end of April, so that precedes some of the festivals," McQuiston said of the US cases on the call.

Some of the most vulnerable people who've come in contact with the monkeypox patients in the US are now being given smallpox vaccines, the CDC said.

Monkeypox 'showing up in different parts of the body'

Officials at the CDC said that the genetic sequence of the first US case diagnosed in this outbreak (from Massachusetts) and genetic sequencing released from Portugal last week both appear "very closely linked to the viruses that we've seen out of West Africa," but it's still unclear how long they might've spread for in Europe and North America, undetected, and whether they are all part of the same cluster of cases. The World Health Organization reported that the virus sequenced from Portugal was a "close match" to cases exported from Nigeria in 2018 and 2019.

Most of the monkeypox cases documented so far have been diagnosed among men who have sex with men, but officials are stressing that may only be because of where the rashes were located on infected people at the time of transmission. Transmission of the monkeypox virus occurs primarily through direct contact with a sick person's infectious lesions (their "pox").

"This is showing up in different parts of the body than we typically expect to see it," Dr. John Brooks, an epidemiologist in the CDC's HIV and AIDS prevention division, said on the call Monday, adding that the "genital area" near the butt has been a common place rashes have been located in this outbreak.

"In one case, a doctor thought the person had very severe herpes at first and didn't immediately think, 'oh, could this be monkeypox?'"

Monkeypox viruses can incubate for anywhere from six to 21 days before people first start showing symptoms. The virus is infectious chiefly through its rash, which can look quite similar to chicken pox, especially in the initial stages. Then, the monkeypox may blister, scab over, and eventually fall off. During that entire period, which can last up to four weeks, the rash is very infectious.

The virus can be transmitted through very close contact, but it's not like you're going to pick monkeypox up while "passing someone in the grocery store," McQuiston said.

"This is not COVID," she added, stressing that the "most infectious aspect of this disease are those lesions on the skin."

"Respiratory spread is not the predominant worry. It is contact, and intimate contact in the current outbreak."

Several monkeypox cases have traveled outside of West Africa in recent years before this outbreak, and even though health authorities closely tracked contacts in those cases, no secondary infections were reported.

The first confirmed US case in this outbreak, diagnosed in Massachusetts last week, was in a man who'd recently traveled to Canada. Four other cases, which are pending CDC confirmation, also had traveled internationally to areas "consistent" with this outbreak, and they were all men.

Brooks said the CDC is working to raise awareness of monkeypox symptoms, as well as how to avoid infection (chiefly, that's by avoiding direct contact with infected people's lesions).

"I don't think at the present time, there is sufficient evidence of spread occurring so rapidly that we want to shut down any events," he said. "What we want to do is empower people to take the initiative to hold themselves back from participating if they're feeling ill, and to also seek evaluation if — as a result of or after attending something — they might feel ill."

But some of the monkeypox cases documented in this outbreak haven't really been "feeling ill" at all — instead of reporting the fever or malaise that is typical of early monkeypox disease, they've only exhibiting rashes in their genital area, which may look like syphilis or herpes.