Current monkeypox cases may look slightly different than those observed in the past, health authorities are warning. The director of the Centers for Disease Control and Prevention (CDC), Rochelle Walensky, MD, said in a recent briefing that “we have seen presentations of monkeypox that are mild and sometimes only [in] limited areas of the body, which differs from the classic presentations seen in endemic countries in West and Central Africa,” according to reporting from NBC News.
Dr. Walensky also said the atypical cases “prompted concern that some cases may go unrecognized or undiagnosed.” As a result, medical professionals are pivoting to thinking more broadly about what monkeypox symptoms could look like, especially as case counts rise globally, Frank Esper, MD, a pediatric infectious disease physician at Cleveland Clinic, tells SELF. As of June 14, there have been 64 confirmed cases in the U.S., per the CDC.
The difference between what experts are used to when they think of monkeypox cases versus what’s being observed now hinges largely on the skin rash or lesions typically associated with the condition. “The way these patients—for the last several months—are presenting is not typical for what is in the textbooks,” Dr. Esper says.
Specifically, the total-body rash often associated with monkeypox isn’t showing up in every case. Instead some people diagnosed with monkeypox are seeing a sole spot: “We expect to see rash all over the place—[sometimes] we’re seeing like one blister [that’s] not spreading,” Dr. Esper explains. Dr. Walensky said it could also resemble a pimple in addition to a blister, per NBC. Experts usually also look for swollen lymph nodes in suspected monkeypox cases (among other flu-like symptoms including fever, muscle aches, headache, and fatigue) but many physicians aren’t noting those either. “They don’t have the swollen lymph nodes; we’re not seeing that nearly as much as with this particular outbreak,” Dr. Esper says. In general, symptoms aren’t always as severe as doctors expect them to be for monkeypox, Dr. Esper says.
Also worth noting: The monkeypox strain currently circulating outside of endemic areas is one of two types and is thought to be the less severe of the two, Dr. Esper says. One strain is endemic to the West Africa (WA) region and the other is endemic to the Congo Basin (CB) region, per the World Health Organization (WHO). In the past the WA strain has “been associated with an overall lower mortality rate of less than 3% while the CB [strain] appears to more frequently cause severe disease with a case fatality ratio reported from 1% to 10%,” per the WHO. We don’t currently know whether people with monkeypox can be completely asymptomatic, Dr. Esper says, though experts are currently investigating that.
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Even though the milder monkeypox strain is thought to be the one causing the current outbreak, clinicians still need to be alert, experts warn. “Before, we didn’t think about monkeypox at all. Now it’s on the list” of possibilities, Dr. Esper says.
Monkeypox is spread through direct contact with an infected person’s sores, body fluids, or scabs. It can also spread through respiratory secretions (during prolonged face-to-face contact) and intimate activities such as sex, kissing, or cuddling, per the CDC. The U.S. government is currently stockpiling the Jynneos vaccine (designed to help prevent monkeypox and smallpox), and it also has reserves of an older vaccine known as ACAM200. This vaccine was designed to prevent smallpox but affords some protection against monkeypox as well, SELF previously reported.
In a recent media call, Demetre Daskalakis, MD, director of the CDC’s Division of HIV/AIDS Prevention, told NBC, “If you notice any new rash or skin condition that you’re just not sure about anywhere on your body, including in your mouth, go get it checked out.”
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Source: SELF
