Georgia investigates first possible monkeypox case

ATLANTA - Georgia public health officials are working to confirm the state's first case of a rare monkeypox virus, a virus not typically seen outside of western and Central Africa.

The Georgia Department of Public Health says the man, who recently reported traveling, is at home in metro Atlanta under an isolation order after testing positive for an orthopoxvirus.

Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security and an infectious disease physician, says both monkeypox and smallpox are orthopoxviruses.

"And for all intents and purposes, if you have an orthopox case, it's going to be monkeypox," Adalja says.

A sample from the man is being tested at the CDC Headquarters in Atlanta, where the agency's point person on the monkeypox investigation, Dr. Jennifer McQuiston, DVM, Deputy Director of the Division of High Consequence Pathogens and Pathology, says her agency is now tracking 17 confirmed monkeypox cases across nine states.

"Our first cases were reported on May 17, so since that day," McQuiston says.  "A lot of the cases have reportedly travelled to other countries.  It's possible they acquired their infections outside the United States, but not all have.

"We have a strong scientific concern this is different from what we typically see with monkeypox," McQuiston says. "But, I do want to reiterate there are only 17 cases being reported in the United States right now.  There could be more that we haven't diagnosed yet, and there could be more cases that are coming from people who were exposed before they learned about this and took their own precautions to prevent acquiring it."

Most, but not all the US cases involve men who recently traveled to European countries or Canada, where there are ongoing monkeypox outbreaks.

The World Health Organization says 550 monkeypox cases have been confirmed in 30 countries, including the US, that do not typically experience monkeypox outbreaks.

"So what's happened is that a traveler from one of those areas in Africa, where there is a particular monkeypox outbreak, for example in Nigeria, traveled to Europe. and that case, or that infection, got into a social network that allowed it to spread wider than it has before," Adalja says.

The first cases appear to be occurring primarily in gay and bisexual men.

"This is likely something that has been spreading at least since April in Europe, unbeknownst to many people, because many of these people were getting misdiagnosed or not recognized," Dr. Adalja says.

Dr. McQuiston cautions anyone can contract monkeypox.

"I think a lot of the media outlets talk about it spreading in Europe, in a certain population, specifically men who self-identify as men who have sex with other men, or the gay community," she says.  "I want to really emphasize we need to base this on science and not stigma.  So, even if that is a community in which the first cases were seen, monkeypox can affect anyone, regardless of their gender or sexual orientation."

The virus, which can cause flu-like symptoms, swollen lymph nodes and a distinct chickenpox-live rash, is typically spread through close contact with the skin lesions.

"We talk about respiratory droplet transmission, but it's usually people engaging closely with each other, skin-to-skin contact, living in the same household," Dr. Adalja says.  "If you look at outbreaks in Africa, the household attack rates have not been very high, which tells you it's not officially transmitting in a respiratory manner; it's transmitting more directly through people having skin to skin contact."

Because the virus is not easily spread, Dr. Adalja says, monkeypox is not a pandemic threat.

"It's a very controllable disease, once you get an idea of how it's spreading in a given community, and you deploy the smallpox vaccine, which is effective against monkeypox, against it," he says.