Wednesday, November 17, 2021

CDC & Maryland DOH Investigating An Imported Case Of Monkeypox (ex Nigeria)


Geographic Range of Monkeypox - Credit WHO  


For the second time in 4 months (see July 16th report CDC & Texas Confirm Monkeypox In US Traveler ex Nigeria), the United States has detected an imported case of Monkeypox.  The patient is currently in isolation, and while the risks of an outbreak here are small, the CDC and local health officials are doing contact tracing and notification. 

Monkeypox, which is endemic in some parts of west and central Africa (see map above), has been gaining more attention in recent years as the percentage of the population protected by the universal smallpox vaccination program - which ended in the 1970s - has declined.

Human monkeypox was first identified in 1970 in the DRC, and since then has sparked numerous small, sporadic outbreaks in the Congo Basin and Western Africa. It produces a remarkably `smallpox looking' illness in humans, albeit not as deadly. The CDC's Monkeypox website states:
The illness typically lasts for 2−4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease.
Humans can become infected in the wild from an animal bite or direct contact with the infected animal’s blood, body fluids, or lesions, but consumption of under cooked bushmeat is also suspected as an infection risk. Human-to-human transmission is also possible.  

This from the CDC’s Factsheet on Monkeypox:
The disease also can be spread from person to person, but it is much less infectious than smallpox. The virus is thought to be transmitted by large respiratory droplets during direct and prolonged face-to-face contact. In addition, monkeypox can be spread by direct contact with body fluids of an infected person or with virus-contaminated objects, such as bedding or clothing.
According to the CDC there are two distinct genetic groups (clades) of monkeypox virus—Central African and West African. West African monkeypox - such as has been spreading recently in Nigeria - is associated with milder disease, fewer deaths, and limited human-to-human transmission.

First a statement from the Maryland Department of Health, followed by a statement from the CDC. 

November 16, 2021

Media contacts:
Deidre McCabe, Director, Office of Communications, 410-767-3536
Andy Owen, Deputy Director, Media Relations, 410-767-6491

Travel-Associated Monkeypox virus infection confirmed in Maryland resident

Individual presented with mild symptoms; public health authorities currently following up with potentially exposed people, no special precautions recommended for the general public

Baltimore, MD – The Maryland Department of Health, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), today confirmed a single case of monkeypox virus infection in a Maryland resident who recently returned from Nigeria. The individual presented with mild symptoms, is currently recovering in isolation and is not hospitalized. No special precautions are recommended at this time for the general public.

“Public health authorities have identified and continue to follow up with those who may have been in contact with the diagnosed individual,“ said MDH Deputy Secretary for Public Health Dr. Jinlene Chan. “Our response in close coordination with CDC officials demonstrates the importance of maintaining a strong public health infrastructure.”

Monkeypox is in the same family of viruses as smallpox but generally causes a milder infection. It can be spread between people through direct contact with skin lesions or body fluids, or contaminated materials such as clothing or linens. It can also be spread through large respiratory droplets which generally cannot travel more than a few feet, and prolonged face-to-face contact is required.

Illness typically begins with flu-like symptoms and swelling of the lymph nodes, progressing to a widespread rash on the face and body. Most infections last 2-4 weeks. The individuals identified as having been potentially exposed to this case will be monitored for symptoms of monkeypox for 21 days after exposure.

Human monkeypox infections primarily occur in central and western African countries and have only rarely been documented outside of Africa. Although all strains can cause infection, those circulating in western Africa, where Nigeria is located, generally cause less severe disease.

Travelers returning from central or western Africa are advised to notify their health care provider if they develop symptoms of monkeypox, particularly flu-like illness, swollen lymph nodes or rash. Clinicians are urged to maintain a high index of suspicion for clinically compatible illness.

Additional details about human monkeypox cases are available on the CDC’s website.

This from the CDC:

Imported Monkeypox case Reported in Maryland
Media Statement

For Immediate Release: Wednesday, November 17, 2021
Contact: Media Relations
(404) 639-3286

Scientists at the Centers for Disease Control and Prevention (CDC) are collaborating with the Maryland Department of Health and other health partners to investigate a case of monkeypox in a traveler who returned to the United States from Nigeria. Late yesterday, CDC laboratory scientists confirmed the patient had monkeypox and that the infection matches the strain that has been re-emerging in Nigeria since 2017. The person is currently in isolation in Maryland.

CDC is working with international health counterparts, the airline, and state and local health officials in the Washington, DC area to contact airline passengers and others who may have been in contact with the patient.

Travelers on the flight to the United States were required to wear masks on the plane as well as in the U.S. airports due to the ongoing COVID-19 pandemic. Therefore, it’s believed the risk of spread of Monkeypox virus via respiratory droplets to others on the planes is low. Working with airline and state and local health partners, CDC is assessing potential risks to those who may have had close contact with the traveler on the plane and after their arrival in the United States.

CDC asks healthcare providers in the U.S. to be vigilant to poxvirus-like lesions, particularly among travelers returning from Nigeria. Because of the health risks associated with a single case of monkeypox, clinicians should report suspected cases immediately to state or local public health authorities regardless of whether they are also exploring other potential diagnoses.

Monkeypox is a rare but potentially serious viral illness that typically begins with flu-like illness and swelling of the lymph nodes and progresses to a widespread rash on the face and body. Monkeypox re-emerged in Nigeria in 2017 after more than 40 years with no reported cases. Since 2017, 218 cases have been confirmed in Nigeria and eight cases have been reported in international travelers from Nigeria, including a case in Texas in July 2021 and the current case.

In recent years we've followed the outbreaks in Africa, scientific research, and a handful of exported cases to places like the UK, Israel and Singapore.  A few (of many) blogs on this subject include:

ECDC CDTR: 3rd Monkeypox Case In the UK

EID Journal: Reemergence of Human Monkeypox and Declining Population Immunity - Nigeria, 2017–2020

WHO Update & Risk Assessment On Monkeypox In The DRC

WHO: Modelling Human-to-Human Transmission of Monkeypox