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The US Centers for Disease Control and Prevention (CDC) said on Friday it was aware of more than 700 global cases of monkeypox, including 21 in the United States, with investigations now suggesting it is spreading inside the country.
Sixteen of the first 17 cases were among people who identify as men who have sex with men, according to a new CDC report, and 14 were thought to be travel associated.
All patients are in recovery or have recovered, and no cases have been fatal.
“There have also been some cases in the United States that we know are linked to known cases,” Jennifer McQuiston, deputy director of the CDC’s Division of High Consequence Pathogens and Pathology, told reporters on a call.
“We also have at least one case in the United States that does not have a travel link or know how they acquired their infection.”
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Monkeypox is a rare disease that is related to but less severe than smallpox, causing a rash that spreads, fever, chills, and aches, among other symptoms.
Generally confined to western and central Africa, cases have been reported in Europe since May and the number of countries affected has grown since.
US health officials on Friday urged doctors to test for monkeypox if they suspect cases, saying there may be community-level spread but that the overall public health risk remained low.
Canada also released new figures on Friday, counting 77 confirmed cases – almost all of them detected in Quebec province, where vaccines have been delivered.
Affected patients are isolating to help prevent the spreading of the virus, CDC officials told reporters in a conference call.
The agency is collaborating with global experts to learn more about how this outbreak began and how it is now spreading within the United States and elsewhere.
Health officials believe community transmission is likely, which is why they want doctors to test patients if they have any reason to suspect monkeypox.
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The CDC stressed that monkeypox is transmitted by close contact with someone who has the virus and to monkeypox sores.
“Anyone can get monkeypox and we are carefully monitoring for monkeypox that may be spreading in any population, including those who are not identifying as men who have sex with men,” Ms McQuiston told the briefing.
So far, the United States has run 120 tests for monkeypox. Officials said the government has the capacity to run 1,000 tests per day.
Currently, all US patients are in recovery or have already recovered. Those who still have a rash are being asked to stay home until they are fully recovered, the CDC said.
A patient is considered recovered when all of the sores have scabbed over, the scabs fall off and healthy skin has emerged.
Ms McQuiston said an analysis of the genetic sequences of US virus samples found that in most cases it is similar to the variant circulating in Europe.
However, US scientists identified two genetically distinct variants of the monkeypox virus among the US samples.
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Both share common ancestors with strains that have been present in Nigeria since at least 2017.
Ms McQuiston said it is possible that some form of the virus has been transmitting under the radar in the United States, albeit on a very limited basis.
US officials said the government has ample vaccines within the Strategic National Stockpile, and the government is offering those to people who have had high-risk contact with infected individuals to prevent transmission of the virus.
Raj Panjabi, senior director for the White House’s global health security and biodefense division, added that 1,200 vaccines and 100 treatment courses had been delivered to US states, where they were offered to close contacts of those infected.
There are currently two authorized vaccines: ACAM2000 and JYNNEOS, which were originally developed against smallpox.
Though smallpox has been eliminated, the United States retains the vaccines in a strategic national reserve in case it is deployed as a biological weapon.
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