When a local man arrived at a Boston emergency department on May 12 with an unusual mix of symptoms, doctors scratched their heads for days.
It looked like monkeypox, a virus that causes symptoms such as fevers, muscle aches and a rash that turns into bumpy red pustules filled with yellowish fluid.
But the man had not traveled anywhere in the world where monkeypox was endemic.
“The patient … had no history of travel to areas of Africa where monkeypox had or had animal contact,” said Paul Biddinger, director of the Center for Disaster Medicine at Massachusetts General Hospital, to the ABC News Daily podcast.
“And at that time, there was no history of people being diagnosed with monkeypox who hadn’t had that contact.”
Four days later there were reports of monkeypox patients in England who had also not traveled to parts of Africa where the disease was endemic.
“We said, ‘My God, this has never happened in the United States before,'” Dr Biddinger said.
“It’s hardly ever happened in the world before, apart from recent reports in England, but we really should pursue it.”
The Boston clinical team transferred the patient to a special part of the hospital that was created after the 2014 Ebola outbreak to care for patients with emerging infectious diseases.
Within days, the Centers for Disease Control and Prevention (CDC) confirmed that this was the first case of monkeypox in the United States.
How did the virus spread?
Monkeypox is making headlines because it is spreading in unusual ways.
According to Amesh Adalja, senior researcher at the Johns Hopkins Center for Health Security in Pittsburgh, it is highly likely that visitors to Africa have returned to places like the United States and the United Kingdom, where they spread the virus.
“There were two raves that took place in Belgium – and people from all over the world may have attended – and it spread the virus in many different countries,” Dr. Adalja told ABC News Daily.
He said the outbreak was also unusual because it had primarily affected a single community group: “men who have sex with men”.
“So it’s likely that this origin came from a traveler who then passed it on in some way to someone who put it in a social network, … [where it has then been ] amplified by certain events where people have multiple sexual contacts,” he said.
“He was able to exploit the close contact that happens in these social groups at raves, saunas, other places like that, to be able to spread from person to person in a way that he wouldn’t. haven’t had a chance to do it before.”
He said that although monkeypox is not classified as a sexually transmitted disease, it required close and prolonged bodily contact with an infectious person to spread.
Doctors never suspected monkeypox
According to Dr. Biddinger of Massachusetts General Hospital, medical professionals around the world have faced the same challenges diagnosing monkeypox as those in Boston.
“Where [the patient] travel [and] who they’ve been in contact with really pushes us to think about what’s possible and impossible,” Dr Biddinger said.
Since most of the patients had no obvious links to outbreaks in central and west African countries where the virus is endemic, no one suspected they might have had monkeypox.
In fact, without news of the outbreak in the UK, American doctors may never have diagnosed monkeypox.
According to the World Health Organization (WHO), monkeypox has now infected more than 780 people in 27 of its member countries.
Disease not at pandemic levels
Australia has recorded its seventh case of monkeypox, most recently in two men who returned to Sydney after traveling together in Europe.
NSW Health is undertaking contact tracing but has so far identified no high-risk contacts.
The WHO said the outbreak of monkeypox outside of Africa would not lead to a pandemic, but questioned whether the outbreak should be assessed as a “potential public health emergency of international concern”.
Such a declaration, as has been done for COVID-19 and Ebola, would help accelerate research and funding to contain the disease.
Last week, he hosted a global research consultation with more than 500 experts, who recommended accelerating studies of the virus to better understand the spread, clinical consequences and vaccine effectiveness.
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