US confirms first case of more aggressive strain of mpox

The United States reported its first case of a more aggressive strain of mpox on Saturday: an individual from California who had recently traveled from East Africa.

The case was confirmed by the California Department of Public Health and reported to the Centers for Disease Control and Prevention.

The person was treated in San Mateo County based on their travel history and symptoms and is now isolated at home and recovering, the state health department said in a news release. Public health workers are contacting people who had close contact with the patient, “but there is no concern or evidence” that the strain is currently spreading in California or the United States, the statement said.

The United States is the sixth country outside Africa to have detected the strain, according to the CDC, which can cause more severe illness than the version of the virus that has spread widely in 2022.

This strain prevalent in several African countries prompted the World Health Organization to declare a global public health emergency in August, the second time for mpox in two years.

Monkeypox, formerly known as monkeypox, is a viral infection that causes painful lesions, often accompanied by flu-like symptoms. It is classified into two distinct groups: the more aggressive strain, clade I, and a slightly milder strain, clade II.

Clade II was the cause of the 2022 global outbreak, which resulted in at least 32,000 infections and 58 deaths in the United States.

Until recently, clade I had not spread beyond Central Africa, where it is considered endemic, and East Africa. But an outbreak in the Democratic Republic of Congo this year led to cases in eight other African countries. In August, the first known case outside Africa was confirmed in Sweden. A few days later, Thailand confirmed a case. Both patients had spent time in Africa.

Travel-related cases have also been detected in Germany, India and the United Kingdom, according to the CDC.

Mpox is spread by direct contact with an infected person, an animal, or contaminated objects like clothing or bedding. The clade II version that spread in 2022 was transmitted primarily through sexual contact, particularly among men who have sex with men.

In the current outbreak, clade I has spread largely through contact with infected animals and transmission within households, disease experts say. Two-thirds of suspected cases between January 2023 and April 2024 involved children aged 15 and younger, according to the Centers for Disease Control and Prevention. But a version of the strain, clade Ib, also spread through sexual contact among female sex workers and men who have sex with men in Congo.

It's unclear what the transmission pathways might look like in the United States, but some experts predict that clade I could spread among the same sexual networks as in 2022.

I expect we will see cases,” said Dr. Marc Siegel, associate professor of medicine at the George Washington School of Medicine and Health Sciences. “I think it will be more likely in the same population that was more at risk in the 2022-2023 epidemic. For the general population, I think it poses very little risk. »

Previous outbreaks of clade I mpox in Africa killed up to 10% of those who became ill, but the current outbreak in the Democratic Republic of Congo has a mortality rate of around 5%. This compares to the global mortality rate of 0.2% for the 2022 outbreak.

However, health officials said there is reason to believe that clade I may pose a lighter threat in the United States than in African countries this year, given that malnutrition rates are lower and that the health system is more robust.

The United States is also better prepared for an outbreak than it was in 2022. The CDC has asked doctors to test for mpox and is looking for both clades at wastewater treatment sites across the country, including included at some airports.

Additionally, the country has an adequate supply of two doses of the Jynneos vaccine, which is available to men who have sex with men and other high-risk groups. The Department of Health and Human Services says two doses of the vaccine or prior infection should protect against severe disease from clade I.

The United States administered approximately 1.2 million vaccine doses between May 2022 and January 2023. Health officials hope to expand this coverage, since only 23% of the population at significant risk has been fully vaccinated.

Mpox usually starts as a rash that progresses to small bumps on the skin, followed by fluid-filled blisters that eventually form. People may also experience fever, headache, muscle pain, back pain, lack of energy, or swollen lymph nodes.

Some people infected with clade II in the United States have described the lesions as extremely painful. They have historically appeared on the face, chest, palms of the hands and soles of the feet, but during the 2022 outbreak, people have developed lesions around the genital and anal area or inside the mouth and throat.

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