Arizona reports its first 'probable' monkeypox case in Maricopa County
Arizona is reporting a 'probable' case of monkeypox in a man in his late 30s who is in isolation and recovering, health officials announced Tuesday.
The case was discovered by a clinician in Maricopa County, according to officials from the Maricopa County Department of Public Health. Public health officials, scientists and health providers are keeping an eye on monkeypox because it recently has been spreading in North America, Europe and Australia.
One of the Arizona patient's lesions was swabbed and tested positive for orthopox at the Arizona State Public Health Laboratory, but the Centers for Disease Control and Prevention will still need to confirm it's monkeypox, said Dr. Rebecca Sunenshine, medical director for disease control at the Maricopa County Department of Public Health.
"This individual has tested positive for orthopox, which is the type of virus that monkeypox is," she said, "and we hope to get the confirmatory testing from the CDC in the next couple of days."
The orthopox virus is a broader group of viruses in the pox family, but because orthopox viruses are so exceedingly rare in the U.S., when someone tests positive for an orthopox virus and has the characteristic monkeypox rash, it's presumed to be positive for monkeypox, Sunenshine said.
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Monkeypox is a viral illness related to smallpox that primarily spreads through skin-to-skin contact. It can also spread through respiratory secretions during prolonged face-to-face contact, county health officials said in a release.
"We're still fairly early in the investigation of this individual," she said. "We are still in the process of determining how monkeypox was acquired. ... We can say that he does not have a history of travel outside of Arizona during the period before he contracted (the virus)."
Any close contacts of someone infected with orthopox is notified by public health, Sunenshine said. There are post-exposure prophylactic treatments that can be offered to prevent developing illness, she said.
"There's also antiviral treatment for those who do have more severe disease," she said. "So there's treatment. There's prevention. And then, we also monitor close contacts who are at higher risk for 21 days after their contact with an infected person."
CDC had identified 35 cases of monkeypox in the U.S. as of Tuesday
Monkeypox is endemic in some countries but not in the U.S. As of Tuesday, the CDC was reporting 35 cases of monkeypox in 14 states and the District of Columbia.
Other states with reported cases include California, Colorado and Utah. California, as of Tuesday afternoon, had reported seven cases. New York had reported eight cases, the highest of any state.
"We've seen enough cases throughout the country that we were actively monitoring for cases here in Arizona," Sunenshine said. "We're very fortunate that in this case the clinician saw a rash that looked like it could be monkeypox and we were able to test right away."
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The last time the U.S. had a monkeypox outbreak was in 2003, when 47 confirmed and probable cases of monkeypox were reported from six states: Illinois, Indiana, Kansas, Missouri, Ohio and Wisconsin. Arizona was not part of that outbreak and the case reported Tuesday appears to be the first-ever reported case of human monkeypox in the state.
All people infected with monkeypox in the 2003 outbreak, which the CDC says was the first time human monkeypox was reported outside of Africa, became ill after having contact with pet prairie dogs. The pets were infected after being housed near imported small mammals from Ghana.
Symptoms typically start with a fever and may include swollen lymph nodes
County public health officials say monkeypox typically starts with a fever, which may be accompanied by a headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.
One to three days after fever starts, a rash begins, often starting on the face before spreading to other parts of the body, according to a county news release.
The rash may begin as small, flat, round discolorations that become raised and fluid-filled (clear or pus) before scabbing. These spots and the fluid in them carry the virus that can infect others. Once scabs fall off, the area is no longer infectious, health officials say.
The lesions can appear anywhere on the skin, genitals, or inside the mouth. Most patients with monkeypox fully recover from the virus without treatment, Sunenshine said.
More info on other viruses: COVID-19 update
"The other important thing for people to know is that if they develop fever, or headache or fatigue and swollen lymph nodes and then develop a rash, that really needs to be evaluated by a health care provider," she said.
"This particular outbreak is unique in that some of the individuals who are presenting in the U.S. are developing lesions on and around their genital area. So anyone who develops any lesions in the genital or anal area would definitely want to have those evaluated right away."
The CDC has issued a Level 2 alert for monkeypox, meaning that travelers should practice enhanced precautions to avoid the disease. Those precautions include avoiding close contact with sick people, including those with skin or genital lesions.
In addition, travelers should minimize exposure to dead animals and steer clear of eating meat from wild game (bushmeat) or using products derived from wild animals from Africa.
'This is not something that we're worried is going to spread quickly through the population'
Monkeypox is a different kind of virus than the novel coronavirus — its genetic material is DNA, not RNA — so it shouldn’t pop out as many variants as SARS-CoV-2., which is the virus that causes COVID-19.
“(DNA) just doesn't accumulate change quite as easily as RNA. And so (monkeypox is) not going to accumulate mutations anywhere near what we see with, say, HIV or influenza or even SARS,” Koenraad Van Doorslaer, an assistant professor at the University of Arizona who teaches virology, told The Arizona Republic in May.
Health officials say the best way to prevent the spread of monkeypox and other viruses is to wash your hands after you touch someone, wear a mask when you are in a crowded indoor space and stay home if you’re sick with fever or respiratory symptoms. Always avoid touching a rash or skin lesions on someone else.
"Monkeypox is not nearly as contagious as COVID and it's predominantly not spread in the same way that COVID is, so this is not something that we're worried is going to spread quickly through the population," Sunenshine said.
There could be more cases in Maricopa County, she said, but it's not likely widespread, Sunenshine said.
"When you find one case, typically that means there could be other cases out there," she said.
"It's important to know that monkeypox is not nearly as contagious as things like COVID and flu. ... It can spread through prolonged face-to-face contact but it is usually through skin-to skin contact. So it takes a lot of contact and exposure to pass monkeypox from one person to the other."
During a visit to Phoenix May 24, Dr. Rachel Levine, assistant U.S. Secretary for Health, said that monkeypox "is not another COVID-19" and that the risk to the general public is low.
"This is not a coronavirus. It is a completely different virus. It's spread by close personal contacts, so it's spread in a completely different way," Levine said. "The CDC is monitoring however the situation really closely, both in the United States and internationally. ... The cases so far have not been severe."
Republic reporter Melina Walling contributed to this story.
Reach the reporter at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes
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This article originally appeared on Arizona Republic: Maricopa County reports Arizona's first 'probable' case of monkeypox
