California's likely monkeypox case tally rises to 12; L.A. County identifies 2nd case

Los Angeles County has reported its second probable case of monkeypox as California's total probable case tally rises to 12.

The L.A. County Department of Public Health said the latest case occurred in an adult who recently traveled. "They are symptomatic but doing well and isolating away from others," officials said in a statement Wednesday.

L.A. County's first suspected monkeypox case — which was first reported last week and has since been confirmed by the U.S. Centers for Disease Control and Prevention — is not related to the suspected case reported on Wednesday, L.A. County Public Health Director Barbara Ferrer said.

San Francisco reported three additional probable cases of monkeypox Thursday, meaning the city has reported a total of four probable cases — two of the people have traveled recently, while the other two have not.

Also on Thursday, Alameda County announced its first probable case of monkeypox.

Sacramento County has reported at least five confirmed and suspected monkeypox cases, according to the California Department of Public Health.

That brings the total of confirmed and suspected monkeypox cases in California to 12 as of Friday morning.

"The risk of monkeypox in the general population remains very low," county health officials said in a statement.

Ferrer said last week that there's no indication that there's going to be a massive outbreak of monkeypox locally, but added that "we need to be prepared for seeing more cases."

“While most cases resolve on their own, monkeypox can be serious in rare cases and we want to prevent further spread in the community," said Dr. Susan Philip, the health officer in San Francisco.

As of Thursday afternoon, there were 45 confirmed and suspected cases of monkeypox nationally, with the most cases in New York, California, Florida, Illinois and Colorado.

In the current outbreak, 1,300 confirmed and suspected monkeypox cases have been reported in 31 countries, mostly in Europe and North America. Of them, Britain has reported more than 300; Spain and Portugal, more than 200 each; and Germany and Canada, more than 100 each.

Officials said it was crucial that people become aware of the symptoms and healthcare providers be on alert for new cases, as the telltale rash — which in some recent cases has been first seen in the genital area — can sometimes appear similar to more common sexually transmitted infections. Health officials say they're hoping to contain the monkeypox outbreak but say it's possible there is already community spread of the virus.

The specific monkeypox variant that has been found in most U.S. cases has been linked to the variant in Europe, Capt. Jennifer McQuiston, deputy director of the U.S. Centers for Disease Control and Prevention's Division of High Consequence Pathogens and Pathology, said at a news briefing last week.

Nationally, most of the monkeypox cases known to the CDC involve people who have recently traveled or have had close contact with someone who was infected. But at least one of the recent cases in the U.S. involves someone who doesn't know how he or she was exposed to the virus, McQuiston said.

"This could be happening in other parts of the United States — there could be community-level transmission that is happening. And that's why we want to really increase our surveillance efforts," McQuiston said. "We want to really encourage physicians that, if they see a rash, and they're concerned it might be monkeypox, to go ahead and test for that."

Health officials have noted that early data show that a high number of the current monkeypox cases are among men who have sex with men; however, anyone can be infected with the virus, including healthcare workers and family taking care of those who are ill. One recent case has occurred in a woman, according to McQuiston.

Monkeypox was first discovered in 1958 in colonies of monkeys kept for scientific research. Most human cases of monkeypox have historically been identified in the Democratic Republic of Congo, where the first human case was identified in 1970. The monkeypox virus is naturally found in certain wildlife in that country; the CDC says rodents and monkeys may harbor the virus and infect people.

For global travelers, the CDC has issued a Level 2 monkeypox travel alert, warning about monkeypox cases related to the current outbreak on every continent except Antarctica.

The CDC urged world travelers to avoid close contact with sick people, including those with skin and genital lesions; avoid contact with dead or live wild animals such as small mammals and nonhuman primates, like monkeys and apes; avoid eating meat that comes from wild game or using products that come from wild animals from Africa, such as creams, powders and lotions; avoid contact with contaminated material used by sick people such as clothing; and wear a mask, which can provide further protection against many diseases.

Health officials emphasized that the threat was low, given that monkeypox is not nearly as contagious as other infectious diseases, such as COVID-19. Between humans, monkeypox can be transmitted through close, sustained, skin-to-skin contact with someone who has an active rash and monkeypox skin sores. The virus can be spread during sexual and intimate contact and through shared bedding and clothing. It’s also possible it can be spread through kissing and breathing at very close range.

Monkeypox can also be spread from animals to humans through a bite or scratch, handling wild game or using products made from infected animals.

Spreading through the air is not thought to be a major avenue for monkeypox transmission, given that disease investigations have shown that monkeypox-infected people who are likely contagious on an airplane flight have not spread the virus to other passengers.

Health officials and experts have sought to strike a balance in their warnings, noting that people generally recover from the disease while also underscoring the urgency to contain the outbreak and identify cases. They also warn that the skin lesions can be painful.

“It can be really painful and some patients have reported needing prescription pain medicine to manage that pain. The sores can also cause long-term scarring on the skin,” McQuiston said.

Traditionally, monkeypox is believed to begin with a fever and feeling of being unwell, followed by a rash. But in some of the recent cases, the rash has appeared first. Other symptoms can include headache, muscle aches, backache, chills, exhaustion and swollen lymph nodes. Rare complications include lesions that appear in the eye, which can endanger vision.

The monkeypox rash results in well-rounded skin lesions, and as they progress, they turn into papules, which are raised areas of the skin that can appear like a pencil eraser, McQuiston said. They can then fill with a clear fluid, which turns into pus.

The rash can appear similar to syphilis and herpes, which are far more common than monkeypox. McQuiston said it can be difficult to distinguish monkeypox from other illnesses, and that’s why healthcare providers should be on the alert for potential cases and request a test if they suspect monkeypox. In some recent cases in Europe, people have been simultaneously infected with both monkeypox and a sexually transmitted disease.

“They should test for monkeypox, even if they think they might have a positive test for another, more common” sexually transmitted infection, McQuiston said.

No deaths have been reported in the current monkeypox outbreak worldwide, McQuiston said. Patients whose cases have been reviewed by the CDC as of last week are either recovering or have already recovered, “and those who still have a rash are being advised to stay home and stay away from other people until they’re fully recovered.”

Full recovery happens “when all of the sores have scabbed over, the scabs fall off, and new healthy skin has emerged,” McQuiston said. A person is no longer contagious once all the scabs have fallen off.

Recent monkeypox cases in the U.S. known to CDC officials have been among adults, McQuiston said, and most reported international travel in the 21 days before their symptoms began. It generally takes seven to 14 days for a person to develop symptoms after being exposed to monkeypox, but it can take up to 21 days.

McQuiston said authorities are working hard to contain the outbreak.

“Our containment strategy is focused on identifying cases, identifying their contacts and making sure they get vaccine offered to them and that cases are being isolated to prevent onward spread,” McQuiston said.

The recent outbreak is concerning because monkeypox cases are not usually found in the U.S., officials have said.

The only previous U.S. outbreak of monkeypox occurred in 2003, leading to 71 confirmed or suspected cases — mostly in Wisconsin, Indiana and Illinois. Those who were infected had come in contact with pet prairie dogs obtained from an animal distributor in suburban Chicago that had been housed near Gambian giant rats and dormice that came from Ghana.

Though monkeypox can be fatal in countries where healthcare resources are poor, the 2003 U.S. outbreak did not lead to any deaths.

This story originally appeared in Los Angeles Times.