America’s first monkeypox patient this year had “smallpox-like” fluid-filled blisters that broke out on the scalp, palms and soles of the feet, doctors say.
The man, who has not been identified, was admitted to Massachusetts General Hospital on May 12 with a fever and rash after antibiotics failed to stop his illness.
Doctors initially believed the patient had chickenpox, a sexually transmitted disease like herpes, or even an allergic reaction. But skin and blood tests for these diseases at the hospital’s specialized laboratory were repeatedly negative.
Doctors were stumped until telltale blisters burst on her skin five days later, resembling smallpox.
Dr. Nesli Basgoz at the hospital noticed the similarity immediately and ordered tests for the smallpox virus, which eventually led to the diagnosis of monkeypox.
The man was the first confirmed case of the virus in the US this year and the first sign that the outbreak from Europe had crossed the Atlantic to the Americas.
A total of 14 cases of the disease, mostly among gay and bisexual men, have been detected in the US so far, and there are now signs that it is spreading in the country.
Today, the World Health Organization (WHO) raised its threat level of the virus to a ‘moderate’ warning, if it continues to spread it could reach children and older people who are more vulnerable to the disease.
Doctors only decided to test the patient in Massachusetts for monkeypox after blisters appeared on his skin with an indentation down the middle. (This is a stock image of the symptoms and does not show the patient)
Monkeypox has now been detected in eight states, with signs of human-to-human transmission now occurring in the United States.
Dr. Nesli Basgoz decided to check the patient for ape.
Basgoz said the lightbulb moment came when the patient’s blisters formed an umbilication, or dent in the center, that is characteristic of smallpox.
She told the Boston Globe that despite recognizing this from previous training, she knew it couldn’t be the specific smallpox virus because it had been eradicated.
But the blisters prompted her to check if any smallpox viruses were spreading outside of West Africa, where they are native.
Searching the internet early on May 17, he came across a notice issued by UK health authorities a day earlier that they had detected four cases of monkeypox unrelated to travel to West Africa.
“It was one of those a-ha moments,” he said.
Two hours after contacting infectious disease experts at hospitals about the theory, a conference call was held with state health officials.
WHO raises risk of monkeypox outbreak to ‘moderate’
Monkeypox’s threat to the world has been upgraded to “moderate” by the World Health Organization (WHO), as the tropical virus spreads to dozens of countries.
The WHO said the explosion of cases with no links to each other or to Africa means the current figure is “likely to be an underestimate”.
He warned that if infections continue to occur, vulnerable people and children, who are most likely to die from the virus, could start to contract it.
So far the outbreak, which was first detected in early May, has spread to 24 countries and has been diagnosed in 106 Britons, the majority of whom are men who have sex with men.
There is also growing concern that the virus could spread to wild animals and become endemic around the world, as is the case in parts of central and western Africa.
Human-animal passage would also increase the risk of monkeypox mutation. At the moment, the risk to public health is moderate, but the WHO said it had the potential to “become high”.
Tests were started and later that day revealed that the patient was infected with a family of viruses that included monkeypox. It was announced to the nation the next day.
The man, who was identified by the state as gay or bisexual, had returned to the US from Canada by car when he was struck by the virus.
But health chiefs still considered it possible that he had monkeypox because of the extensive travel links between the continent and the Americas.
Currently, the patient is said to be in good condition, but it may take up to four weeks to recover from the illness.
Since the first US case was detected nearly two weeks ago, another 13 have been detected in seven more states.
Mainly found among gay and bisexual men, the outbreak in Europe, which has now surpassed 300 cases, was likely sparked by unsafe sex at two mass gatherings in Spain and Belgium.
Cases in the United States were initially linked to international travel, with health chiefs saying there was a “very low risk” of further transmission.
But two infections emerged over the weekend that are in ‘close contacts’ of previously detected infections, with no signs of international travel.
This suggests that person-to-person transmission is now occurring in the United States.
Monkeypox is spread primarily through contact with infectious skin lesions, although in rare cases it can also be transmitted through the air.
Patients initially develop a fever for up to 21 days after infection, but then develops into a rash that begins on the face before spreading to the rest of the body.
Most cases are mild and go away within four weeks. But about one in ten people who contract the virus die, estimates suggest. However, the currently circulating strain is believed to be less lethal with a fatality rate of about one in 100.
The virus is endemic in West Africa, but in the latest outbreak it has spread beyond the region.
There is concern that it could become established in these areas if it spreads to the animal population, acting as a reservoir of infection.
Doctors also fear it could spread widely between people because few now have immunity to smallpox, which also protects against monkeypox, and mass vaccination campaigns were abandoned in the 1970s when the virus was eradicated.
It comes as the WHO raised its threat level on the virus to “moderate” today, as cases are detected in 24 countries where it is not endemic.
In a risk assessment published on Sunday, they warned that their “moderate” rating could be upgraded to “high” if the virus “seizes the opportunity to establish itself as a human pathogen” and spread to vulnerable groups.
The “sudden onset” and “wide geographic range” of cases suggest that widespread human transmission of the virus, which spreads through skin-to-skin contact and droplets from an infected person, is underway, the WHO said.
He also warned that the rise in monkeypox infections suggests the virus “may have been circulating unrecognized for several weeks or more.”
Reported cases so far have been mild, but there is a risk that the virus could have a “greater health impact” if it spreads to people at risk, including children and immunocompromised people, such as some HIV patients, who “may be especially at risk for more severe disease.
Monkeypox can kill up to 10 percent of the people it infects. The milder strain causing the current outbreak kills one in 100, similar to when Covid first appeared. The death rate from the virus has been highest among children in previous outbreaks.
The WHO warned that there is a “high risk” of further spread of the virus through skin-to-skin contact between families and sexual partners, as well as through contact with contaminated materials, such as utensils, bedding and clothing.