America may already have as many as 300 cases of monkeypox — more than nine times the official tally of 31 — but has missed hundreds due to a lack of testing, an expert warned Monday.
Dr Boghuma Titanji, an infectious diseases expert at Emory University in Georgia, claimed the U.S. likely already has the same number of infections as the UK — which is currently the world’s monkeypox hotspot.
But she said the arduous process of checking swabs — which must be sent to one of 74 local labs and then the Centers for Disease Control and Prevention (CDC) for confirmation — was leading to too few being done and many being missed.
Other experts say infections may not be detected because cases can be mild and clear up on their own, leading to patients not coming forward, or get misdiagnosed as a sexually transmitted disease like syphilis.
America’s monkeypox cases are mostly among gay and bisexual men and linked to international travel — particularly to Europe, which has spotted about 900 of the 1,000 global cases in 21 countries.
But at least one patient in the U.S. had not recently traveled or being a contact of another known case, suggesting the virus is spreading undetected stateside. Officials at the CDC have not revealed where the patient is based, although it is likely to be either Florida or Pennsylvania.
This week a World Health Organization chief warned the virus — native to West Africa — may have been spreading around the world for years before it was detected after cases multiplied due to unsafe sex at two raves in Europe.
America has now confirmed 31 cases of monkeypox across 12 states and Washington D.C.
Warning there may be hundreds of cases of the tropical disease in the country, Titanji told STAT News: ‘The U.S. probably has as many cases as Canada or the UK.
Dr Boghuma Titanji, from Emory University, said U.S. may have as many cases as the UK
‘We’re just not testing enough to be able to reliably say that there are only 25 cases. I think we need to be testing way more than we’re doing.’
Titanji spoke to the publication before the tally was updated to 31 cases across 12 states and Washington D.C.
The UK has detected 302 cases — the most in the world — while Canada has 95 — the fourth highest tally globally, also behind Spain (230) and Portugal (153).
Many monkeypox infections in the current outbreak are beginning with a rash in the genital area, the CDC revealed at a briefing last week.
Monkeypox was spreading globally undetected for ‘years’, WHO expert claims
Monkeypox may have been spreading around the world undetected for ‘a couple of years’, a World Health Organization expert has claimed.
Dr Rosamund Lewis, the agency’s technical lead for the tropical disease, told a briefing work was ongoing to pinpoint how long it had been transmitting in people.
But she suggested the tropical disease could have been in the population for several years after jumping from animals to humans.
Monkeypox has likely been spreading silently in social and sexual networks for some time, experts say, before super-spreader events at two raves in Europe sparked the current outbreak.
It is not clear how long the virus has been circulating undetected in America, but top advisers suggest it was ‘possibly’ in the country before the first case was detected in Massachusetts last month — although not to ‘any great degree’.
This differs from how the infection typically progressed in the past, with patients suffering a fever within the first 21 days of infection followed by a rash on the face that then spread to the rest of the body.
Dr Joseph Osmundson, a molecular microbiologist at New York University, has raised fears this could lead to cases being misdiagnosed as a common illness.
He also warned that as many infections tend to be mild and clear up on their own, it could lead to patients not coming forward for medical care — and hence being missed.
Last week the CDC revealed it was monitoring more than 400 ‘contacts’ of patients who tested positive for monkeypox. Of these, about 55 are considered ‘high risk’ — meaning there is a reasonable likelihood they have caught the disease.
But despite the high numbers it has so far only carried out around 120 PCR swabs for orthopox virus — the family of viruses that include monkeypox and smallpox.
CDC bosses say they have the capacity to do more than 74,000 tests a day for the virus — and are calling on state health departments to send swabs.
But many experts say the testing process is too complicated, and are instead calling for monkeypox tests to be dispatched directly to states.
The current process sees a swab from a suspected patient sent to one of 74 labs to be checked for an orthopox virus.
If it the test comes back positive, it is then transferred to the CDC which can confirm whether the case is monkeypox.
There is an overwhelming likelihood that any orthopox virus case will test positive for monkeypox. The other major virus in this family, smallpox, has been eradicated for decades.
America currently has one of the smaller monkeypox outbreaks worldwide despite its large population — having detected 31 cases.
The UK is currently the global hotspot for this outbreak with 302 cases, followed by Spain, Portugal and Canada.
A total of 12 states have reported the virus so far. These are: California, Colorado, Florida, Georgia, Hawaii, Illinois, Massachusetts, New York, Pennsylvania, Utah, Virginia and Washington. A case has also been detected in Washington D.C.
WHO experts have suggested the virus may have been spreading in the UK for up to four years but remained unnoticed.