Emergence of a Deadly Monkeypox

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The number of suspected monkeypox cases in New York City has nearly doubled in the last five days, with health officials reporting a total of 55 presumed cases on Tuesday, an 83% jump since late last week as vaccine supply woes continue.

The health department announced the latest case count in a Tuesday tweet that was notably -- and similarly, to a Monday one -- bereft of reference to new appointments opening up at the lone Manhattan clinic prepared to offer monkeypox vaccines.

New York City began offering vaccination against monkeypox Thursday to at-risk groups, with the outbreak primarily linked at this point to men having sex with men, according to officials, but demand was so high walk-ins were closed within hours.

After once again running out of vaccines over the weekend, the city's health department said it was in continued talks with the CDC to secure more doses

As cases of monkeypox virus surge in the U.S., the Biden administration will start distributing the monkeypox vaccine across the country, focusing on people most at risk and communities with the highest numbers of cases, White House officials announced Tuesday.

The U.S. Department of Health and Human Services will send 56,000 doses of the Jynneos vaccine immediately to areas with high transmission. An additional 240,000 doses will be distributed over the next few weeks, with even more to come this summer and fall. Officials expect to make at least 1.6 million doses available by the end of the fall.

States with the highest numbers of cases include California, New York, Illinois and Florida, as well as Washington, D.C., according to the latest count from the Centers for Disease Control and Prevention.

"We are recommending that vaccines be provided to both people with known monkeypox exposures who are contacted by public health and also to those people who’ve been recently exposed to monkeypox,” the CDC’s director, Dr. Rochelle Walensky, said at a news briefing Tuesday.

The CDC is prioritizing initial access to the vaccine for people who have been in close contact, including sexual contact, with someone who has diagnosed with the virus. The agency will also provide vaccines to men who have sex with men who report having had multiple recent sex partners at a venue or party where the virus is known to have spread, or who have had sex with multiple partners in an area of the country with elevated spread.

The vast majority of confirmed monkeypox cases, both in the U.S. and in the global outbreak as a whole, have been among men who have sex with men.

While case numbers continue to rise in the U.S., the White House Covid-19 coordinator, Dr. Ashish Jha, seemed hopeful the U.S. could contain the outbreak and said it was important to remain vigilant.

“Monkeypox is not novel,” Jha said at the briefing. “We as a global community have known about it for decades. We know how it spreads. We have tests that help identify people who are infected. We have vaccines that are highly effective against it.”

“We’ve already lost control of this outbreak,” said David Harvey, the executive director of the National Coalition of STD Directors. “We think there’s many more cases, and we need to act now to get control of this outbreak.”

Doctors diagnosing monkeypox should be on the lookout for symptoms that don't quite match the typical descriptions of the disease, the Centers for Disease Control and Prevention (CDC) warned (opens in new tab) June 14.

Doctors diagnosing monkeypox should be on the lookout for symptoms that don't quite match the typical descriptions of the disease, the Centers for Disease Control and Prevention (CDC) warned (opens in new tab) June 14.

The monkeypox virus belongs to the same family and genus as the virus that causes smallpox and triggers similar, but milder, symptoms, according to the CDC (opens in new tab). At the start of the infection, people usually develop fever, headache, muscle aches, swollen lymph nodes and fatigue. Then the characteristic rashes associated with monkeypox begin to appear. These rashes typically progress through several stages, initially looking like discolored patches of skin then raised bumps, then blisters and finally large, pus-filled pimples; eventually, these skin lesions scab over and fall off.

Historically, monkeypox rashes tend to erupt around the face and in the oral cavity, first, and then may progress to the extremities, including the palms of the hands and soles of the feet. However, some of the recent monkeypox cases in the U.S. have diverged from this pattern, the CDC reported.

Many U.S. patients' rashes have initially appeared around the genitals and anus, as well as the tissues lining the mouth. In some patients, these rashes have caused pain in the anus and rectum, rectal bleeding, painful inflammation of the rectal lining (proctitis) and the sensation of having to pass stool when the bowels are empty (tenesmus). These symptoms are not included in the typical descriptions of monkeypox.

In some cases, patients' rashes have either been "scattered or localized to a specific body site," apart from the face and extremities, the CDC noted. Rashes in different stages of progression have sometimes appeared alongside each other at the same body site. And the usual flu-like symptoms of fever, swollen lymph nodes and fatigue "have not always occurred before the rash if they have occurred at all."

Similarly odd presentations of monkeypox have been seen in other countries impacted by the current outbreak. "It’s now clear that there is an unusual situation, meaning even the virus is behaving unusually from how it used to behave in the past," Dr. Tedros Adhanom Ghebreyesus, the World Health Organization (WHO) Director-General, said at a briefing, according to NBC News.

People who develop potential symptoms of monkeypox should contact their healthcare provider, especially if they meet the following criteria:

Have traveled to countries where monkeypox cases have been reported

Had recent contact with a person who has a similar rash or received a diagnosis of confirmed or suspected monkeypox

Had close or intimate in-person contact with individuals in a social network experiencing monkeypox infections


"Any person, irrespective of gender identity or sexual orientation, can acquire and spread monkeypox. In this outbreak, however, many of the reported cases in the United States are among gay, bisexual, or other men who have sex with men," the CDC noted. For this reason, the health agency has emphasized that men who have sex with men should be aware that the virus may be spreading within their social networks.

There are already at least 700 cases in the United States, but experts say the real number is likely to be much higher. There probably will be many more infections before the outbreak can be controlled, if at this point it can be controlled at all.

Just as we get over one pandemic, another one comes along.

New York City officials declared monkeypox a public health emergency Saturday, saying the city is the epicenter of the state's outbreak and the move will boost measures to help slow the spread of the disease.

"We estimate that approximately 150,000 New Yorkers may currently be at risk for monkeypox exposure," Mayor Eric Adams and Dr. Ashwin Vasan, commissioner of the city's health and mental hygiene department, said in a joint statement. "This outbreak must be met with urgency, action, and resources, both nationally and globally, and this declaration of a public health emergency reflects the seriousness of the moment."

It comes just a day after New York Gov. Kathy Hochul issued an executive order declaring a state disaster emergency, saying "more than one in four monkeypox cases in this country" are in the state. Among several other actions, the governor's order expands the number of people eligible to administer monkeypox vaccines, requires providers to send vaccine data to the state's health department and will boost ongoing response efforts including efforts to get more vaccines and expand testing capacity, the governor's office said.

San Francisco became the first major US city to declare a local health emergency on Thursday in an effort to strengthen its preparedness and response amid "rapidly rising cases" and high demand for the vaccine, the city said. The declaration goes into effect on Monday.

"We know that this virus impacts everyone equally -- but we also know that those in our LGBTQ community are at greater risk right now," San Francisco Mayor London Breed said in a statement. "Many people in our LGBTQ community are scared and frustrated. This local emergency will allow us to continue to support our most at-risk, while also better preparing for what's to come."

In Washington, the federal government is continuing to monitor the response to monkeypox and will use it to consider whether to declare the outbreak a public health emergency, US Health and Human Services Secretary Xavier Becerra said Thursday.

The World Health Organization (WHO) is renaming monkeypox amid concerns that the name may be considered racist and might not accurately describe the origin of the virus.

WHO director general Tedros Adhanom Ghebreyesus said in mid-June that the organization would be renaming monkeypox.

A group of scientists wrote a joint statement earlier in June urging for the monkeypox to be renamed, calling the current name “discriminatory and stigmatizing.”

“The prevailing perception in the international media and scientific literature is that [monkeypox virus] is endemic in people in some African countries. However, it is well established that nearly all [monkeypox virus] outbreaks in Africa prior to the 2022 outbreak, have been the result of spillover from animals to humans and only rarely have there been reports of sustained human-to-human transmissions,” they said.

“In the context of the current global outbreak, continued reference to, and nomenclature of this virus being African is not only inaccurate but is also discriminatory and stigmatizing. The most obvious manifestation of this is the use of photos of African patients to depict the pox lesions in mainstream media in the global north.”

There are also concerns about whether the name of the virus accurately describes the origin of the monkeypox. The virus received its name because it was first found in monkey colonies in 1958, but the Centers for Disease Control and Prevention noted that the actual source of the virus is unclear.

That’s led some officials to warn people against targeting monkeys over the disease.

“What people need to know very clearly is the transmission we are seeing is happening between humans to humans. It’s close contact transmission. So the concern should be about where it’s transmitting in the human population, and what humans can do to protect themselves from getting it and transmitting it. They should certainly not be attacking any animals,” WHO spokesperson Margaret Harris said on Tuesday.

A slight uptick in mpox cases this spring in Chicago has some infectious disease experts concerned as Pride festivals and other large groups convene during the summer months.

Mpox is "predicted to spike up a little bit over the summer," said Dr. Michael Saag, associate dean for global health at the University of Alabama at Birmingham.

Mpox is usually transmitted through close physical contact.

"Mpox is not seasonal. It's really about the way people get together,” Guest said. "This is something that we want to be really clear about watching and getting people to vaccinations."

This is critically important for gay and bisexual men who have accounted for the vast majority of cases. Mpox vaccines are available, as well as treatments.