State health officials in Kansas and Missouri have not identified any local cases of monkeypox, a viral infection that has now been reported in nearly 20 states, the largest outbreak in US history.
But monkeypox has been here before, including the Kansas City metro.
The first outbreak in the United States, in 2003, affected six Midwestern states, including Kansas and Missouri, when people became sick after coming in contact with pet prairie dogs that had been infected by animals imported from Africa. The current outbreak is also linked to Africa, where monkeypox is endemic in about a dozen countries.
Every few years, cases of diseases pop up that “we don’t see every day,” such as swine flu and Ebola, Dr. Sayo Weihs, pharmacist and infectious disease specialist for University Health in Kansas City, said this past week. “What’s different now is it is not in the typical geographical part of the world we usually see it.”
Doctors emphasize that monkeypox is not like COVID-19, and the risk of getting it is low. Monkeypox is a cousin of smallpox with similar but less severe symptoms. Despite its name, rodents, not monkeys, are a main source of transmission.
Cases in the United States are rare, though earlier cases have been linked to international travel and animals imported from parts of the world where it is more common. Two cases last July and November were identified in people in Maryland and Texas who had traveled to Nigeria.
Health officials in Kansas and Missouri have started pushing out information about the disease to the public. The Missouri Department of Health and Senior Services this past week added an information page about monkeypox to its website.
And it’s been discussed this month at health briefings hosted by University Health and The University of Kansas Health System.
“We are closely monitoring what is happening across the country, and KDHE is ready to respond if we have a positive case,” said Matt Lara with the Kansas Department of Health and Environment.
The first outbreak
It’s called monkeypox because it was first discovered in monkeys in a Danish laboratory in 1958, according to the World Health Organization.
The first human case was recorded in 1970 in a child in the Democratic Republic of the Congo and since then has been reported in people in many other central and western African countries.
In 2003, more than 70 cases of monkeypox in Kansas, Missouri, Illinois, Indiana, Ohio and Wisconsin were reported to the Centers for Disease Control and Prevention. Kansas reported one case, Missouri had two, including the infection of a 38-year-old man in Platte County.
Everyone infected in that outbreak had contact with pet prairie dogs, according to the CDC.
The outbreak was traced to a shipment of exotic animals from West Africa that arrived in Texas in April 2003. It was a Noah’s Ark-type delivery.
Federal investigators said the shipment contained about 800 small mammals of nine species, including six types of rodents — rope squirrels, tree squirrels, brush-tailed porcupine, and Gambian giant pouched rats among them. Some were infected with the monkeypox virus.
After they arrived, an animal vendor in Illinois housed some of the sick animals near prairie dogs that were sold as pets before they showed any signs of infection, according to the CDC.
Every person who got sick with monkeypox somehow came in contact with those sick prairie dogs. Their exposures varied — “noninvasive” from touching the infected animal or cleaning its cage, and “invasive” from a bite or scratch that broke the skin. Some people reported only being in the same room with a sick prairie dog.
One family bought two of them during a Mother’s Day event, according to Slate online magazine. One dog died from the illness but the second — named Chuckles — recovered and the family kept it.
CNN reported in 2003 that about 16 children at an Indiana day care, as well as the woman who ran the center, were suspected to have monkeypox The family that owned the day care had unknowingly bought two infected prairie dogs and used them to entertain the kids .
It came to Kansas City subway
In June 2003, Missouri’s health department reported that a 38-year-old man in northwest Missouri bought a prairie dog from Phil’s Pocket Pets in Villa Park, Illinois, where many of the infected animals were sold.
The Star reported then that the CDC confirmed a Platte County man had monkeypox one day after state officials quarantined his pets. Officials euthanized a prairie dog so the CDC could test it.
State health officials asked the man to isolate at home until his symptoms were gone and the scabs had fallen off. The family’s menagerie of pets — a raccoon, dog, puppies, a cat and other animals — were also quarantined.
The Star also reported that one of the man’s prairie dogs had bitten a Kansas woman, and she too had monkeypox.
How do you get it?
No one in the 2003 outbreak got it from person-to-person contact, the CDC says, unlike what is happening now.
Monkeypox is spread through contact with the lesions and rashes caused by the infection, Dr. Kellie Wark, infectious disease specialist at the KU health system, said during a recent briefing.
The CDC says it’s not clear how everyone in the current outbreak was exposed. But “early data suggest that gay, bisexual, and other men who have sex with men make up a high number of cases,” the CDC says.
“However, anyone who has been in close contact with someone who has monkeypox is at risk.”
Monkeypox “is not necessarily sexually transmitted, but that’s one kind of intimate contact,” says Yale School of Medicine. “Often, outbreaks get identified in certain communities, but that doesn’t mean that one specific type of sexual behavior is inherently more conducive to the transmission.
“An at-risk community gets identified because someone from that community traveled somewhere and started an outbreak. It’s a situation that occurs because of the intimacy of the contact, not the kind of sex people are having.”
It can also be spread through large respiratory droplets, but not nearly as easily as COVID-19, doctors say. “It needs prolonged exposure,” Weihs said. “In the CDC definition, more than three hours. That is a very long time.”
What are symptoms?
The CDC this month issued new guidance based on what doctors have seen in patients so far.
Usually, people with monkeypox have a fever, swollen lymph nodes, muscle aches, headaches — similar to flu symptoms. Then they develop a rash on their face or in their mouth that spreads to other parts of the body, usually the hands and feet.
But patients in the United States have first experienced a rash in the mouth or near the genitals or anus, the CDC says.
“And instead of widespread rashes, some patients saw scattered or localized lesions in areas other than the face, hands or feet,” the CDC says. “In some cases, flu-like symptoms developed after the rash, but other people didn’t have those symptoms at all.”
Doctors suspect that cases are going undetected. Symptoms look different than what is shown in medical textbooks, said Dr. Dana Hawkinson, medical director of infection prevention and control for the KU system.
Is there a vaccine?
Though monkeypox “might sound novel and interesting and really deadly,” said Wark, it tends to have a very low mortality rate, especially the strain detected now in the United States.
Because the monkeypox virus is so closely related to the one that causes smallpox, the smallpox vaccine is effective in protecting people before exposure, the CDC said. In Africa, it’s been shown to be at least 85% effect at preventing monkeypox.
Researchers also think the smallpox vaccine given to someone after they’ve been exposed might help prevent them from getting it, or make symptoms less severe.
Hawkinson said cases were fewer when people were routinely vaccinated for smallpox. That stopped in 1972.
“What we have seen since those vaccine programs stopped, is that generations after that now have become susceptible to monkeypox, whereas before they were protected,” said Hawkinson.
Generally, however, the public does not need smallpox vaccination, he said.
The incubation period for monkeypox is seven to 14 days, so as soon as you think you’ve been exposed, call your doctor, Weihs advised.