DENVER – Colorado has detected its first presumptive case of monkeypox, state health officials said Thursday, but they reassured the public the risk of getting infected with the latest disease making headlines across the world remains low.
The case is presumptive as it is awaiting confirmation from the U.S. Centers of Disease Control and Prevention (CDC).
The presumptive case is from a young man who sought care at Denver Health and who acquired the virus during a recent trip to Canada, which is one of more than a dozen countries currently experiencing an outbreak of this virus.
The Colorado Department of Public Health and Environment (CDPHE) said the man is isolating at home and his condition is improving.
There are currently no other presumptive positive monkeypox cases in Colorado, the CDPHE said in a news release Thursday.
“While anyone who has been in close contact with a confirmed or suspected monkeypox case can acquire monkeypox, people who have recently traveled to a country where monkeypox has been reported, or men who have sex with other men, are currently at a higher risk for monkeypox exposure,” state health officials said.
The CDPHE said Coloradans can help prevent the spread of monkeypox by avoiding close physical contact with individuals who have acquired monkeypox, wearing a high-quality mask if they will be spending time in close contact with someone experiencing symptoms of monkeypox, and contacting a health care provider as soon as possible if they experience symptoms.
“We want to reassure Coloradans that the risk to the public is low, but we also want them to know of the symptoms so that we can catch other cases as soon as possible,” said Dr. Rachel Herlihy, the CDPHE's state epidemiologist.
While monkeypox is rare in the United States, cases have popped up in people who have a recent history of international travel or people who had contact with animals from areas where the disease is more common, the CDPHE said.
In 2021, for example, there were two monkeypox cases in the United States associated with international travel, and there was a monkeypox outbreak in six states involving 47 cases associated with contact with infected animals that had contact with small mammals from Ghana in 2003.
Neither of those outbreaks included cases in Colorado.
What is monkeypox?
Monkeypox is caused by an infection from a virus in the same family as smallpox, causing a similar (but less severe) illness, according to Harvard Health. Complications can include pneumonia, vision loss due to eye infection, and sepsis, a life-threatening infection.
Up until this year, the illness – which was first discovered in 1958 – was mostly concentrated in Africa, but an outbreak is currently being reported across Europe, with other cases appearing in more than a dozen countries including the United States, Canada, Israel, Australia, and some Nordic territories.
Health experts are looking into why this large outbreak is happening, as those who've come down with the illness have not traveled to or from a place where the virus is usually found and have had no known contact with infected animals. Additionally, there seems to be more person-to-person spread happening than in previous outbreaks, they said.
There are two known types of monkeypox — the West African strain (1% fatality rate) and the Congo Basin strain (10% fatality rate). The current outbreak happening outside of Africa comes from the West African strain, according to health experts.
About 5% of people who contract monkeypox die.
What are the symptoms of monkeypox?
Symptoms of monkeypox are similar to but less severe than the symptoms of smallpox, according to the CDC.
The illness begins with a fever, a headache, muscle aches and exhaustion. Backaches, swollen lymph nodes and chills will also afflict a person infected with monkeypox.
The incubation period for monkeypox is usually between a week and 14 days, but symptoms can appear in as little as 5 to as long as 21 days, the CDC notes.
The CDC has a helpful guide to help you recognize monkeypox infection here.
What are some physical signs you should watch out for?
Health officials say it may take one to three days (sometimes longer) after a fever breaks out before a person infected with the virus starts developing a rash, which usually begins on the face and spreads to other parts of the body, including the palms, arms, legs, and most recently, the genital area.
"People are most infectious when they have the rash itself," said Dr. Michelle Barron, medical director of infection control and prevention for UCHealth. "If you come into contact with that rash, it doesn't mean you're necessarily going to get infected, but your risk is highest when the vesicles are there until they scab and completely fall off."
Harvard Health states the rash changes from small, flat spots to tiny blisters (called vesicles) which are similar to chickenpox, which then turn to large blisters filled with pus. The blisters can take several weeks to scab over, health officials say, but once that’s happened, a person is no longer infectious.
The illness typically lasts for two-to-four weeks.
How is monkeypox spread?
People in areas where monkeypox cases occur more often are typically exposed through bites or scratches from infected rodents and small mammals, while preparing wild game, or having contact with an infected animal or possibly animal products, health officials say.
Monkeypox does not happen regularly in animals that live in the United States, the CDC states.
The virus can also spread from human to human through large respiratory droplets (but this likely requires prolonged face-to-face contact, so it's not a bad idea to continue wearing a N95 respirator or its equivalents) and through intimate contact, like sleeping next to someone, or by engaging in sexual activities, where an exchange of fluids for prolonged periods of time might occur between two or more people — regardless of sexual orientation.
Walking next to someone in the street is unlikely to spread the virus, Barron said.
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Other human-to-human ways of spreading the virus include direct contact with body fluids or broken lesions, and through contaminated clothing or linens.
It’s not all bad news, however, as monkeypox spreads after symptoms begin, unlike SARS-CoV-2 – the novel coronavirus which causes COVID-19 – which can spread asymptotically.
Is there a vaccine against monkeypox? Can it be treated?
While the program to vaccinate against monkeypox in the U.S. ended in the 1970s, the U.S. government does keep a stockpile of the vaccine in the event of a widespread outbreak.
Having said that, there are two preventive vaccines and three potential antiviral treatments that can be used for orthopox — the family of viruses that includes monkeypox, CNN reports.
ACAM200 and JYNNEOS (also known as Imvamune or Imvanex) are the two currently licensed vaccines in the United States to prevent smallpox. JYNNEOS is also licensed specifically to prevent monkeypox, according to the CDC, and has an 85% efficacy rate against the disease.
JYNNEOS, which uses a live version of the smallpox virus that has been engineered to prevent it from replicating or causing infection in the body, but which can still activate an immune response to mount defenses against both the smallpox and monkeypox virus, was approved by the U.S. Food and Drug Administration (FDA) in 2019, according to TIME.
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"At this time, there are no specific treatments available for monkeypox infection, but monkeypox outbreaks can be controlled," the CDC states on its website.
FDA-approved antivirals that may be effective for monkeypox include cidofovir, brincidofovir, and tecovirimat.
The CDC also says on its website the risks from monkeypox disease are greater than the risk from the smallpox or monkeypox vaccine.
Based on past experience, the CDC writes, "it is estimated that between 1 and 2 people out of every 1 million people vaccinated will die as a result of life-threatening complications from the vaccine."
What should you do if you think you've come into contact with someone who has monkeypox?
Barron said the first thing people should do if they think they've come into contact with someone who has monkeypox is to thoroughly check and examine the skin "quite well."
You'll also want to contact your doctor if you start developing a rash that looks something like this.
"The most important thing is, again, awareness of this (disease)" Barron said. "If you see this rash and you don't know what it is, you want to make sure that you pay attention and don't just ignore it and have someone examine it."
Gov. Polis released a statement late Thursday afternoon following news of the detection of the first presumptive case of this disease, saying the state is requesting vaccines from the federal government.
"As our dedicated teams at the state have identified Colorado’s first presumptive case of Monkeypox, we look forward to getting more information on the virus and how it is transmitted to keep you informed in the days and weeks ahead,” Polis said in a statement. "At this time, the risk to the public continues to be low and the data suggests that this disease, while serious, is not typically fatal for those with healthy immune systems."
Monkeypox cases have been confirmed in Massachusetts, Florida, Utah, Washington, California, Virginia and New York. As of Thursday, nine other cases of the virus had been detected in the U.S. with more than 300 detected across the world.
