When a local man arrived at the Boston emergency room on May 12 with an unusual mix of symptoms, doctors scratched their heads for days.
It resembled monkey pox, a virus that causes symptoms such as fever, muscle aches, and a rash that turns into red, bumpy pustules filled with yellowish fluid.
But the man had not traveled anywhere in the world where monkeypox was endemic.
“The patient … had no history of traveling to areas in Africa where monkeypox has been or contact with animals,” Paul Biddinger, director of the Center for Disaster Medicine at Massachusetts General Hospital, told the ABC News Daily podcast.
“And at that time, there was no history of people diagnosed with monkey pox not having that contact.”
Four days later, reports came in of monkey pox patients in England who had also not traveled to areas in Africa where the disease was endemic.
“We said, ‘Gosh, that’s never happened in the United States before,'” said Dr. biddinger.
“It’s almost never happened in the world before, apart from the recent reports in England, but we really should be pursuing it.”
The Boston clinical team moved the patient to a special section of the hospital that was established after the 2014 Ebola outbreak to care for patients with emerging infectious diseases.
Within days, the Centers for Disease Control and Prevention (CDC) confirmed that this was the first case of monkeypox in the United States.
How is the virus spread?
Monkeypox is making headlines because it spreads in an unusual way.
According to Amesh Adalja, a senior scientist at the Johns Hopkins Center for Health Security in Pittsburgh, it is highly likely that visitors from Africa have traveled back to places like the US and UK, where they have spread the virus.
“There were two raves in Belgium – and maybe people from all over the world attended – and that has brought the virus to many different countries,” said Dr. Adalja to ABC News Daily.
He said the outbreak was also unusual in that it mainly affected a single community group: “men who have sex with other men”.
“So it’s likely that this origin comes from a traveler who somehow passed it on to someone who got it on a social network, … [where it has then been ] reinforced by certain events where people have multiple sexual contacts,” he said.
“It’s been able to exploit the close contact that takes place in those social clusters at raves, in saunas and other places to spread from person to person in a way it hasn’t had a chance to do before.†
He said that while monkeypox was not classified as a sexually transmitted disease, it did require close and prolonged body contact with an infectious person to spread.
Doctors never suspected monkey pox
Medical professionals around the world faced the same challenges diagnosing monkeypox as those in Boston, according to Dr. Biddinger of Massachusetts General Hospital.
“Where [the patient] traveled [and] who they’ve been in contact with drives us to think about what’s possible and what isn’t possible,” said Dr. Biddinger.
Because most patients had no clear link to outbreaks in Central and West African countries where the virus is endemic, no one suspected that they could have had monkeypox.
In fact, had it not been for the news of the UK outbreak, US doctors might never have diagnosed monkeypox.
According to the World Health Organization (WHO), monkeypox has now infected more than 780 people in 27 of its member states.
Disease not at pandemic level
Australia has registered its seventh case of monkey pox, most recently in two men returning to Sydney after traveling together in Europe.
NSW Health is conducting contact tracing but has not identified any high-risk contacts so far.
The WHO said the monkeypox outbreak outside Africa would not lead to a pandemic, but is considering whether the outbreak should be assessed as a “potential public health emergency of international concern”.
Such a statement, like the one made for COVID-19 and Ebola, would help accelerate research and funding to contain the disease.
Last week, it hosted a global research meeting with more than 500 experts, who recommended speeding up research on the virus to better understand the distribution, clinical implications and efficacy of vaccines.
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