Outbreak Alerts
Editor: Alyson Browett, MPH

Contributors: Christina Potter, MSPH, Eric Toner, MD, and Rachel Vahey, MHS, and Lane Warmbrod, MS, MPH
The Johns Hopkins Center for Health Security is analyzing and providing updates, as needed, on the confirmed and suspected monkeypox outbreaks that have been identified in several non-endemic nations worldwide. If you would like to receive these updates, please sign up here.
Recent Outbreaks Update as of June 1, 2022 at 1:00pm ET

As of 1:00pm ET today, there are 617 confirmed monkeypox cases in 26 countries, 2.7 times the number of confirmed cases at this time one week ago. An additional 129 suspected cases are under investigation in 12 countries. No deaths have been reported. 

The WHO said this week that the world has a “window of opportunity” to bring the growing monkeypox outbreak under control and that the organization does not currently expect a pandemic-level event to occur, assessing the overall public health risk at the global level as “moderate.” The atypical nature of the outbreaks—happening concurrently in widely disparate geographic regions with no known links to endemic countries in West and Central Africa—suggests that undetected transmission may have been occurring for some time, with some recent gatherings and events possibly amplifying transmission. 

The WHO also provided updates on ongoing monkeypox outbreaks in several endemic countries—including Cameroon, Central African Republic, Democratic Republic of the Congo, Nigeria, and Republic of the Congo—where there have been 1,365 cumulative cases and 69 cumulative deaths since December 15, 2021. 

Monkeypox virus can be passed from person to person by close contact with skin lesions, body fluids, respiratory droplets, and contaminated items like bedding. Typically, symptoms begin with a fever, fatigue, headache, weakness and progress to a rash including lesions. Notably, many of the cases in the current outbreak have had atypical symptoms, with mild-to-no initial symptoms and lesions primarily in the genital or perianal areas, raising concerns that the cases could be linked through sexual networks in addition to social networks and that cases may go undiagnosed if clinicians are unfamiliar with these new clinical presentations. Monkeypox virus can infect anyone who has close contact with an infected person, and anyone with possible, probable, or confirmed monkeypox should be isolated immediately to control transmission. Additionally, all healthcare workers should be alert to symptoms associated with monkeypox and contact state, local, or regional health departments immediately if a case is suspected.

Many, but not all, of the cases have been diagnosed among men who have sex with men (MSM) and possibly spread more widely during large parties or events, according to an update from the WHO Regional Office for Europe. Notably, the update warns that the potential for further transmission is high in the region and elsewhere, as more mass gatherings are planned over the summer months. However, such gatherings also provide opportunities to raise awareness and improve individual and community protections. Education efforts should be incorporated into upcoming events, particularly as Pride month gets underway today. Importantly, messaging surrounding the outbreak should continue to be careful not to stigmatize MSM or other queer populations and continue to stress that monkeypox is a disease impacting the MSM community in addition to non-MSM communities, not a disease inherent to MSM populations.

While health officials are urging vigilance around the current outbreak, they advise that monkeypox is not COVID-19 and can be brought under control. The WHO and the UK Health Security Agency have expressed concern that the potential exists for monkeypox to spread into more vulnerable populations, such as people with underlying conditions, children, or pregnant women, or that monkeypox could find an animal host, which could help the virus entrench itself in additional geographic regions. While scientists know more about monkeypox than SARS-CoV-2, the virus that causes COVID-19, much remains to be learned about the orthopoxvirus. 

In the United States, where 18 monkeypox cases are confirmed, the US CDC published updated guidance regarding the use of orthopox vaccines for use among certain people at risk for occupational exposure to orthopoxviruses, including healthcare and laboratory workers. Two vaccines are available through the US Strategic National Stockpile (SNS): JYNNEOS, a live, non-replicating vaccine licensed by the US FDA for the prevention of smallpox and monkeypox among high-risk individuals, and ACAM2000, a live vaccine licensed by the FDA for immunization against smallpox disease for high-risk individuals. The JYNNEOS vaccine is being used among certain healthcare workers treating patients in the current outbreak. The CDC also is reviewing its testing network for monkeypox, weighing how to expand its Laboratory Response Network (LRN), which is currently handling monkeypox testing, if necessary. 

As diagnostic, treatment, and prevention resources for monkeypox appear to expand in the US and other western nations amid the growing outbreak, officials in African nations—where more than twice as many cases have been reported in outbreaks this year—point to ongoing inequities in access to such resources. Some hope the increased attention to the disease will help to expand research and access to therapies and vaccines but lament the fact that, once again, awareness has been raised only when those in higher income or Global North nations are impacted.