The CDC said it is trying to redouble its efforts to detect infections, and more cases are likely.
Genetic analyzes of the most recent cases of monkeypox indicate that there are two distinct strains in the United States, health officials reported Friday, raising the possibility that the virus has been circulating undetected for some time.
Many of the cases identified in the United States were caused by the same strain as recent cases in Europe, but a few samples indicate a different strain, federal health officials said.
Each strain had been seen in US patients in the past year, before the recent international outbreak was identified.
Testing many more patients will be needed to determine how long monkeypox has been circulating in the United States and elsewhere, said Jennifer McQuiston of the Centers for Disease Control and Prevention.
“I think it’s very possible that there have been previously unrecognized cases of monkeypox in the United States, but not on a large scale,” McQuiston told reporters on Friday.
However, he added, “community-level transmission may be occurring” in some areas of the United States where the virus has not yet been identified.
The CDC said it is trying to redouble its efforts to detect infections, and more cases are likely.
The findings indicate the outbreak is likely to be difficult to contain, said Dr. Angela Rasmussen, a virologist at the University of Saskatchewan.
It is not known for sure how long the infections have been occurring, or where. Some infections may have been misdiagnosed as something else.
“We don’t really have a clear picture of how many cases are out there,” Rasmussen said.
Monkeypox, or monkeypox, is endemic in parts of Africa, where people have become infected through the bites of rodents or small animals.
As of Friday, the United States had identified at least 20 cases in 11 states. Hundreds of cases have been detected in other countries, many of them apparently related to sexual activity at two recent parties in Europe.
The illness usually begins with flu-like symptoms and swollen lymph nodes, followed by a rash on the face and body.
So far, no deaths from monkeypox have been reported in the United States or Europe. But this might change if infections start to occur in more vulnerable people, such as very young children or people with weakened immune systems, Rasmussen said.
It also raised another concern: Even if outbreaks among people are contained, it’s possible the virus might take hold in the US rodent population, either through pets or unwanted rodents in homes.
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