California mpox cases skyrocketing, could spread to more states
In this DML Report…
California health officials have confirmed three cases of the Clade I mpox variant in men with no recent travel outside the US or to East Africa, marking the first instances of local transmission of this strain in the country. The cases, diagnosed on Tuesday, Thursday, and Friday, involve two in Los Angeles and one in Long Beach; all patients are gay or bisexual men with no known connections between them. This follows a prior Clade I case in November in San Mateo County linked to East Africa travel. Clade I has a fatality rate of up to one in 10 untreated patients, higher than Clade II's less than three percent, and spreads more readily through close contact like massages, cuddling, or sex. Both clades cause identical symptoms, requiring lab tests to differentiate. The US has seen hundreds of Clade II cases this year, including 276 in New York City and 118 in Los Angeles, after a 2022 Clade II outbreak that infected over 32,000 and caused 63 deaths.
Symptoms start with flu-like signs, followed one to four days later by a rash, pimples, or pus-filled lesions on areas like hands, genitals, or mouth, which can be painful; full onset may take up to three weeks post-infection. Transmission occurs via intimate contact with sores or contaminated items like bedding. All three patients were hospitalized, treated with antivirals, and discharged to isolate at home during recovery; most cases resolve with treatment. Public health measures include tracing sources, advising isolation, frequent handwashing, and potential JYNNEOS vaccination for exposed individuals. High-risk groups are men who have sex with men and those with untreated HIV. The ongoing 22-day government shutdown may delay CDC confirmations, but state-funded tracking continues.
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Infectious disease expert Dr. Bill Schaffner noted the cases indicate a "smoldering" outbreak in California communities without African ties, calling it inevitable for Clade I to establish in the US. Los Angeles County health officer Dr. Muntu Davis expressed concern over potential local spread and ongoing investigations. Sonali Kulkarni, medical director for HIV and STD programs in Los Angeles County, described the infections as worrisome with possible more severe disease, though too early to confirm. Dr. Krutika Kuppalli, former WHO physician, highlighted concerns about community transmission absent links to affected countries. Globally, nearly 40,000 suspected Clade I cases were reported in Central and East Africa last year, mainly in the Democratic Republic of the Congo, while the US Clade II outbreak persists at low levels.