Update | Tri-Cities man in his 50s likely has 1st monkeypox case in Eastern Washington

The Benton Franklin Health District is investigating in the Tri-Cities area what likely is the first probable case of monkeypox in Eastern Washington.

A man in his 50s has tested positive for orthopoxvirus, the family of viruses that causes monkeypox, and is presumed to have the disease. But the Centers for Disease Control and Prevention is doing further testing, said Dr. Amy Person, health officer for Benton and Franklin counties at a Friday news briefing.

“The risk to the general public is low,” Dr. Person said.

But the health district wants to alert medical providers to watch for symptoms in patients and for the public to be aware that the disease has been found in the Tri-Cities area so they can seek care if they might be infected, she said.

She commended the local monkeypox patient for seeking care, his cooperation with the health district and the quick action by his health care provider to test for the virus.

The patient is isolating and the health district, and his health care provider are working to identify anyone who he may have been in close contact while he was infectious.

The first case in the state was announced in King County, home to Seattle, May 27, and as of Friday 57 probable or confirmed cases had been reported in Washington state.

Cases in Washington state were initially in people who had traveled outside of Washington state, but in recent weeks cases in the state have been diagnosed in people who have not traveled recently, meaning they were likely exposed to monkeypox locally, according to the Washington state Department of Health.

The man in the Tri-Cities area with a presumed infection had not traveled outside Washington state, Dr. Person said.

Washington is one of only nine states in the nation to have more than 50 monkeypox cases, but some states have far more, including New York with 830, Illinois with 230 and Florida with 226, according to CDC data from Thursday.

Nationally, most cases are in men who have sex with men, but anyone who is sexually active with multiple partners or who has sex with someone with multiple partners is at increased risk, says the Washington state Department of Health.

However, not all cases are spread through sexual contact.

“Transmission generally requires close, skin-to-skin contact with someone who has symptoms of the disease,” said Dr. Scott Lindquist, Washington state epidemiologist for communicable diseases.

Kissing, cuddling or other prolonged face-to-face close contact can spread the virus, Dr. Person said.

It can also spread through contact with objects, such as shared towels or bedding contaminated with fluid or scabs from rash blisters, said Heather Hill, infectious disease supervisor for the Benton Franklin Health District, speaking Wednesday on the Kadlec on Call podcast.

“You don’t just get it casually passing someone in the supermarket or at the mall,” she said.

Painful rash among symptoms

Monkeypox is still considered a rare disease and is not a new disease, according to the CDC.

“What is unique about this current outbreak is that we are seeing it in parts of the world where monkeypox is usually not found,” Dr. Person said.

The monkeypox virus, discovered in 1958, is caused by the same family of viruses that causes smallpox and symptoms are similar, but milder. It is not related to chickenpox.

Monkeypox is rarely fatal, according to the CDC.

Three deaths have been reported internationally, but none in the United States, Dr. Person said.

Rapid identification of monkeypox cases is key to bringing the 2022 outbreak in the United States under control, say public health officials. Vaccination is most effective in preventing the diseases when given within four days of exposure.

The Benton Franklin Health District is coordinating with the Washington state Department of Health and the CDC to provide vaccine to Tri-Cities area residents if they are identified as a close contact to someone who has been diagnosed with monkeypox.

The virus is only spread when people have symptoms, Dr. Person said.

Symptoms include a sometimes painful rash that can look like pimples or blisters that eventually scab over.

The rash may be in the genital area, so doctors need to be alert to not assume it is a sexually transmitted disease that causes a rash, Dr. Person said.

Monkeypox is not considered a sexually transmitted disease.

The rash may be the only symptom. But often before the rash is visible, people may have flu-like symptoms such as fever, headache, muscle aches and backaches, swollen lymph nodes, chills and exhaustion.

People with a new rash or sores or who might have had close contact with someone with monkeypox in the last two weeks should contact their doctor to see if they need to be tested, says the Benton Franklin Health District. They also should avoid sex or intimate contact in the meantime.

The health district has gotten calls recently from parents concerned about a rash on their child. But they have not been the blistered rashes characteristic of monkeypox, and health officials have been able to reassure them that their child is not infected, Hill said.

All cases to date in Washington state have been in adults, Dr. Person said.

The time between infection with the virus and symptoms is usually seven to 14 days but can range from five to 21 days.

The CDC says that “monkeypox can spread at any time the symptoms start until sores have healed and a fresh layer of skin has formed after several weeks.”

Monkeypox vaccine

While the vaccine is most effective in preventing monkeypox when given within four days after exposure, it can be given within four to 14 days to reduce the symptoms of the disease, if not prevent it.

Washington state has initially been allocated enough vaccine doses for 398 people from the nation’s limited strategic stockpile. More doses are expected to be distributed to states late this month or in early August.

With the vaccine in extremely limited supply in the nation now because it has been a rare disease, it is only being given to people after they are exposed, Dr. Person and Hill said.

Since the monkeypox virus is closely related to the virus that causes smallpox, the smallpox vaccine also can provide some protection against monkeypox, according to the CDC.

Drugs may also be available again soon that once were used to treat smallpox, Hill said.

There is no shortage of testing capacity for orthopox in Washington state, Dr. Person said.

Anyone who suspects they have been exposed to monkeypox should isolate themselves at home while awaiting test results, says the CDC.

If they have a rash or other symptoms they should stay in a separate room from other family members and pets, if possible.

The infection can spread from both animals and humans. It was first identified in 1958 in monkeys being used for research.

The first known cases in the United States were in the 1970s when rodents imported from Africa for pets were discovered to be infected with the virus.