Concern is growing around the metro Atlanta area as monkeypox cases continue to climb.
Many Atlantans may just now be learning about the rapidly evolving outbreak of monkeypox in the United States.
Georgia confirmed its first case — ever — the first week of June. Now, the state has 625 confirmed cases, according to the Centers for Disease Control and Prevention.
A MARTA train rider reported to police Monday afternoon that another passenger said they had monkeypox, WSB-TV reported Tuesday.
But to contract monkeypox, which is not related to chickenpox but is similar to smallpox, one must be in close contact for a prolonged period of time.
That's unlikely to happen on a MARTA train headed to East Point.
Still, officials told WSB-TV the passenger who said they were sick was evaluated by emergency medical services, and the other passengers boarded a different train.
MARTA did not release any other information about the passenger. It is unclear if the passenger tested positive or negative.
The Georgia Department of Public Health said in a news release Tuesday that while touching items such as clothing or linens that previously touched the infectious rash or body fluids is a way monkeypox spreads, but has not been identified to be a common mode of transmission in this outbreak or for monkeypox in general.
It is important to remember that monkeypox is not transmitted like COVID and typically takes skin-to-skin or other close contact to transmit.
"Most settings where people congregate such as workplaces, schools, grocery stores, gas station, or public transportation are not considered high risk settings for monkeypox transmission," DPH said. "It is important to remember that monkeypox is not transmitted like COVID and typically takes skin-to-skin or other close contact to transmit. Unlike COVID or measles, this means far lower risk to persons that may be in a room with someone with monkeypox, but who do not have contact with the infected individual."
DPH epidemiologist Dr. Cherie Drenzek said that though, traditionally, swollen lymph nodes are a defining feature of monkeypox infection, many of the state's cases are occurring in people who are not extremely sick.
The infected people have neither had a fever nor swollen lymph nodes, and the number of lesions in the monkeypox rash is very minimal, Drenzek said.
"Some of them have very few lesions, maybe even one or two, and they often are located in the genital area," Drenzek said. "And they also can progress pretty rapidly through the stages of the rash."
In roughly 46% of cases nationwide, patients said they had a rash in the genital area, the CDC reported Aug. 5.
Drenzek said she believes the symptoms could have been overlooked because, in some patients, the rash doesn't look the same as in previously documented cases.
You can recognize potential monkeypox infection based on the similarity of its clinical course to that of ordinary discrete smallpox, the CDC says.
After infection, there is an incubation period of roughly one to two weeks, before the development of symptoms such as fever, malaise, headache, weakness, etc. Shortly afterward, lesions and a rash appears develop and evolve together on any given part of the body. The evolution of lesions progresses through four stages — macular, papular, vesicular, to pustular — before scabbing over and resolving.
The illness typically lasts two to four weeks.
Monkeypox begins with fever, headache, muscle aches and exhaustion and can be fatal, even though it is typically milder than smallpox. It is transmitted to people from various wild animals, such as rodents and primates.
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Julie Swann, a public health supply chain expert with the Institute for Operations Research in the Management Sciences, said she believes that reported cases are probably an undercount of what true cases are in the U.S. as well as in other countries.
Currently, men who have sex with men are at highest risk of contracting the disease and make up 99% of confirmed cases, but monkeypox is not considered a sexually transmitted infection.
The virus enters the body through broken skin, the respiratory tract, or mucous membranes in the eyes, nose or mouth.
Human-to-human transmission is thought to occur through prolonged physical contact, including but not limited to sex. At least four children have contracted monkeypox during the current outbreak. None of those cases were in Georgia.
Monkeypox, which does not occur naturally in the United States, is a rare disease.
"Most doctors may have never expected to see a case of monkeypox in their clinic in their lifetime," Swann said. "And now many providers are faced with potential cases and may not necessarily be familiar with the symptoms and how they're being realized or with the testing procedures."
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Swann said there is only a limited amount of time to do additional testing and take prevention measures to try to reduce the impact of both the current monkeypox outbreak, as well as the spread that could occur."
The U.S. Food and Drug Administration approved in 2019 the Jynneos vaccine for the prevention of smallpox and monkeypox disease in adults 18 years of age and older who are determined to be at high risk for smallpox or monkeypox infection.
This is the only currently FDA-approved vaccine for the prevention of monkeypox disease, and it is manufactured only by Bavarian Nordic.
The federal government allocated nearly 50,000 doses to Georgia, but they have not yet all arrived.
"We have drawn down all of that (Phase I) vaccine," DPH spokeswoman Nancy Nydam said in an email. "Our next allocation is 34,120, which will be available over the next four to six weeks."
Tuesday, Nydam confirmed that DPH distributed vaccine to all health districts in the state, and those districts are determining how to distribute those doses locally.
"Whether to county health departments or Ryan White clinics, for example," she said.
Vaccine supply remains limited at this time and monkeypox cases increase daily. DPH continues to prioritize vaccine for people who have been exposed to monkeypox and people who may be more likely to get monkeypox including:
Individuals should contact their local health department for information about appointments, events and vaccine availability.
