Monkeypox in Sacramento: Traveler ‘likely’ has infection, but risk of outbreak ‘extremely low’

Sacramento health officials are investigating a “likely” case of monkeypox virus related to travel in Europe and are awaiting confirmation Tuesday of tests by the Centers for Disease Control and Prevention.

“Based on symptoms and preliminary testing, monkeypox confirmation is likely,” Sacramento County health officials said in a Tuesday morning announcement. The California Department of Public Health said the individual “tested preliminarily positive for an orthopox virus” and state and local officials were awaiting confirmation from the CDC.

Sacramento County Public Health Officer Dr. Olivia Kasirye said in a news conference that the risk to the public is “extremely low.”

“This case appears to be related to recent travel to Europe,” Kasirye said earlier Tuesday in a news release. “Public Health is working with CDPH to conduct contract tracing, and risk to the general public is extremely low.”

CDPH said health officials began investigating the case on Saturday, though it was not disclosed when the person returned to the U.S. or if the traveler arrived at Sacramento International Airport. Kasirye said the tests were sent to CDC officials on Monday, and that a timeline for the confirmation was not known.

“California is reporting its first suspected case of monkeypox infection in Sacramento County in a person who recently traveled abroad,” said state Epidemiologist Dr. Erica Pan. “The patient is isolating, and the California Department of Public Health is working quickly with local and federal health officials to ensure appropriate care and response.”

Monkeypox is very rare and does not naturally occur in the United States, county health officials said. “U.S. cases are related to international travel or importing animals from areas where the disease is more common,” they said.

“Because the disease is rare, health care providers may not be familiar with the presentation of monkeypox and the possibility of monkeypox transmission during intimate or sexual contact may not be well known,” Pan said in prepared remarks. “As such, CDPH is promoting awareness amongst healthcare providers and the public, including appropriate infection control for monkeypox cases in the healthcare setting.”

Monkeypox symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. Within one to three days after the appearance of fever, the patient develops a rash. The rash often begins on the face before spreading to other parts of the body. The span from infection to symptoms can range from five to 21 days and the illness can last two to four weeks.

There is no “proven, safe treatment” for the virus, according to the CDC.

To date, the World Health Organization has recorded more than 90 cases of monkeypox in a dozen countries including Canada, Spain, Israel, France, Switzerland, the U.S. and Australia. U.S. health officials said Monday they knew of one confirmed case, in the state of Massachusetts, and four probable cases — two in Utah, one in Florida and one in New York City. All were men who had traveled outside the U.S.

According to CDPH, the CDC has “warned of a potential increased risk of exposure for those who self-identify as men who have sex with men.” A WHO adviser called the outbreak “a random event” that might be explained by sexual behavior at two recent raves in Europe.

Dr. David Heymann, who formerly headed WHO’s emergencies department, told the Associated Press on Monday that the leading theory to explain the spread of the disease was sexual transmission at raves held in Spain and Belgium.

“We know monkeypox can spread when there is close contact with the lesions of someone who is infected, and it looks like sexual contact has now amplified that transmission,” said Heymann.

Health officials said, however, that anyone can be infected through close contact with a sick person, their clothing or bedsheets. Scientists say it would be difficult to disentangle whether the spread was being driven by sex or merely close contact.

A CDC official said Massachusetts health officials had identified 200 people who came in contact with a patient hospitalized with the virus in Boston, the “vast majority” of whom were health care workers, the Boston Globe reported. The virus is not considered easily transmissible and people are not contagious until after they have symptoms. The man, who had traveled to Canada, was being treated in isolation at the Boston facility.

The United States previously saw two cases of the “rare but potentially serious virus” in 2021, in Texas and Maryland. Both cases were from residents who had recently traveled to Nigeria.

The name monkeypox comes from the first documented animal cases in 1958 when two outbreaks occurred in monkeys kept for research, according to Rodney E. Rohde, a microbiologist and the Regents’ Professor of Clinical Laboratory Science at Texas State University. “However, the virus did not jump from monkeys to humans, nor are monkeys major carriers of the disease,” he said.