There are now nearly 2,000 lab-confirmed cases of monkeypox in the United States, according to the Centers for Disease Control and Prevention.

The virus, which is highly contagious and causes painful, itchy lesions and sometimes-deadly complications, has now been detected in all but seven states. As of late Monday, only Alaska, Maine, Mississippi, Montana, North Dakota, Vermont and Wyoming had zero confirmed cases.

The range is wide: A handful of states have each reported a single case, while New York has more than 520. The Washington Post just reported that Washington, D.C., has the most cases per capita, “prompting public health officials to launch an aggressive vaccination campaign aimed at blanketing the most at-risk communities.”

“I do think it’s important to say that U.S. surveillance numbers likely undercount cases,” said Jennifer McQuiston, CDC deputy director of the Division of High Consequence Pathogens and Pathology, during an interview for the American Medical Association’s “Moving Medicine” series.

She said undercounts occur because “detection really depends on a lot of factors, including patients presenting for care, clinicians thinking about monkeypox when they’re seeing patients, and then also requesting and having access to diagnostic tests.”

Meanwhile, worldwide, the virus has spread to 69 countries, including 63 that rarely or never see cases of monkeypox. As of July 18, more than 13,300 cases had been confirmed.

McQuiston and other public health experts say cases are increasing daily in the United States. “Our outbreak curve is in a period of acceleration,” said McQuiston, who noted the same pattern is seen in the United Kingdom, Spain and Portugal.

That new cases are showing up daily indicated community spread, and the CDC expects the numbers will continue to rise, she said.

So far, monkeypox has been considered endemic only in western and central African nations. But there’s fear that unless the United States and other countries control the outbreaks within their borders, the virus could become endemic in those places, too.

That’s something both White House chief medical adviser Anthony Fauci, who directs the National Institute of Allergy and Infectious Diseases, and former Food and Drug Administration Commissioner Scott Gottlieb have recently warned could happen, as the Deseret News reported.

Containment has been hard. As The Guardian reported, “at-risk communities continue to face a limited supply of vaccines and lack of access to testing, while those contracting the virus in the U.S. have struggled to receive treatment, according to reports.”

Containment challenges

Monkeypox can spread a number of ways, including contact with animals or people who have the virus. A previous and much smaller outbreak in the U.S. was linked to prairie dogs, for example.

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Monkeypox infects by way of respiratory secretions, physical contact with lesions or with surfaces and materials that have had such contact. It can also pass from a pregnant woman to baby in utero.

Monkeypox symptoms are typically flu-like: fever, headache, muscle aches and swollen lymph nodes. Then a rash occurs and spreads, before turning into pus-filled lesions that look like terrible acne. It usually lasts two to four weeks before scabs form and fall off and the illness resolves on its own. But the rash and lesions can be very painful, the scabs itchy and the results are, on occasion, devastating. People have died from monkeypox, including stillbirth of infants.

In this outbreak, many who contracted the virus were men who had sex with men, though it’s not a sexually transmitted virus. It comes from close physical contact, including through broken skin, respiratory secretions and by entering the mucous membranes in the eyes, nose and mouth. It can also spread by touching contaminated surfaces, cloth and other material that have been infected by the pus-filled lesions or respiratory secretions.

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According to the Chicago Tribune, “Some in the gay community feel that the lack of public concern about the virus is because it’s mostly affecting men who have sex with other men, but health officials warn there is nothing to stop the virus from spreading to the entire population.”

Health experts say the virus is not impacting just one community or demographic.

“It doesn’t care if you’re gay or not,” Dr. Aniruddha Hazra, an infectious disease physician at Howard Brown Health Center and the University of Chicago Medicine, told the Chicago Tribune. “We have the tools to stop this from moving to other populations.”

Public health experts are using education, testing, vaccination and contact tracing to try to stop the virus’ spread. But many worry that supplies of vaccine are inadequate, too many are having to rely on word of mouth to find vaccine and treatment — which in some areas are in short supply — and people aren’t acting on information that would help stop the spread, including simply knowing how monkeypox spreads so they can protect themselves and others.

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