California records more local cases of new deadlier mpox strain as expert warns virus could spread to more states
A third case of a potentially deadlier strain of mpox has been detected in California, officials say, amid warnings of a wider outbreak.
Three men have now been hospitalized in the state with the 'Clade I' variant of the disease, a more severe strain that kills up to one in 10 patients who are not treated.
None of the men had traveled outside of the US or to East Africa, where the strain is more common, making the cases the first time this strain has been locally transmitted in the US.
There are also no known links between the three men, who are all gay or bisexual, raising the prospect that others are also likely infected.
Dr Bill Schaffner, an infectious diseases expert in Tennessee, told Daily Mail that the cases suggested an outbreak of the strain was likely 'smoldering away' in the US.
'It was inevitable that this virus would appear here and might establish itself at some point,' he said, 'and spread among individuals who have not been to Africa'.
'The Clade I virus is being transmitted in a smoldering fashion in communities in California.'
The 2022 US outbreak that sickened more than 32,000 people and led to 63 deaths was caused by 'Clade II' mpox, a less severe strain that has a fatality rate of less than three percent among patients who are not treated.
California has detected three cases of the Clade I mpox variant in people who had not traveled. The above is a stock image
Doctors say that the 'Clade I' strain spreads more easily, including through close personal contact such as massages, cuddling and sex.
All three of the patients have now been discharged from the hospital and sent home to isolate while they recover from the infections, officials say.
The first patient was diagnosed on Tuesday last week, while the second was on Thursday, and the third on Friday of the same week.
Two of the patients were in Los Angeles, doctors said, while a third was in Long Beach, on the border of the city.
Dr Muntu Davis, the Los Angeles County health officer, added: 'The confirmation of a third case with no travel history raises concerns about possible local spread in Los Angeles County.
'We're working closely with our partners to identify potential sources and understand how this potentially more serious type of the mpox virus may be spreading.'
The press release revealing the third case did not reveal their gender or sexuality, but Sonali Kulkarni, the medical director of the division of HIV and STD programs at the Los Angeles County Department of Public Health, told the New York Times that all three patients were in a high-risk group of gay and bisexual men.
She also told the publication that the infections were worrisome, adding, 'It's still too early to tell, but we're concerned there will be more severe disease'.
The above is a graphic showing symptoms that could be a warning sign for an infection with the virus. Both strains trigger the same symptoms
The above shows mpox cases in the US recorded this year. They are all the Clade II variant, with the outbreak continuing to smoulder in the country
Dr Krutika Kuppalli, an infectious diseases physician formerly at the World Health Organization, who spoke to Daily Mail in a personal capacity, said: 'I think it's concerning as the cases represent likely community transmission given the lack of a link between these cases and the country where Clade I mpox is spreading.'
The cases are the latest since Clade I mpox was first detected in the US, also in California last November in a resident of San Mateo county, neighboring San Francisco.
The patient was an individual who had recently returned to the US from East Africa, where Clade I mpox circulates, and was hospitalized. It is believed that the individual was infected abroad, before returning to the US.
Complicating the potential spread of the disease is the government shutdown, which is now in its 22nd day.
The longest ever shutdown in the US was 35 days, and was triggered during President Donald Trump's first term amid a dispute over funding for a wall along the US-Mexico border. It lasted from December 2018 to January 2019.
Dr Schaffner said the shutdown could cause delays if local officials were seeking to confirm any test results with the CDC, including confirming whether patients are infected with Clade I.
But he said it was likely not impacting the tracking and tracing of the Clade I cases and their contacts in the state because local public health officials are typically state-funded.
'There will be federal persons assigned to the state that may struggle to participate in the activity,' he said, 'I would think, [however], that most of the groundwork can be done effectively.'
As of last year, there had been nearly 40,000 suspected cases of Clade I mpox in Central and East Africa, mostly in the Democratic Republic of the Congo.
So far this year, the US has recorded hundreds of Clade II mpox cases, with New York City registering the highest tally at 276 infections. Los Angeles has recorded 118 infections with Clade II mpox this year to date.
Previously known as monkeypox, mpox spreads through close, intimate contact with the characteristic sores on patients, which can appear on their hands, genitals, mouth or be left on their bedding or clothing.
Warning signs of the illness generally begin as a flu-like symptoms, followed by a rash or pimple or pus-filled lesions on the body that can be extremely painful.
But it can take up to three weeks for patients infected with either strain to develop symptoms, raising the risk that they pass on the virus to others.
Both strains trigger the same symptoms, doctors say, and people can only be diagnosed with Clade I or Clade II mpox using an extensive lab test.
Patients generally develop the rash about one to four days after flu-like symptoms appear, the CDC says.
Men who have sex with men are at the highest risk of an infection, the CDC says, as well as those with untreated HIV.
Most patients recover on their own through antiviral treatments, doctors say.
Patients are also advised to isolate, to stop them from spreading the disease, and to wash their hands often with soap and water or a sanitizer to also avoid spreading the infection.
In some cases, people exposed to the virus may receive the JYNNEOUS vaccine, which can help prevent an infection.
