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Monkeypox cases are going undetected or misdiagnosed


Health officials are warning that the current monkeypox outbreak is larger than it appears. At the moment, there are about 800 reported cases. Those cases have been found in more than two dozen countries, including the U.S. Officials at both the Centers for Disease Control and Prevention and the World Health Organization say many transmissions are being missed. Here to explain why is NPR's Michaeleen Doucleff. Hi, Michaeleen.


KELLY: All right, so 800 cases - not great, obviously, but compared to COVID, it doesn't sound very big. Why are health officials worried?

DOUCLEFF: Well, the concern is because the virus seems to have changed, especially in terms of how it spreads. There's a possibility it has become more contagious. Another big problem is the virus is spreading under the radar. Doctors and nurses have been missing a lot of cases. And when a virus spreads cryptically like this, it can be really hard to stop, and there's a chance it could become a long-term problem.

KELLY: Although I have read it causes a very distinctive rash, so I guess I'm curious why doctors would be missing it. It seems like it's easy to spot.

DOUCLEFF: Yeah. So in the current outbreak, the symptoms, actually, of monkeypox aren't matching up with what you describe - with what doctors were actually taught in medical school. I was talking to Dr. Donald Vinh about this. He's been taking care of patients with monkeypox at McGill University. He says if you look in a medical textbook, you'll see pictures of people with this horrible rash.

DONALD VINH: It's glaring. You see skin lesions. The pox lesions cover, eventually, head to toe on the person. And again, we're not seeing that.

DOUCLEFF: For starters, in this outbreak, the rash can be very localized. It's often in the genital region. And there can be very few lesions. One recent patient, Vinh says, had only one small lesion.

VINH: I mean, it is extremely subtle. It is not what you're seeing on the Google pictures of monkeypox. And so this is a bit concerning because if you have subtle lesions - skin lesions - and they're contagious, you can see how this may lead to more propagation that can be missed.

DOUCLEFF: In fact, Vinh says doctors could easily misdiagnose these cases for common sexually transmitted diseases, such as herpes or syphilis.

KELLY: Although it sounds like the good news, if we can say that, is that the rash isn't as bad as classic monkeypox. Is it milder what's spreading now?

DOUCLEFF: So it can be mild. That's what they're seeing. But it can also be really severe and really painful. And it can make you sick for, like, up to four weeks, sometimes even put you in the hospital. And for young children or people with suppressed immune systems, it can be really severe.

KELLY: So bottom line - it sounds like doctors need to change what they are looking for.

DOUCLEFF: Exactly. Officials in the U.K. are asking everyone who has a blister-like rash to go to a sexual health clinic where practitioners are really good at looking out for STDs. And here in the U.S., Jennifer McQuiston at the CDC says doctors should suspect monkeypox in anyone with a new rash.

JENNIFER MCQUISTON: There could be community-level transmission that is happening. And that's why we want to really encourage physicians that if they see a rash and they're concerned it might be monkeypox to go ahead and test for that.

KELLY: One more thing to ask you, Michaeleen, which is do we know more about how it is transmitted? I have read it's primarily transmitted through sex.

DOUCLEFF: Yeah. You know, we don't know exactly yet if it's sexually transmitted, but they do know that it spreads through close physical contact, which, of course, can happen during sex. Right now, many cases are in men who identify as having sex with men. And in some places, like Montreal, people have caught it at gay bathhouses. But the WHO says this virus can infect anyone, and countries need to broaden out the scope of their testing and surveillance.

KELLY: We've been speaking with NPR's Michaeleen Doucleff. Thank you so much.

DOUCLEFF: Thank you, Mary Louise.

(SOUNDBITE OF BADBADNOTGOOD SONG, "TONE'S RAP") Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Michaeleen Doucleff, PhD, is a correspondent for NPR's Science Desk. For nearly a decade, she has been reporting for the radio and the web for NPR's global health outlet, Goats and Soda. Doucleff focuses on disease outbreaks, cross-cultural parenting, and women and children's health.
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