The dorsal surfaces of the hands of a monkeypox case patient, who was displaying the appearance of the characteristic rash during its recuperative stage.

This 1997 image provided by the CDC during an investigation into an outbreak of monkeypox, which took place in the Democratic Republic of the Congo (DRC), formerly Zaire, and depicts the dorsal surfaces of the hands of a monkeypox case patient, who was displaying the appearance of the characteristic rash during its recuperative stage.

Credit: (CDC via AP, File)

The first case of monkeypox in Georgia was confirmed by public health officials in early June. Now, the state has more than 41 confirmed cases.

"And that is most certainly an undercount," Georgia Department of Public Health epidemiologist Dr. Cherie Drenzek said during the July board meeting, adding that more cases were expected to be confirmed Tuesday.

"Since May, since this outbreak was discovered, it really has exploded in a short period of time," Drenzek said. "Four weeks ago, the total number of cases of monkeypox globally at that time was 1,500, which I thought was tremendous. We're up to 9,600 globally."

Co-infections with other sexually transmitted infections such as chlamydia, syphilis and herpes are common.


What is monkeypox?

Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, thus leading to the naming of the disease.

It originates in various wild animals, not only monkeys, and can be transmitted if a person comes into contact with the virus from an animal, a human or contaminated materials.

The virus enters the body through broken skin, the respiratory tract, or mucous membranes in the eyes, nose or mouth.

Animal-to-human transmission may occur by bite or scratch, through preparation of an infected animal for food, direct contact with body fluids or lesion material, or indirect contact with lesion material such as via contaminated bedding, according to the Centers for Disease Control and Prevention. African rodent species are suspected to play a role in transmission.

Human-to-human transmission is thought to occur primarily through large respiratory droplets. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required.


Monkeypox in metro Atlanta

The median age of Georgia's known monkeypox patients is 40, ranging from 23 to 57, and appearing mostly in men who have sex with men, according to DPH data shared during the July board meeting.

Almost all of the people who have been infected are from the broad metro area in Atlanta.

"We're not seeing a lot of cases, at least yet, in other parts of Georgia or from rural areas," Drenzek said.

More than half of Georgia's cases have occurred among Black people, with roughly 35% of cases among the white population.

Most are of non-Hispanic ethnicity.

The main risk factor is close physical contact with somebody who had monkeypox lesions as the outbreak was evolving and health officials were first hearing about it.

Drenzek said many suspected cases involved travel, especially international travel, but now the outbreaks are evolving in different — not connected — social communities, including in Georgia.


Recognizing the symptoms

You can recognize potential monkeypox infection based on the similarity of its clinical course to that of ordinary discrete smallpox, the CDC says.

Examples of monkeypox rash on skin
Credit: Courtesy of Centers for Disease Control and Prevention

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. None of the infected Georgians have died.

A traditional feature that distinguishes infection with monkeypox from that of smallpox is the development of swollen lymph nodes, according to the CDC. But in Georgia's outbreak, Drenzek said, many of these individuals are not extremely sick, neither presenting with a fever nor swollen lymph nodes, and the number of lesions in the monkeypox rash is very minimal.

"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."

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.

"But this allows us, again, to have a raised index of suspicion clinically so that individuals can get tested, isolated and, you know, the prevention strategies can be implemented," Drenzek said.

The health department wants to make sure doctors know what to look for in suspected monkeypox cases so that contact tracing can begin early.

The two public health laboratories are currently testing samples at least twice a day, Drenzek said.

"We now have two commercial labs available for monkeypox testing: LabCorp and a Mayo Clinic, but others are coming very fast," she said. "So, probably by next week we should have some other commercial labs up and running too."

DPH provides information for clinicians about collecting samples and advising patients of isolation protocols.