A Potentially Disruptive Infectious Disease Outbreak That Flew Under Our Radar

Monkeypox is nothing to sneeze at.

In the April 8, 2022, edition of the Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC), we are treated to an interesting story of an outbreak of monkeypox in Texas. This is not your typical outbreak, where many people are infected, some severely, and the government has to institute “draconian” public health measures to contain it.

This 1997 image was created during an investigation into an outbreak of monkeypox, which took place in the Democratic Republic of the Congo (DRC), formerly Zaire, and depicts the palms of a monkeypox case patient from Lodja, a city located within the Katako-Kombe Health Zone, of the DRC. It is important to note, how similar this maculopapular rash appears to be when compared to the rash of smallpox, also an Orthopoxvirus. Image via CDC’s Public Health Image Library: CDC/ Brian W.J. Mahy, BSc, MA, PhD, ScD, DSc

Instead, it is the story of one man who presented to the hospital with flu-like symptoms, a bit of a rash, and a history of travel from Africa. The story should be required reading this week for all epidemiologists and public health workers on the front lines at local and state health departments. It should also be required reading for healthcare providers, especially those doing triage in emergency departments and urgent care centers. And it should send a chill down your spine when you think of what could happen.

Why is one case of monkeypox an outbreak? Because it is one more than what is expected in Texas at any time of the year (or ever, for that matter). If one or two cases a year happened in Texas all the time, this would be more of a curiosity, a case to be reviewed by infectious disease geeks. But orthopoxvirus…