Monkeypox update: Local transmission of the virus in King County likely

Cases of monkeypox are increasing nationally and in King County. As more cases are reported, people in our community may have questions about local transmission and access to vaccination.

First, a bit about the numbers. Multiple states and counties have reported cases. As of July 6, 2022, CDC reports almost 7,000 cases globally and 560 cases in the United States. Public Health has identified nine King County cases as of July 6th. These numbers change often, so for the latest case counts visit CDC’s outbreak summary and King County’s monkeypox page.

Local Transmission

Recent cases of monkeypox have been identified in residents that did not report travel during the time they would have been exposed, suggesting that the virus was transmitted locally. Public Health connects with known cases to provide advice and to assess potential exposure to others. If close contacts are anonymous, Public Health reaches out to locations or events where exposure may have occurred.

Anyone who has symptoms of monkeypox or has been in close contact with someone with monkeypox should contact a health care provider as soon as possible for an evaluation.

“Finding monkeypox in residents who were likely exposed locally highlights the importance for people who are at higher risk for monkeypox and for healthcare providers to be able to recognize the symptoms promptly, and to take steps to limit the risk for infection and the spread to others.”

“We expect to see additional cases locally as the outbreak grows in the US and globally. We are working to limit the impact on our community, collaborating with a strong network of community-based organizations to share information so that people can quickly recognize if they develop a rash or other flu-like symptoms, limit close contact if symptoms develop, and get checked out right away.”

Dr. Jeff Duchin, Health Officer, Public Health – Seattle & King County

There are other contagious illnesses that can cause a rash or skin lesions. It’s important for anyone with a new rash to be evaluated by a healthcare provider who can assess if the rash is monkeypox or another infection. In particular, people with new rashes should be aware that the rate of syphilis is rising in King County and nationally.

“In the current outbreak, people have presented with skin lesions that may resemble common sexually transmitted infections such as herpes or syphilis. Some cases are more subtle and might be missed if people aren’t looking for them,” Dr. Duchin added.

Risk factors

A person’s identity does not put them at risk for monkeypox. A person’s risk is determined by their behavior and the people, or network of people, they come into physical contact with. Monkeypox is spread through close physical contact. The risk of monkeypox is not limited to people who are sexually active or men who have sex with men.

As this is a newer outbreak, public health entities nationally and internationally are still learning about the potential networks or behaviors that may put people at increased risk. What we do know is that the majority of cases have been among men who reported sexual or close intimate contact with other men, sometimes with multiple partners. Many cases nationally and internationally have been identified at sexual health clinics. To date, cases in King County have been among men who report sexual contact with other men.

Monkeypox vaccine

Monkeypox vaccine can be an effective tool to help prevent disease before exposure or make it less severe after exposure. Jynneos is the main vaccine being distributed at this time.

It can take up to three weeks after being exposed to the virus before symptoms begin. CDC recommends the vaccine be given within 4 days from exposure for the best chance to prevent the disease. If given between 4 and 14 days after exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease.

It’s important to reach out to your healthcare provider if you think you have been exposed. Public Health is working with healthcare providers to help facilitate vaccine access for those who have been exposed.

Vaccine distribution

The national supply of vaccine for monkeypox is currently limited, although more is expected in the coming weeks and months. The CDC is allocating the limited amount of vaccine using a tiered distribution strategy that prioritizes jurisdictions with the highest case rates of monkeypox. King County has had relatively few cases compared with other jurisdictions. Therefore, we are currently not prioritized to receive a large number of doses of vaccine.

We are coordinating with the Washington State Department of Health (DOH) who is in charge of vaccine allocation for the entire state. We will be receiving about 250 courses (500 doses) from DOH and are able to facilitate vaccination for high-risk contacts of people who test positive for monkeypox. We are also working with healthcare systems now to plan for when more vaccine becomes available, including ensuring an equitable distribution to people who are uninsured. We will provide updates when more vaccine becomes available.


Severity of monkeypox

Infections with the strain of monkeypox virus identified in this outbreak are rarely fatal. People who get sick commonly experience flu-like symptoms like fever, headache, and back and muscle aches, as well as swollen lymph nodes and general exhaustion. Most people also develop a painful rash. People infected with the virus usually recover in 2-4 weeks, but the disease can be serious, especially for immunocompromised people, children, people with a history of eczema, or people who are pregnant or breastfeeding.

How monkeypox spreads

Monkeypox spreads from person to person in different ways.

  • Direct contact with the infectious rash, scabs, or body fluids
  • Respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex
  • Touching items (such as clothing or linens) that previously touched the infectious rash or body fluids
  • Pregnant people can spread the virus to their fetus through the placenta

The monkeypox virus does not spread through the air over longer distances, unlike the virus that causes COVID-19.

Monkeypox can cause flu-like symptoms, swollen lymph nodes, and a rash that can appear anywhere on the body. In the current outbreak, many men have presented with lesions on the genitals or in the anal area and some men have initially had rectal pain.

Key Characteristics of Monkeypox Rash

How to protect yourself and others

Talk to people you have been in close physical contact with about their general health, such as recent rashes or sores.

If you have symptoms, particularly a rash consistent with monkeypox, or if you have been in contact with someone who has been diagnosed with monkeypox:

  • Contact a health care provider as soon as possible for an evaluation
  • Avoid sex and gatherings, especially if they involve close, personal, skin-to-skin contact, or prolonged face-to-face contact, until you’ve been checked out by a medical provider
  • Inform sex partners about any symptoms you are experiencing
  • Cover the rash with clean, dry, loose-fitting clothing
  • Wear a well-fitted mask

Decreasing risk of stigma

Public health is committed to informing people about health issues that may affect them and we recognize that there is risk for stigma or discrimination when communicating about a new disease outbreak that primarily affects a specific community. Stigmatizing a particular group or person for any illness is never okay. We all need to do what we can in public health and in the community to call out any stigmatizing actions related to monkeypox virus and instead, do what we can to share information so that people can make the best decisions for their health and the health of the community.

Additional information about monkeypox for the public and healthcare providers is available from CDC.

Originally posted 7/6/2022