2022–2023 mpox outbreak in the United States explained

Disease:Mpox
Location:United States
First Case:Boston, Massachusetts[1]
Arrival Date:May 17, 2022
Confirmed Cases:30,344[2]
Date:as of April 13, 2023
Deaths:42

The 2022–2023 mpox outbreak in the United States is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. The United States was the fourth country outside of the African countries with endemic mpox, to experience an outbreak in 2022. The first case was documented in Boston, Massachusetts, on May 17, 2022.[3] As of August 22, mpox has spread to all 50 states in the United States, as well as Washington, D.C., and Puerto Rico.[4] The United States has the highest number of mpox cases in the world. California has the highest number of mpox cases in the United States.

On August 4, 2022, the U.S. Centers for Disease Control and Prevention declared mpox a public health emergency in the United States.[5] Wyoming was the last state in the United States to report at least one mpox case.On August 30, 2022, the first mpox death in the United States was reported.[6]

Background

An ongoing outbreak of mpox was confirmed on May 6, 2022, beginning with a British resident who, after travelling to Nigeria (where the disease is endemic), presented symptoms consistent with mpox on April 29, 2022. The resident returned to the United Kingdom on May 4, creating the country's index case of the outbreak.[7] The origin of several of the cases of mpox in the United Kingdom is unknown. Some monitors saw community transmission taking place in the London area as of mid-May,[8] but it has been suggested that cases were already spreading in Europe in the previous months.[9]

Transmission

A large portion of those infected were believed to have not recently traveled to areas of Africa where mpox is normally found, such as Nigeria, the Democratic Republic of the Congo as well as central and western Africa. It is believed to be transmitted by close contact with sick people, with extra caution for those individuals with lesions on their skin or genitals, along with their bedding and clothing. The CDC has also stated that individuals should avoid contact and consumption of dead animals such as rats, squirrels, monkeys, and apes along with wild game or lotions derived from animals in Africa.[10]

In addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. CDC has also warned clinicians to not rule out mpox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.[11]

The CDC has stated that, among mpox cases with available data, 99% occurred in men, 94% of whom reported recent male-to-male sexual or close intimate contact.[12]

Cases transited through the United States

California

The 2022–2023 mpox outbreak in California. As of July 2022, the virus has infected 4,886 people in the U.S. state of California, with 1 death. The state has the highest number of recorded cases in the country.[13]

Florida

Florida currently has 2,444 people infected by the virus, with no deaths. It started on May 23, 2022, in Fort Lauderdale and quickly started spreading across the State.[14]

New York

The 2022–2023 mpox outbreak in New York currently has no deaths. This state has the second highest number of recorded cases in the country with 3,679 cases.[15]

In New York the outbreak began on June 10, 2022, with the first mpox case recorded in Ithaca. On July 29, Governor Kathy Hochul declared a public state disaster emergency in New York State.[16] New York is currently the state with the highest recorded number of cases in the US.

The World Health Organization in New York reports its first mpox case outside New York City on June 7.[17]

On July 13, New York becomes the epicenter of the outbreak. With 489 cases only behind California with 266 cases.[18]

On July 27, New York reaches 1,228 cases, with an increase of 739 cases in only 14 days.[19]

On August 1, Mayor Eric Adams declares a state of emergency over the mpox outbreak.[20]

Cases by county

Based from the NYSDOH.[21]

Cases of mpox!County!Cases!Change
Albany3(+0)
Broome1(+0)
Chemung1(+0)
Columbia1(+0)
Dutchess5(+0)
Erie5(+0)
Greene1(+0)
Monroe7(+0)
Nassau14(+0)
Niagara1(+0)
Orange6(+0)
Rockland4(+0)
St. Lawrence1(+0)
Suffolk25(+0)
Sullivan2(+0)
Tompkins2(+0)
Westchester50(+0)
New York City1,831(+0)
Total cases1,960(+0)
at 2:00pm Eastern Time

Timeline

The first known case was detected on May 18, 2022, in a man from Boston, Massachusetts, who had traveled to Canada, where a case of the virus was reported the following day.[22] [23] The person was hospitalized in Boston.[24] There, he tested positive for mpox, becoming the first case in the United States.[22]

Two days after the man tested positive for the virus, other states began reporting cases, with New York reporting its first case on May 21.[25] On May 22, President Biden gave a speech at Osan Air Base in South Korea during which he indicated the disease was "something that everybody should be concerned about".[26] On May 26, Virginia reported its first case in a woman who had traveled to Africa,[27] followed by California and Hawaii on June 4, 2022.[28] [29] As of June 3, the United States had 21 confirmed cases,[30] a number which had risen to 460 as of July 1.[31]

On May 23, 2022, Florida reported a case of mpox. On the same day, the Tampa Bay Times reported that the Florida Department of Health had announced the case on a man that had been isolated since the day before.[32] WESH later on also confirmed the case, which was in Broward County.[33] The following day, WESH reported another mpox case as being "investigated".[34] The case was then confirmed to be in the same county as the first case, adding up the total in the county to two. Later, a third case was also investigated, this time being reported by CBS Miami to also be in the same county as the first and second case.[35] This case added up the total in the United States to 18. A fourth case was reported by the Sun-Sentinel, although the state of Florida did not disclose the county where it was detected.[36]

In early June 2022, a man in Washington, D.C., was reported to test positive for orthopox, potentially mpox.[37]

On July 26, 2022, the United States had more mpox cases than any other country.[38] At the end of August 2022, there were early signs that the mpox spread in the U.S. may be slowing.[39]

Ref:

Cases by state

Data sourced from the CDC [40]

Cases of mpox!State!Cases!Change
186(+74)
5
580(+134)
72(+16)
5,670(+784)
407(+144)
144(+20)
43(+7)
525(+31)
2,855(+411)
1,984(+248)
35(+8)
16(+4)
1,422(+152)
285(+62)
29(+4)
47(+38)
97(+46)
306(+63)
13(+4)
739(+103)
456(+75)
395(+138)
234(+52)
108(+35)
209(+101)
7(+2)
31(+3)
319(+101)
33(+4)
764(+81)
57(+17)
4,203(+361)
728(+216)
6
263(+128)
68(+32)
270(+65)
864(+128)
198(+28)
84(+11)
226(+70)
3(+1)
392(+119)
2,882(+657)
194(+45)
3
564(+112)
658(+75)
12(+1)
87(+18)
4(+2)
Total cases29782(+4,936)
As of January 4, 2023 at 2:00pm EDT

Timeline of first confirmed cases by state

First confirmed mpox cases by state
DateStates
[41]
[42]
[43]
[44]
[45] • [46]
[47] • [48]
[49] • [50]
[51]
[52]
[53]
[54]
[55]
[56] • [57]
[58]
[59] • [60]
[61]
[62]
[63]
[64]
[65]
[66] • [67]
[68] • [69]
[70]
[71]
[72]
[73] • [74]
[75] • [76]
[77] • [78]
[79]
[80]
[81] • [82]
[83]
[84]
[85]
[86]
[87]
[88] • [89]
[90]
[91]

Timeline of first deaths by state

As of May 8, 2023 there have been 42 mpox-related deaths reported in the US.

First confirmed mpox deaths by state
DateStates
[92]
[93]

Responses

Vaccination

On May 19, 2022, Bavarian Nordic announced that BARDA, part of the Department of Health and Human Services (HHS), exercised a $119 million option, under a $299 million contract, to supply a freeze-dried version of JYNNEOS vaccine, converting existing bulk vaccine.[94] The United States spent $119 million to purchase doses of the Modified vaccinia Ankara-based two-shot[95] Jynneos vaccine from Bavarian Nordic in May 2022.[96] The contract also allows the United States to purchase an additional $180 million worth of the vaccine at a later date.[97] The vaccine, JYNNEOS (also known by the brand names Imvamune and Imvanex), was approved by FDA in 2019 to prevent both smallpox and mpox. As of June 14, the United States had around 70,000 doses of JYNNEOS in its stockpile, and the federal government placed an order for 500,000 more on June 10, 2022. Dawn O'Connell, assistant secretary for preparedness and response at Department of Health and Human Services (HHS), said around 300,000 doses would be delivered in June–July 2022, and the remainder would be delivered later in that year.[11] [98]

In addition, the Strategic National Stockpile (SNS) holds over 100 million doses of an older smallpox vaccine (ACAM2000).[99]

As of June 28, the Biden administration was allocating tens of thousands of vaccine doses from the Strategic National Stockpile to clinics nation-wide.[100] [101] The rollout of vaccines and testing was criticized as too slow, as well as for having similar problems to the rollout of vaccines and tests during the COVID-19 pandemic in the United States.[102]

The United States government's response is coordinated by the National Security Council Directorate on Global Health Security and Biodefense – more commonly known as the White House Pandemic Office – in collaboration with the Department of Health and Human Services (HHS). The White House Pandemic Office had previously reinstated Dr. Beth Cameron to the executive position.[103] [104] The HHS is overseen by Secretary of Health and Human Services Xavier Becerra.

As of June 29, HHS has received requests from 32 states and jurisdictions, deploying over 9,000 doses of JYNNEOS vaccine and 300 courses of ST-246 (tecovirimat)[105] [106] antiviral smallpox treatments.[107] The United States expanded deployment of JYNNEOS vaccines, allocating 296,000[108] [109] doses over the coming weeks, 56,000 of which will be allocated immediately. Over the coming months a combined 2.5 million[110] [111] [95] additional doses will become available.[112] As of November 2022, New York state ended its state of emergency, mobile mass vaccination sites set up since summer in New York city closed, but vaccinations were moved to outpatient and sexual health clinics.[113]

Precautionary measures

Hospitals have begun making their own preparations to help control the current mpox outbreak, including screening patients, increasing decontamination and cleaning procedures,[114] [115] [116] and wearing appropriate safety gear[117] [118] when interacting with infected patients.

See also

External links

External links

Notes and References

  1. Web site: Health officials confirm first U.S. case of monkeypox virus this year in Massachusetts. Annika Kim. Constantino. 17 May 2022. CNBC. June 5, 2022. June 5, 2022. https://web.archive.org/web/20220605172218/https://www.cnbc.com/2022/05/19/monkeypox-virus-case-confirmed-in-massachusetts.html. live.
  2. Web site: 2022 U.S. Map & Case Count . 1 March 2023 . 8 October 2022 . USA CDC . live . 8 October 2022 . https://web.archive.org/web/20221008045138/https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html.
  3. Web site: Constantino . Annika Kim . 2022-05-19 . Health officials confirm first U.S. case of monkeypox virus this year in Massachusetts . 2022-07-16 . CNBC . en . June 5, 2022 . https://web.archive.org/web/20220605172218/https://www.cnbc.com/2022/05/19/monkeypox-virus-case-confirmed-in-massachusetts.html . live .
  4. Web site: CDC . 2022-07-15 . Monkeypox in the U.S. . 2022-07-16 . Centers for Disease Control and Prevention . en-us . June 16, 2022 . https://web.archive.org/web/20220616111102/https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html . live .
  5. Web site: U.S. declares monkeypox outbreak a public health emergency . 2022-08-04 . Reuters . August 5, 2022 . August 5, 2022 . https://web.archive.org/web/20220805012247/https://www.reuters.com/world/us/us-declare-monkeypox-public-health-emergency-washington-post-2022-08-04/ . live .
  6. Web site: Kimball . Spencer . Texas reports what may be the first U.S. death from monkeypox . 2022-08-31 . CNBC . August 30, 2022 . en . August 31, 2022 . https://web.archive.org/web/20220831061351/https://www.cnbc.com/2022/08/30/texas-reports-what-may-be-the-first-us-death-from-monkeypox.html . live .
  7. Web site: 16 May 2022 . Monkeypox – United Kingdom of Great Britain and Northern Ireland . live . https://web.archive.org/web/20220517223855/https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON381 . 17 May 2022 . 17 May 2022 . World Health Organization.
  8. Web site: Pinkstone . Joe . 17 May 2022 . Monkeypox 'spreading in sexual networks' . live . https://web.archive.org/web/20220517223851/https://www.telegraph.co.uk/news/2022/05/17/monkeypox-likely-sexually-transmissible-infection-health-officials/ . 17 May 2022 . 17 May 2022 . The Telegraph.
  9. Web site: Nsofor . Ifeanyi . 2 June 2022 . OPINION: Media coverage of monkeypox paints it as an African virus. That makes me mad . live . 2 June 2022 . . June 2, 2022 . https://web.archive.org/web/20220602115245/https://www.npr.org/sections/goatsandsoda/2022/06/02/1102199023/opinion-media-coverage-of-monkeypox-paints-it-as-an-african-virus-that-makes-me- .
  10. Web site: Vargas . Ramon Antonio . 2022-06-07 . US raises monkeypox alert level but says risk to public remains low . 2022-06-09 . the Guardian . en . June 9, 2022 . https://web.archive.org/web/20220609161424/https://www.theguardian.com/world/2022/jun/07/monkeypox-cases-cdc-alert-level-us . live .
  11. Web site: Monkeypox update: Where the outbreak stands now . June 16, 2022 . June 15, 2022 . https://web.archive.org/web/20220615201305/https://www.advisory.com/daily-briefing/2022/06/14/monkeypox-update . live .
  12. Web site: Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May 17–July 22, 2022. 5 August 2022. Centers for Disease Control. 12 August 2022. August 13, 2022. https://web.archive.org/web/20220813010455/https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7132e3-H.pdf. live.
  13. Web site: Monkeypox outbreak: Epidemiological overview as of July 30. 29 July 2022.
  14. Web site: Florida has three cases of monkeypox, all in Broward County. Sun Sentinel. June 2022 .
  15. Web site: Monkeypox outbreak: Epidemiological overview as of August 20 . 13 September 2022.
  16. Web site: Governor Hochul Declares State Disaster Emergency in Response to Ongoing Monkeypox Outbreak Governor Kathy Hochul . 2022-07-31 . www.governor.ny.gov . en . 31 July 2022 . https://web.archive.org/web/20220731012900/https://www.governor.ny.gov/news/governor-hochul-declares-state-disaster-emergency-response-ongoing-monkeypox-outbreak . live .
  17. State Department of Health Update: First Case of Orthopoxvirus/Monkeypox Outside of New York City. 29 July 2022. 19 August 2022. 12 August 2022. https://web.archive.org/web/20220812030857/https://health.ny.gov/press/releases/2022/2022-06-07_monkeypox.htm. live.
  18. Web site: 2022 U.S. Map & Case Count - Updated July 12, 2022. 12 July 2022. https://web.archive.org/web/20220713094654/https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html. 13 July 2022.
  19. Web site: 2022 U.S. Map & Case Count - Updated July 27, 2022. 27 July 2022. https://web.archive.org/web/20220727212755/https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html. 27 July 2022.
  20. Web site: Adams declares monkeypox state of emergency in New York. Politico. 1 August 2022. 20 August 2022. 21 August 2022. https://web.archive.org/web/20220821181502/https://www.politico.com/news/2022/08/01/new-york-monkeypox-state-of-emergency-00048947. live.
  21. Web site: Monkeypox in New York state. 10 June 2022. New York State Department of Health. 8 June 2022. https://web.archive.org/web/20220608000744/https://www.health.ny.gov/diseases/communicable/zoonoses/monkeypox/. live.
  22. Web site: 18 May 2022 . Massachusetts man is confirmed for monkeypox . live . https://web.archive.org/web/20220520011140/https://www.nytimes.com/2022/05/18/health/massachusetts-monkeypox.html . May 20, 2022 . 18 May 2022 . .
  23. News: 2022-05-20 . Canada confirms first two monkeypox cases . en . Reuters . 2022-06-05 . May 31, 2022 . https://web.archive.org/web/20220531060209/https://www.reuters.com/business/healthcare-pharmaceuticals/montreal-health-officials-investigate-17-cases-suspected-monkeypox-2022-05-19/ . live .
  24. News: 19 May 2022 . CDC and Massachusetts health officials investigating monkeypox case . CNN News . live . 5 June 2022 . https://web.archive.org/web/20220601012700/https://www.cnn.com/2022/05/18/health/cdc-monkeypox-massachusetts/index.html . June 1, 2022 .
  25. News: New York City resident tests positive for monkeypox virus . 24 July 2022 . CNBC . 21 May 2022 . en . July 24, 2022 . https://web.archive.org/web/20220724145503/https://www.cnbc.com/2022/05/21/new-york-city-resident-tests-positive-for-monkeypox-virus.html . live .
  26. News: Goldman . Russell . 'Everybody Should Be Concerned' About Monkeypox, Biden Warns . 24 July 2022 . The New York Times . 22 May 2022 . July 24, 2022 . https://web.archive.org/web/20220724145720/https://www.nytimes.com/2022/05/22/world/asia/monkeypox-biden-concern.html . live .
  27. Web site: Virginia Reports First Presumed Case of Monkeypox . 2022-06-05 . Newsroom . en-US . June 2, 2022 . https://web.archive.org/web/20220602224129/https://www.vdh.virginia.gov/news/virginia-reports-first-presumed-case-of-monkeypox/ . live .
  28. Web site: 2022-06-04 . San Francisco reports first suspected monkeypox case . 2022-06-05 . Los Angeles Times . en-US . June 5, 2022 . https://web.archive.org/web/20220605172218/https://www.latimes.com/california/story/2022-06-03/san-francisco-reports-first-suspected-monkeypox-case . live .
  29. Web site: 4 June 2022 . Hawaii reports probable case of monkeypox amid nationwide outbreak . 2022-06-05 . Hawaii News . en . June 5, 2022 . https://web.archive.org/web/20220605172218/https://www.hawaiinewsnow.com/2022/06/03/hawaii-confirms-monkeypox-case-patient-tripler-army-medical-center/ . live .
  30. News: Mandavilli . Apoorva . 21 Americans Infected With Monkeypox, C.D.C. Reports . The New York Times . 3 June 2022 . June 7, 2022 . June 7, 2022 . https://web.archive.org/web/20220607231048/https://www.nytimes.com/2022/06/03/health/monkeypox-vaccine-treatments.html?searchResultPosition=4 . live .
  31. News: Mandavilli . Apoorva . Monkeypox Can Be Airborne, Too . 7 June 2022 . The New York Times . 7 June 2022 . June 7, 2022 . https://web.archive.org/web/20220607231050/https://www.nytimes.com/2022/06/07/health/monkeypox-masks-cdc.html . live .
  32. Web site: Broward County may have Florida's first case of monkeypox . July 30, 2022 . July 31, 2022 . https://web.archive.org/web/20220731210807/https://www.tampabay.com/news/health/2022/05/23/broward-county-may-have-floridas-first-case-of-monkeypox/ . live.
  33. Web site: Florida health officials looking into monkeypox case . 23 May 2022 . August 8, 2022 . June 25, 2022 . https://web.archive.org/web/20220625101215/https://www.wesh.com/article/florida-monkeypox-case/40075640 . live .
  34. Web site: Second possible case of monkeypox investigated in Florida . 24 May 2022 . August 8, 2022 . June 25, 2022 . https://web.archive.org/web/20220625201046/https://www.wesh.com/article/second-case-monkeypox-florida/40088883 . live .
  35. News: Third monkeypox case confirmed in Broward County . . August 8, 2022 . July 31, 2022 . https://web.archive.org/web/20220731210818/https://www.cbsnews.com/miami/news/monkeypox-broward-third-case/ . live .
  36. Web site: Florida reports fourth case of monkeypox. CDC presumes community spread in US . June 7, 2022 . August 8, 2022 . June 27, 2022 . https://web.archive.org/web/20220627195930/https://www.sun-sentinel.com/news/fl-ne-florida-reports-fourth-case-of-monkeypox-20220607-nalerpndgvekjc3gslf6obfh2i-story.html . live .
  37. Web site: DC reports 1st orthopox, potential monkeypox case . 2022-06-06 . ABC News . en . June 6, 2022 . https://web.archive.org/web/20220606210651/https://abcnews.go.com/Health/dc-reports-1st-orthopox-potential-monkeypox-case-send/story?id=85205624 . live .
  38. Web site: Jacoby . Sarah . 2022-07-26 . US records more cases of monkeypox than any other country . 2022-08-28 . TODAY . en . August 28, 2022 . https://web.archive.org/web/20220828215405/https://www.today.com/health/health/us-records-cases-monkeypox-country-rcna40112 . live .
  39. Web site: Early signs suggest monkeypox may be slowing in the U.S. . 26 August 2022 . 2 September 2022 . www.npr.org.
  40. Web site: January 5, 2023 . 2023 U.S. Map & Case Count Monkeypox . January 5, 2023 . cdc.gov.
  41. Web site: Massachusetts public health officials confirm case of monkeypox Mass.gov . 2022-07-30 . www.mass.gov . en . May 18, 2022 . https://web.archive.org/web/20220518210000/https://www.mass.gov/news/massachusetts-public-health-officials-confirm-case-of-monkeypox . live .
  42. Web site: Knutson . Jacob . 2022-05-21 . New York City confirms first case of monkeypox . 2022-07-30 . Axios . en . July 30, 2022 . https://web.archive.org/web/20220730190206/https://www.axios.com/2022/05/21/new-york-city-confirms-case-monkeypox . live .
  43. Web site: Broward County may have Florida's first case of monkeypox . 2022-07-30 . Tampa Bay Times . en . July 31, 2022 . https://web.archive.org/web/20220731210807/https://www.tampabay.com/news/health/2022/05/23/broward-county-may-have-floridas-first-case-of-monkeypox/ . live .
  44. Web site: Bojórquez . Kim . 2022-05-25 . Utah confirms first monkeypox cases . 2022-07-30 . Axios . en . July 30, 2022 . https://web.archive.org/web/20220730190644/https://www.axios.com/2022/05/25/utah-monkeypox-cases . live .
  45. Web site: Virginia Reports First Presumed Case of Monkeypox . 2022-07-30 . Newsroom . en-US . June 2, 2022 . https://web.archive.org/web/20220602224129/https://www.vdh.virginia.gov/news/virginia-reports-first-presumed-case-of-monkeypox/ . live .
  46. Web site: First presumptive case of monkeypox in Colorado . 2022-05-26 . Denver Gazette . May 26, 2022 . en-US . August 5, 2022 . https://web.archive.org/web/20220805005904/https://denvergazette.com/news/health/first-presumptive-case-of-monkeypox-identified-in-colorado-state-health-department-says/article_827e1926-dd3a-11ec-986a-ff8ed267072a.html . live .
  47. Web site: Washington state reports first confirmed case of monkeypox . 2022-05-27 . Washington State Department of Health . en-US . June 29, 2022 . https://web.archive.org/web/20220629044353/https://doh.wa.gov/newsroom/washington-state-reports-first-confirmed-case-monkeypox . live .
  48. Web site: CDC confirms first case of monkeypox in California . 2022-05-27 . KCRA . May 27, 2022 . en-US . June 28, 2022 . https://web.archive.org/web/20220628085332/https://www.kcra.com/article/monkeypox-likely-sacramento-county-patient-recently-traveled-europe-health-officials-1653598647/40120338 . live .
  49. Web site: Pennsylvania detects first case of monkeypox in Philadelphia. 2022-06-02. Phila. en-US. August 5, 2022. https://web.archive.org/web/20220805005904/https://www.phila.gov/2022-06-02-philadelphia-department-of-public-health-announces-first-case-of-monkeypox-in-pennsylvania/. live.
  50. Web site: City, State public health officials confirm first probable case of monkeypox virus in Illinois. 2022-06-02. Illinois Department of Public Health. en-US. August 5, 2022. https://web.archive.org/web/20220805005904/https://dph.illinois.gov/resource-center/news/2022/june/city--state-public-health-officials-confirm-first-case-of-monkey.html. live.
  51. Web site: DOH Identifies Probable Monkeypox Case in Hawaii. 2022-06-03. Hawaii.gov. en-US. August 5, 2022. https://web.archive.org/web/20220805083716/https://health.hawaii.gov/news/newsroom/doh-identifies-probable-monkeypox-case/. live.
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  53. News: First suspected case of monkeypox in Georgia confirmed by CDC . 2022-06-06 . The Atlanta Journal-Constitution . en-US . Oliviero . Helena . Hansen . Zachary . August 5, 2022 . https://web.archive.org/web/20220805005903/https://www.ajc.com/news/atlanta-news/first-suspected-case-of-monkeypox-in-georgia-confirmed-by-cdc/2IFT3Y3SN5HODE66HDCFIUO4XE/ . live .
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  55. Web site: First probable case of monkeypox identified in Rhode Island. 2022-06-09. Providence Journal. en-US. July 8, 2022. https://web.archive.org/web/20220708190753/https://www.providencejournal.com/story/news/local/2022/06/09/monkeypox-rhode-island-first-case-identified-virus-outbreak/7566214001/. live.
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  57. Web site: OSDH Identifies First Probable Case of Monkeypox in Oklahoma. 2022-06-14. Oklahoma.gov. en-US. August 5, 2022. https://web.archive.org/web/20220805011406/https://oklahoma.gov/health/news---events/newsroom/2022/june/osdh-identifies-first-probable-case-of-monkeypox-in-oklahoma.html#:~:text=OKLAHOMA%20CITY%20%E2%80%93%20The%20Oklahoma%20State,a%20country%20with%20confirmed%20cases.. live.
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  65. Web site: First probable case of Monkeypox in Kentucky reported. 2022-06-24. WBKO. en-US. August 5, 2022. https://web.archive.org/web/20220805011406/https://www.wbko.com/2022/06/25/first-probable-case-monkeypox-kentucky-reported/#:~:text=FRANKFORT%2C%20Ky.,released%20due%20to%20privacy%20concerns.. live.
  66. Web site: First Case Of Monkeypox Identified In Nebraska. 2022-06-27. Nebraska Department of Health and Human Services. en-US. August 4, 2022. https://web.archive.org/web/20220804232053/https://dhhs.ne.gov/Pages/First-Case-of-Monkeypox-Identified-in-Nebraska.aspx. live.
  67. Web site: Minnesota reports first case of monkeypox. 2022-06-27. Minnesota Department of Health. en-US. August 5, 2022. https://web.archive.org/web/20220805083716/https://www.health.state.mn.us/news/pressrel/2022/monkpox062722.html#:~:text=Health%20officials%20investigating%20case%20history,in%20the%20Twin%20Cities%20area.. live.
  68. Web site: First Probable Case of Monkeypox Identified in New Hampshire. 2022-06-29. New Hampshire Department of Health and Human Services. en-US. August 5, 2022. https://web.archive.org/web/20220805005903/https://www.dhhs.nh.gov/news-and-media/first-probable-case-monkeypox-identified-new-hampshire#:~:text=Concord%2C%20NH%20%E2%80%93%20The%20New%20Hampshire,the%20patient%20can%20be%20released.. live.
  69. Web site: MDHHS announces first probable monkeypox case in Michigan. 2022-06-29. Michigan Department of Health and Human Services. en-US. July 15, 2022. https://web.archive.org/web/20220715060047/https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2022/06/29/monkeypox#:~:text=LANSING%2C%20Mich.,presumptive%20positive%20result%20for%20Orthopoxvirus.. live.
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  72. Web site: Connecticut records first case of monkeypox. 2022-07-05. The CT Mirror. July 5, 2022. en-US. July 17, 2022. https://web.archive.org/web/20220717132520/https://ctmirror.org/2022/07/05/connecticut-records-first-case-of-monkeypox/. live.
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  74. Web site: First probable monkeypox case reported in Idaho. 2022-07-06. Idaho Department of Health and Welfare. en-US. August 5, 2022. https://web.archive.org/web/20220805005904/https://healthandwelfare.idaho.gov/news/first-probable-monkeypox-case-reported-idaho. live.
  75. Web site: LDH identifies first monkeypox case in a Louisiana resident. 2022-07-07. Louisiana Department of Health. en-US. August 5, 2022. https://web.archive.org/web/20220805015030/https://ldh.la.gov/news/monkeypox. live.
  76. Web site: First case of monkeypox being investigated in Tennessee. 2022-07-07. Action News 5. July 7, 2022 . en-US. August 5, 2022. https://web.archive.org/web/20220805005904/https://www.actionnews5.com/2022/07/07/first-case-monkeypox-being-investigated-tennessee/. live.
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  88. Web site: Alaska reports first case of monkeypox. 2022-07-29. Alaska Department of Health and Social Services. en-US. August 5, 2022. https://web.archive.org/web/20220805005646/https://dhss.alaska.gov/health/News/Documents/press/2022/DOH_PRESSRELEASE_Monkepox_20210729.pdf. live.
  89. Web site: Vermont announces first case of monkeypox virus (HMPXV) infection. 2022-07-29. Vermont Department of Health. July 29, 2022. en-US. August 5, 2022. https://web.archive.org/web/20220805013553/https://www.healthvermont.gov/media/newsroom/Vermont-Announces-First-Case-of-Monkeypox-Virus-Infection#:~:text=Virus%20(hMPXV)%20Infection-,News%20Release%3A%20Vermont%20Announces%20First,of%20Monkeypox%20Virus%20(hMPXV)%20Infection&text=BURLINGTON%2C%20VT%20%E2%80%93%20The%20Vermont%20Department,adult%20from%20Franklin%20County%2C%20Vermont.. live.
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