Although Hawaii was among the first U.S. states to detect cases of monkeypox, state Department of Health officials continue to reassure the public that the risk to most residents remains low.

Currently, Hawaii has five confirmed cases of monkeypox and one probable case. Testing for the orthopox- virus genus is initially done at the state laboratory before samples are sent to the Centers for Diseases Control and Prevention for confirmation of monkeypox.

DOH said it is treating the remaining probable case as a likely confirmed monkeypox case and following isolation protocols. All six cases are in Oahu adults who have a connection to one another. Only one was hospitalized while the others had mild to moderate symptoms.

“There’s treatment and vaccination available right here in Hawaii,” said DOH spokesperson Katie Arita-­Chang. “People should have no hesitation seeing their doctor if they think they have monkeypox, because treatments and vaccinations are available.”

DOH has been offering health care providers guidance on monkeypox, she said, and continues to coordinate vaccination and treatment.

Hawaii has antiviral treatments such as tecovirimat, or TPOXX, available. Hawaii also has had the Jynneos vaccine for monkeypox available since June 9, with more expected doses to arrive following the Biden administration’s announcement last week that it would be rolling out some 296,000 doses throughout the U.S.

Arita-Chang said DOH is still waiting to hear more from the U.S. Department of Health and Human Services on the rollout and has no specific details yet.

What is monkeypox?

Monkeypox is a rare disease caused by the monkeypox virus, which is in the same family of viruses as smallpox, according to the CDC.

It was first discovered in 1958 in research monkeys, but the first human case was in an infant in the Democratic Republic of Congo. Prior to the recent international outbreak, the disease occurred primarily in Central and West Africa.

Infection often begins with flu-like symptoms such as fever, headache, muscle aches, chills, exhaustion and swollen lymph nodes in the neck, underarm or groin area.

Symptoms that often follow include rashes that initially look like pimples or blisters, which can occur on the face, inside the mouth and on the hands, feet, chest, genitals or anus. Some people get a rash first, followed by other symptoms, the CDC said, while others experience only a rash.

The illness can last two to four weeks, and the virus can be spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. Individuals generally become ill within 21 days of exposure.

The CDC in mid-June issued a health alert warning of some unusual presentations of symptoms, such as rashes that start in the lower genital or perianal areas (around the anus), which lead to pain, rectal bleeding, or the feeling of needing to pass stools even though the bowels are empty.

Health care providers should be aware of this and look for and test lesions for monkeypox, officials said.

Anyone in Hawaii with a new or unexpected rash or other monkeypox symptoms should contact their health care provider, according to DOH. People without a primary care provider can seek help at a community health center, go to an urgent care clinic or the STI/HIV clinic at Diamond Head Health Center.

Prior to this year’s outbreak, nearly all monkeypox cases in people outside of Africa were linked to travel or through imported animals.

There are now more than 5,000 confirmed cases in more than 50 countries, including the U.S.

As of Friday, the CDC listed 460 monkeypox or orthopoxvirus cases in more than 30 states and the District of Columbia. The highest numbers were in California, with 95 cases, followed by New York, with 90.

Getting ahead of it

Some health care advocates are urging Hawaii to remain vigilant and to get ahead of the outbreak with public outreach and awareness, timely contact tracing, and treatment and vaccinations.

“The risk to most residents is quite low right now, but now is the time — if we take action and make people aware and everyone does what they should — we can contain this before it becomes another health emergency,” said Jacob Schafer, epidemiologist at Waianae Coast Comprehensive Health Center. “Right now, the window to stop it is still open.”

That means making sure the public knows what symptoms to look for, that family and friends are discussing them with those at higher risk, and that people seek health care immediately if they think they have been exposed.

According to the CDC, the monkeypox virus can spread person-to-person through direct contact with body fluids, infectious rashes or scabs, or touching contaminated items such as bedding, towels and clothing used by someone with monkeypox.

It also can be spread through respiratory secretions during prolonged, face-to-face contact or intimate physical contact, such as kissing, cuddling or sex.

DOH said monkeypox also can be spread through large respiratory droplets that occur when people cough, sneeze or talk, but that the droplets generally cannot travel more than a few feet.

Monkeypox cases have been disproportionately reported among gay or bisexual men nationwide, DOH said, and in Hawaii, some of the cases have been reported among gay or bisexual men.

However, anyone who has close contact with someone with monkeypox is at risk of infection, regardless of sexual orientation or gender identity.

Schafer, who is gay, warns that the disease should not be stigmatized as being specific to men who have sex with men, because the virus is spread primarily through skin-to-skin contact.

“Viruses don’t discriminate,” he said. “Anyone can get monkeypox, regardless of gender, race, age or sexual orientation. When we talk about this as men who have sex with men, that gets stuck in people’s minds.”

Anyone who thinks they may have monkeypox symptoms should seek help from a health care provider right away and not be embarrassed about it, he said.

The good news is that both treatments and vaccines are available, said Schafer, and the vaccines can be administered after someone has been exposed to help prevent them from getting the disease.

“If you’ve been exposed, we can give you the shot,” he said.

Schafer also said he expects the state’s case count to grow because the outbreak is global and because more people are traveling.

“We will certainly see more cases in the future,” he said. “But we have the vaccine available, we have treatment available, and it’s not a terrible, deadly virus for most people.”

Those who are at higher risk of severe disease include the immunocompromised, women who are pregnant or breastfeeding, newborns and young children.

Sexual partners should talk to one another about any recent illness or unexplained rashes, and for social gatherings, the CDC advises that events where attendees are fully clothed are safer than raves, clubs, saunas and similar settings where minimal or no clothing is the norm.

The CDC is currently researching whether the monkeypox virus can be spread when someone has no symptoms and whether it is present in semen, vaginal fluids and fecal matter.

Not an emergency yet

A World Health Organization committee has acknowledged that monkeypox is an “evolving health threat” emerging at a concerning scale and speed, but stopped short of declaring monkeypox a global public health emergency.

To stop the outbreak from spreading further, the committee said coordinated surveillance, contact tracing and isolation is needed.

Monkeypox, however, is not at the same scale as COVID-19, experts say.

“This is not going to be another pandemic,” said Dr. Scott Miscovich of Hawaii’s Premier Medical Group. “It’s not in the same category, and it never will be in the same category, so people do not have to worry we have another COVID pandemic or something along those lines coming.”

However, Miscovich, who recently updated his WHO monkeypox certification, is concerned of what could come if not enough action is taken in time.

“We are taking a chance that we are going to let this disease become endemic in our country,” he said. “The worst thing that could happen is if this shifts from a human and gets into an animal vector, a rat.”

He suggests deploying the “ring vaccination” strategy — vaccinating the broad ring of contacts or specific groups at risk around a confirmed infection or outbreak — to slow transmission.

Testing by local labs also could add more efficiency because currently only the CDC is able to confirm monkeypox cases, he said.

In New York, the health department offered monkeypox vaccines to men at higher risk due to multiple or anonymous sex partners in the past 14 days and not just close contacts of suspected or confirmed monkeypox cases.

Hawaii health officials said vaccination is not recommended for the general public at this time but that it has supply on hand to vaccinate any close contacts of cases.

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Monkeypox in Hawaii

>> June 3: First probable case identified in Hawaii in an Oahu adult who had recently traveled to an area with confirmed cases and was hospitalized at Tripler Army Medical Center.

>> June 8: Second probable case identified in an Oahu adult in close contact with the first.

>> June 9: Third probable case identified in an Oahu adult who attended a social gathering.

>> June 14: Two additional probable cases found, both with connections to the earlier cases.

>> June 24: Additional probable case found, after CDC confirmed first five cases as monkeypox.

Resources

>> State Department of Health: 808ne.ws/DOHmp.

>> Centers for Disease Control and Prevention: 808ne.ws/CDCmp.

>> World Health Organization: 808ne.ws/WHOmp.

Get tested

>> Diamond Head Health Center STI/HIV Clinic, 808-733-9849 (call before visiting)

>> Search for nearby health clinic at gettested.cdc.gov.