CDC releases updated recommendations to avoid monkeypox, researchers in the United Kingdom identify new monkeypox symptoms, and more in this week's roundup of monkeypox news.

Monkeypox is officially a public health emergency

• CDC on Friday released updated guidance advising sexually active individuals to limit their number of partners until they are vaccinated against monkeypox. While the virus is not classified as a sexually transmitted disease, CDC noted that it is typically transmitted during "close, sustained physical contact, which can include sexual contact." According to data released Friday by CDC, most infections are currently among men who have sex with men (MSM). However, anyone who has sustained contact with an infectious individual could become infected, according to the World Health Organization. According to CDC, if an individual or their partner suspects they have the virus, the best way to prevent the spread "is to avoid sex of any kind (oral, anal, vaginal) and kissing or touching each other's bodies." In addition, CDC recommends that sexually active individuals limit their number of sexual partners to lower the chances of exposure. "Spaces like back rooms, saunas, sex clubs, or private and public sex parties, where intimate, often anonymous sexual contact with multiple partners occurs—are more likely to spread monkeypox," the agency added. Since the monkeypox rash can occur anywhere on the body, condoms alone may not prevent exposure. As an alternative, CDC suggests wearing clothes while having sex or covering any part of the body where the rash is present, limiting as much skin-to-skin contact as possible. "Have virtual sex with no in-person contact," CDC also suggested. (Habeshian, Axios, 8/5)

• The American Red Cross has started checking potential blood donors for signs of the rash that appears on individuals infected with monkeypox during its routine arm exams. In October, the Red Cross will implement a 21-day waiting period before allowing blood donations from individuals who have been diagnosed with the virus or exposed to anyone with an infection. "This decision is a reasonable response to prevent transmission of the monkeypox virus given scientific uncertainty about whether it is capable of spreading through blood," said Lawrence Gostin, who runs the O'Neill Institute for National and Global Health at Georgetown Law. While the risk of contracting monkeypox through donated blood is theoretical, with no known reports of this type of transmission, there have been some reports of the virus being detected in the blood of infected patients. In a recent study published in The Lancet, the virus was detected in the blood samples of six out of seven patients diagnosed with monkeypox in the United Kingdom from 2018 to 2021. Last month, researchers studying the current outbreak published a study in the New England Journal of Medicine saying that they detected the virus in some of their patients' blood samples. "There's a lot of uncertainty right now about the potential for bodily fluids to cause monkeypox infections," said Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco. "We don't know what detection in blood means for transmissibility." (Molteni, STAT News, 8/3)

• Researchers in the United Kingdom identified several novel symptoms in the current monkeypox outbreak. For the study, they analyzed the health records of 197 individuals infected with monkeypox. Notably, all of the participants were men who identified as gay, bisexual, or other MSM, with a median age of 38. In the study, lesions were usually detected on the genitals, anus, or perianal area. Unlike previous outbreaks, which suggested that skin lesions developed after the onset of systemic symptoms, the researchers found that 38.5% of individuals developed skin lesions first. In addition, they found that 13.7% of patients developed skin lesions but did not experience systemic symptoms. Thirty-six percent of patients experienced rectal pain or pain with defecation, 16.8% reported a sore throat, and 15.7% reported penile edema. Overall, 10.2% of participants were admitted to the hospital for clinical symptoms, which included perianal or rectal pain, penile swelling, and perianal or groin abscesses. "Our study corroborates previous findings from this outbreak – the majority of patients, but not all, identify as GBMSM [gay, bisexual, men who have sex with men]. However, it is important not to stigmatize individual groups or populations. Monkeypox is an infection that is transmitted through any close contact, including sex, so it can, in theory, affect anyone," said study author Aatish Patel from Chelsea and Westminster NHS Foundation Trust. (Lennon, Medical News Today, 8/9)

• Wastewater surveillance techniques, which have become a critical tool in detecting Covid-19 outbreaks, are now being adapted to monitor the spread of monkeypox in several U.S. communities, including the San Francisco Bay area. The Sewer Coronavirus Alert Network (SCAN), the same research team that adapted wastewater collection to detect the coronavirus in the early days of the pandemic, is now expanding wastewater monitoring to detect monkeypox outbreaks. In June, SCAN adapted its surveillance to monitor for monkeypox in sewersheds in Northern California. Since then, it has detected the virus in several sewersheds, including Palo Alto, San Jose, Gilroy, Sacramento, and two locations in San Francisco. SCAN is also currently conducting similar monitoring in several other states, including Colorado, Georgia, and Michigan. The network hopes to expand to monitor 300 U.S. sites. Moving forward, SCAN's scientists hope to use wastewater sludge to track a growing list of public health concerns. "We're looking at a whole range of things that we might be able to test for," said Marlene Wolfe, an assistant professor of environmental health at Emory University. (Kreidler, "Shots," NPR, 8/8)

• Florida state health officials announced they would only administer the first dose of the two-dose monkeypox vaccine to extend its limited supply. While the Florida Department of Health (FDOH) ordered the full 72,000 vaccine doses allocated by HHS, the supply will likely not be sufficient to address the state's sharp rise in infections. To stretch the state's limited supply, FDOH instructed county health offices to reschedule thousands of appointments for the second dose of the vaccine. Similarly, New York City has prioritized delivering first doses of the vaccine to those at high risk of contracting the disease. "Given the rapid increase in cases, the Health Department has decided that providing first doses to offer protection to more at-risk New Yorkers is the best strategy until we receive adequate vaccine supply. Until there is sufficient supply in the city, all vaccine doses will be treated as first doses, and we will only begin scheduling second dose appointments once we have enough vaccine to do so. The department will communicate to people who have received first doses about when second doses are available and how to receive them," the New York City Health Department said in a press release. (Sarkissian, Politico, 8/9; Branswell, STAT News, 7/15)