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Monkeypox case reported in man whose ‘primary risk factor’ was close, non-sexual contact at crowded outdoor event

One man noticed his first lesion and then developed a rash about two weeks after attending a “large, crowded outdoor event that involved a few hours of close contact with others, including close dancing,” according to researchers at the Stanford University School of Medicine. He tested positive for monkey pox after seeking help from an emergency department about a week later.

The patient’s “primary risk factor was close, nonsexual contact with numerous unfamiliar individuals during a crowded outdoor event,” the researchers wrote, and the case “highlights the potential for spread at such gatherings, which could affect the fight against epidemics.”

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The event he attended in the UK was not a rave and was not attended specifically or mostly by individuals who identified as gay or bisexual, according to the researchers. While many attendees wore tank tops and shorts, he wore pants and a top with short sleeves. He didn’t notice anyone with skin lesions or who seemed sick, and he attended a few other similar events over the next four days.

According to CDC guidelines, “monkeypox can spread to anyone” through close contact, which is often skin-to-skin, as well as intimate contact that includes sex, cuddling, massage and kissing.

The patient – a man in his 20s who recently returned to the US after a trip to the UK – reported no sexual contact and had no evidence of genital lesions. Samples of both saliva and nasal swabs tested positive for the virus, although the patient reported no related illness symptoms such as fever, chills or cough.

A previous analysis of monkeypox cases by the CDC found that early warning signs of disease are less common in the current outbreak compared to “typical” monkeypox. In about 2 in 5 cases, the disease started with the rash – but no prodromal symptoms such as chills, headache or malaise were reported.

These findings indicate that transmission may be “associated with clinical symptoms” and things like hotel beds and high-touch areas in public settings may be modes of transmission.

Despite no reported sexual contact, a rectal swab from the patient tested positive for the virus, indicating “potential for continued sexual transmission.”

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