(Bloomberg) -- The monkeypox outbreak in the US has expanded to include nine cases in seven states, senior health officials said Thursday, adding that the outbreak is expanding in countries where the virus does not normally circulate. 

Officials from the Centers for Disease Control and Prevention said the new monkeypox infections were found in Virginia, California and Washington state. Earlier this week, the agency said four cases had been identified in Massachusetts, Florida, Utah and New York. Some but not all of the US patients had recently traveled abroad. 

“We shouldn’t be surprised to see more cases in the US in the upcoming days,” Raj Panjabi, the White House’s pandemic office coordinator said. “It’s actually a sign that Americans are remaining vigilant and health-care providers and public health workers are doing their jobs.”

Monkeypox is in the same family of viruses as smallpox. The US has been preparing for a possible smallpox outbreak for decades, so there is an ample supply of vaccines and therapeutics that should be effective against monkeypox. Bavarian Nordic’s Jynneos vaccine already has FDA approval for use against monkeypox and is a safer alternative to Emergent Biosolutions Inc.’s vaccine, ACAM2000, which comes with serious side effects. Covid vaccinemaker Moderna Inc. has also said it’s in the early stages of studying possible monkeypox vaccine candidates. 

Abbott Laboratories is also working on coming up with a PCR test for monkeypox, a spokesperson said Thursday.

Vaccine Efforts

Officials said that they have already begun mobilizing to get treatments to states where cases have been identified. Jennifer McQuiston, the deputy director of the CDC’s Division of High Consequence Pathogens and Pathology, said that doses of the Jynneos vaccine arrived Sunday in Massachusetts, where the first US monkeypox case was identified. Health officials are in the process of getting the vaccine to high risk contacts, such as health-care workers. 

The best use of vaccines for monkeypox is to utilize what’s called a ring vaccination strategy, which focuses on inoculating people who have been directly exposed to infectious persons with the type of contact that could facilitate spread. Aside from health care workers who may have treated monkeypox patients, health officials have said that the virus appears to be spreading via close, intimate contact, possibly among sexual networks. Most of the cases thus far have been in men who have sex with men, but by no means is the risk of infection isolated to the LGBTQ community, the CDC said.

Along with vaccines, the US has two smallpox antivirals which have shown effectiveness against monkeypox when tested in animals. CDC officials said the drugs can be released under an Investigational New Drug application, which allows for use of an experimental drug during an emergency. One of the antivirals, SIGA Technologies’s Tpoxx, has already been deployed to Florida and California, officials said. So far, most of the cases have been “mild and self-limited,” McQuiston said.

“In a case like that, an antiviral would not necessarily be something that was automatically recommended or administered,” she said. 

Symptoms of monkeypox typically resolve on their own, but because infections present with a blister-like rash, they can be easily confused for common sexually transmitted infections such as herpes or syphilis. Misdiagnosing cases could lead to undetected spread and improper treatment. McQuiston said Thursday that typical safe sex practices may not be enough to stop monkeypox from spreading during sex. 

“Unless the condom is actively covering an area where a lesion is, I wouldn’t give a false sense of assurance that a condom alone would be enough to prevent monkeypox virus transmission,” she said. 

©2022 Bloomberg L.P.