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America may already have up to 300 cases of monkeypox - more than nine times the official number of 31 - but missed hundreds due to a lack of testing, an expert warned on Monday.
Dr. Boghuma Titanji, an infectious disease expert at Emory University in Georgia, claimed the US probably already has the same number of infections as Britain - which is currently the world hotspot for monkeypox.
But she said the laborious process of verifying swabs — which must be sent to one of 74 local laboratories and then to the Centers for Disease Control and Prevention (CDC) for confirmation — results in too few being done and many being missed.
Other experts say infections may go undetected because cases can be mild and clear up on their own, leading to patients not coming forward or being misdiagnosed as a sexually transmitted disease such as syphilis.
America's monkeypox cases occur primarily in gay and bisexual men and are linked to international travel - particularly to Europe, where about 900 of the 1,000 global cases have been detected in 21 countries.
But at least one patient in the U.S. had not recently traveled or been in contact with another known case, suggesting the virus is spreading undetected in the U.S. CDC officials have not revealed where the patient is, although it is likely either Florida or Pennsylvania.
This week, a World Health Organization chief warned that the virus, native to West Africa, may have been spreading around the world for years before it was discovered after cases multiplied due to unsafe sex at two raves in Europe.
America has now confirmed 31 cases of monkeypox in 12 states and Washington DC
Warning that there could be hundreds of cases of the tropical disease in the country, Titanji said STAT news: “The US probably has as many cases as Canada or the UK.
Dr. Boghuma Titanji of Emory University said the US could have as many cases as the UK
"We just don't test enough to reliably say there are only 25 cases. I think we need to test a lot more than we are doing."
Titanji spoke to the publication before the number was updated to 31 cases in 12 states and Washington DC
The UK has detected 302 cases - the most in the world - while Canada has 95 - the fourth highest number in the world, also behind Spain (230) and Portugal (153).
Many monkeypox infections in the current outbreak begin with a rash in the genital area, the CDC revealed at a briefing last week.
This differs from the typical course of the infection in the past, where patients experienced a fever within the first 21 days of infection, followed by a rash on the face, which then spread to the rest of the body.
Dr. Joseph Osmundson, a molecular microbiologist at New York University, has expressed fears that this could lead to cases being misdiagnosed as a common disease.
He also warned that because many infections tend to be mild and resolve on their own, this could result in patients not reporting for medical care - and therefore being missed.
Last week, the CDC announced that it was monitoring more than 400 “contacts” of patients who tested positive for monkeypox. Of those, about 55 are considered “high risk” – meaning there is a reasonable chance they have contracted the disease.
But despite the high numbers, it has only carried out about 120 PCR swabs so far for orthopoxvirus - the family of viruses that includes monkeypox and smallpox.
CDC chiefs say they have the capacity to conduct more than 74,000 tests a day for the virus — and are urging state health officials to send swabs.
But many experts say the testing process is too complicated and are instead calling for monkeypox tests to be sent directly to states.
The current process involves sending a swab from a suspected patient to one of 74 laboratories to be tested for orthopoxvirus.
If the test is positive, it is forwarded to the CDC, which can confirm whether it is monkeypox.
There is an overwhelming likelihood that any case of orthopoxvirus will test positive for monkeypox. The other major virus in this family, smallpox, has been eradicated for decades.
Despite its large population, America currently has one of the smaller monkeypox outbreaks in the world - 31 cases have been detected.
The United Kingdom is currently the global hotspot for this outbreak with 302 cases, followed by Spain, Portugal and Canada.
A total of 12 countries have reported the virus so far. These are: California, Colorado, Florida, Georgia, Hawaii, Illinois, Massachusetts, New York, Pennsylvania, Utah, Virginia and Washington. A case was also discovered in Washington DC
WHO experts have suggested the virus may have been spreading in Britain for up to four years but has gone unnoticed.