Some of the key steps have included deployment of more community health workers and decentralized lab testing.
The test the US Centers for Disease Control and Prevention uses to identify clade I mpox cases is 'most likely not reliable' for detection of the substrain identified in the study, the authors say.
Another mpox study today showed that dose-sparing vaccine administration of the Jynneos vaccine appeared to have worked.
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Many had a single lesion or sore in their mouth or on their genitals, which is not typical.
"It is clear that the US was not prepared for an outbreak of a virus such as monkeypox."
Also, a report details a case in a child who had no known contact with a case-patient.
"Without the widespread availability of vaccine it can't be contained."
Tomorrow experts will meet to decide whether the outbreak is a public health emergency of international concern.
Over the past 5 days, monkeypox cases have doubled in New York, to 490 cases, while Washington, DC, has the highest per capita rate.
Patients recount waiting days for test results and hours in the emergency department for a diagnosis.
Walensky says clinicians must ensure proper screening and counseling are taking place.
Indications of high viral loads were detected in all 12 saliva samples, and DNA was found in 7 of 9 semen samples.
Many men who have sex with men are seeking vaccine that is so far in short supply in the US and Europe.
