One case was detected by Kansas City, Missouri, health officials on Saturday, with a resident who had recently traveled domestically testing positive for the orthopox family of viruses that includes monkeypox.
State health officials in Indiana also revealed they had detected a potential case in an undisclosed part of the state.
Samples from both persons will be sent to the Centers for Disease Control and Prevention (CDC) to confirm if they are monkeypox infections with results expected in the coming days.
The Midwest and Great Plains regions of the U.S. had largely been spared from the rare tropical virus so far, with only Ohio and Illinois having recorded cases before the weekend. Though it is possible that the virus has been circulating in the region before these two recent cases were logged and just were not picked up by surveillance.
In total, the U.S. has confirmed 111 cases – with neither of the cases in Indiana and Missouri being included in official figures yet – with New York and California suffering the worst outbreaks with nearly two dozen infections each.
Just over 2,500 cases have been detected worldwide, with the 574 cases in the UK being the most. No deaths have been tied to the recent monkeypox outbreak in countries where it is not endemic.
Cases from Missouri and Indiana have not yet been added to official CDC case figures as federal officials work to confirm them. Over the weekend, the case tally rose from 100 to 111
‘This week, one of our excellent nurses suspected one of our patients may have monkeypox virus,’ Dr Marvia Jones, director of the Kansas City Health Department said.
‘We are considering this a probable case of monkeypox virus until we receive final confirmation from the CDC labs.’
The case would be the first in the state of Missouri. Neighboring Illinois and Oklahoma has also recorded cases of monkeypox during this outbreak.
If the cases in Missouri and Indiana are confirmed then it would bring America’s infection count to 113.
WHO investigating if monkeypox can spread through semen
The World Health Organization (WHO) has said it will investigate whether monkeypox can be passed on through semen.
Currently, scientists say it may spread through sex due to physical contact with infectious skin lesions on the genital area or other parts of the body.
But this week Italian scientists said they had detected fragments of the virus in semen — raising the possibility it could transmit through this route.
German scientists say they have also detected the virus in semen.
A WHO official revealed they were looking into the reports Wednesday.
The agency’s monkeypox incident manager Catherine Smallwood said: ‘We really need to focus on the most frequent mode of transmission and we clearly see that to be associated with skin-to-skin contact.’
More than 2,000 cases have been detected globally outside of West Africa, where it is endemic.
These are mostly among gay and bisexual men.
But scientists warn the rash-causing virus spreads through close personal contact, and it is likely the disease could spill over into other groups.
Officials in both states are also undergoing contact tracing measures to notify others who have may been exposed to the virus.
While the exact symptoms being faced by each infected person has not been revealed, the CDC warns that common symptoms include rashes, blisters on the hands, feet, arms, genitals and other areas of the body, muscle aches and fatigue among others.
The agency also warns that many may mistake the pox that come as part of the infection – the most obvious sign a person has contracted the virus – with STIs like syphilis.
Monkeypox usually spreads by body-to-body contact with the infectious lesions on a person’s body, though it can also be transmitted through sustained face-to-face contact.
Patients are expected to first experience a fever within three weeks, followed by a rash that covers the face, and then the rest of the body.
Last week, the CDC warned that many patients were not experiencing the typical symptoms.
The agency reports that many were developing the rashes before fevers, with some never experiencing a fever at all.
Rashes were being recorded in the mouth and genital area or anus, which has not previously been associated with the illness. The patterns of lesions appearing around the body were not consistent either.
Almost all cases in the U.S. have been tied to international travel, either to an African nation where the virus is endemic or to a European country that has experienced significant spread.
Some cases have no links to travel, though, indicating multiple examples of human-to-human transmission on U.S. soil.
Gay and bisexual men in particular have suffered the largest burden of infections, with the virus believed to be spreading through the sexual network.
Outbreaks have been tied to wo sex-raves in Belgium and Spain, and a recent Mr Leather fetish event in Chicago, Illinois, is believed to be at the center of another cluster of cases.
This has left some worried that Pride parades this June will be sources of rampant monkeypox spread. Doctors and community leaders are encouraging people to still attend these events, but to take precautions.
Speaking at the town hall on monkeypox, Henry said: ‘Going out at Pride, going to the stores, the restaurants, the bars — if you are avoiding prolonged skin-to-skin contact that should be safe.
‘The only other method of transmitting monkeypox is through respiratory droplets, but that’s rare.
‘If you are not touching someone, you would need to be indoors without a mask for several hours — if not more — to catch it.
‘So you can go outside at the Parade, don’t be afraid to go for pubs and bars but watch for the rashes and look at what is on their body.’
He added: ‘Essentially you don’t want prolonged skin-to-skin contact with someone who has that rash.
‘For people who might recreationally enjoy dark rooms or commercial sex clubs where you can’t see what’s on the person’s body — now is not the time to be there.’
Gorensek, an infectious disease specialist from the state’s Holy Cross Medical Group, warned people to ‘minimize’ skin-to-skin contact.
‘There would be less risk going to concerts and gatherings — that is not high risk,’ she said. ‘But skin-to-skin contact puts you more in that category.