Monkeypox cases have been reported in all 50 U.S. states since Wyoming reported its first case on Monday.

Public health officials from the Wyoming Department of Health (WDH) were investigating whether the patient, a male from Laramie County, had direct contact with anyone else, according to Dr. Alexia Harrist, Wyoming’s health officer and epidemiologist.

“Because monkeypox spreads through close, intimate contact, we do not believe the risk for the virus is now a higher concern for the local community or most people in Wyoming,” Harrist said in a statement on Monday.

“Monkeypox does not spread easily like familiar viruses such as influenza or COVID-19,” she explained.

Wyoming began recommending vaccinations for people who were exposed to monkeypox and those who were more likely to be exposed.

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People eligible for pre-exposure vaccination were those who lived or worked in Wyoming, including sex workers and men who have sex with men and who have had multiple or anonymous sexual partners.

“While anyone can become ill with monkeypox, vaccine eligibility is currently limited to people who are at highest risk in connection with this outbreak and how it’s spreading,” Harrist said. “The goal is to put available vaccine supplies to the best possible use.”

Monkeypox can spread to anyone through close, personal, often skin-to-skin contact, according to the U.S. Centers for Disease Control and Prevention. But CDC Director Dr. Rochelle Walensky told reporters that men who have sex with men and are HIV positive or are taking medicines to reduce their chance of contracting HIV face the most significant health risk from monkeypox.

Dr. Ward Carpenter is the co-director of health services at the Los Angeles LGBT Center, which administers monkeypox vaccines, conducts screenings, and prescribes antiviral treatments.

“What we really want to do is get to the point where we can vaccinate everyone who wants it,” Carpenter said. “We’re still not anywhere close to that. We are really trying to focus on the people who are most in need, most at risk.”

The CDC reported 16,603 cases of monkeypox in the U.S. as of Wednesday, August 24. Globally, 45,535 cases and 12 total deaths had been reported.

The largest numbers of U.S. monkeypox cases were in California (3,068), New York state (3,038), Georgia (1,669), and Texas (1,374).

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