A fifth person has tested positive for what is presumed to be monkeypox in New York City, city health officials said late Thursday night.

That makes three new cases in less than 36 hours for a previously rare disease that is now spreading so quickly, top global health officials say they don’t know if it’s “too late to contain.”

As of Thursday afternoon, the CDC said there were 21 confirmed cases nationwide from the recent outbreak. That’s more than double in a week.

Globally, the World Health Organization has identified infections from the current outbreak in at least 12 countries.

The WHO says so far, there is no link between this outbreak and travel to countries where the virus is already endemic.

“We don’t really know whether it’s too late to contain. What WHO and all member states are trying to do is prevent onward spread,” Dr. Rosamund Lewis, the WHO’s monkeypox technical lead, said during a news conference in Geneva on Wednesday.

What Is Monkeypox?

Monkeypox was first discovered in 1958, when outbreaks occurred in colonies of monkeys kept for research – resulting in its name. (What you need to know about monkeypox.)

The first case in a human was reported in 1970 in the Democratic Republic of the Congo, which still has the majority of infections. Other African countries where it has been found: Cameroon, Central African Republic, Cote d’Ivoire, Democratic Republic of the Congo, Gabon, Liberia, Nigeria, Republic of the Congo and Sierra Leone.

Human symptoms of monkeypox are similar to but milder than the symptoms of smallpox, the CDC says. It presents itself as a flu-like illness accompanied by lymph-node swelling and rash on the face and body.

Monkeypox starts off with fever, headache, muscle aches, and exhaustion. Monkeypox also causes lymph nodes to swell, something that smallpox does not. The incubation period is usually 7−14 days but can range from 5−21 days.

The CDC is urging healthcare providers in the US to be alert for patients who have rashes consistent with monkeypox, regardless of whether they have traveled or have specific risks for monkeypox. See more information from the travel notice here.

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