Community health and LGBTQ rights leaders in California are demanding a much more aggressive response to monkeypox from government and health agencies, saying shortages of vaccines and limited public outreach are exacerbating the outbreaks.
Confirmed and probable cases of monkeypox across California have climbed by 65% in the last week, from 85 to 141. There were 47 confirmed and probable cases of the virus in Los Angeles County as of Thursday — an almost 60% increase since last week — and in San Francisco, cases have more than doubled in a similar time frame, rising from 16 to 40.
While monkeypox is nowhere near as contagious as the coronavirus, officials said they are concerned about the increase in infections. The cases in both counties are spreading primarily among men who have sex with other men, health officials said, as has been the trend since the outbreak began in early May.
Monkeypox is primarily transmitted by skin-to-skin contact with someone who has a rash and pus-filled skin sores, which are filled with the virus. In some cases, the rash has appeared first in the genital area and in or around the anus. Symptoms can include fever, aches, chills, exhaustion, sore throat, swollen lymph nodes; and the skin lesions can be so intense that patients are prescribed painkillers.
Transmission likely accelerated at Pride events attended by gay and bisexual men in June. The month is a season of travel for many gay and bisexual men, with Pride events held in major cities — in California, the U.S. and abroad — every weekend in June. This weekend, the city of Long Beach is hosting its Pride parade and celebrations. As reports of infection and exposure have increased, there is a clamor for vaccinations, and widespread frustration about the inability to get the shots.
“What we need most immediately is warnings and public announcements by the county department of public health — which we have not had,” said Michael Weinstein, president of L.A.-based AIDS Healthcare Foundation. “We’re not treating this seriously enough.”
Local health officials say their job is severely limited by the shortage of monkeypox vaccines, which they hope can soon be ramped up with promised federal shipments.
“Until about a couple of days ago, we only had 1,000 doses” of the Jynneos vaccine in L.A. County, said Barbara Ferrer, the county’s public health director. “We’re doing everything we can to have an equitable distribution of what is, at the moment, a scarce supply of this vaccine.”
Ferrer said that initial allotment has nearly been exhausted, but 6,000 additional doses recently arrived which will allow some expansion — but not nearly enough to meet demand. Ferrer said she expected vaccine supplies would be scarce at least through August.
As of last week, the L.A. County Department of Public Health was limiting Jynneos vaccine doses to people confirmed by officials as having intermediate- or high-risk contact with a confirmed monkeypox case, or people who attended an event where there was high risk of exposure to someone with confirmed monkeypox through skin-to-skin or sexual contact.
Ferrer said her department on Friday will announce a broadening of eligibility for the vaccine to people identified by a healthcare provider as being at higher risk for monkeypox.
Ferrer did also say that the county health department has been using social media to alert people about monkeypox. The Jynneos vaccine can help prevent monkeypox illness even after a person is exposed to the virus. But Weinstein said he would like to see much more messaging and prevention education, especially for those most vulnerable.
“I understand the concern about stigmatizing gay men, but if our concern about not stigmatizing [these groups] trumps actually informing them, that’s a major problem,” Weinstein said. “We have to urge the county as well as the federal government to do community engagement. The way we got a handle on HIV in this country was to engage with communities.”
The Jynneos vaccine is administered in two doses, 28 days apart. A person is considered protected two weeks after the second dose, meaning that it takes about six weeks after the first dose for a person to be considered fully vaccinated.
It can take one to two weeks before a person exposed to monkeypox develops symptoms.
It is possible for someone to develop a pus-filled skin sore and not be aware of it, and it’s also possible for someone to develop such sores in their mouth, making it possible they could breathe out the virus and infect other people during close contact, such as cuddling, kissing or sex. Touching clothing or fabric that previously touched the virus can also spread monkeypox. Officials emphasize that anyone can get monkeypox, including family members and friends caring for people recovering from an infection.
The illness can last two to four weeks. The rash can progress across the body, and eventually scab over before the scabs fall off. People are not contagious once all scabs have fallen off.
Ferrer urged people who have any signs or symptoms of monkeypox to see a healthcare provider immediately, especially people who have bumps on the skin or rashes that could be from a monkeypox infection. Some people initially have only a handful of skin lesions, perhaps even just one or two, but that’s enough to warrant a trip to a healthcare provider, Ferrer said.
“If you have lesions, it’s important to not have anybody else come in contact with those lesions. So that means staying away from other people and avoiding close contact, keeping those lesions covered,” Ferrer said.
With the risk of monkeypox infection higher, Ferrer said people “attending large events where there’s going to be a lot of skin-to-skin contact, or there’s going to be perhaps a fair amount of sexual activity with multiple partners, or partners who you don’t know well, it is really sensible to be extraordinarily cautious in those settings, because it may be hard to do a quick scan and see whether people have lesions.
“So it may be best, for now, to take extra precautions, if you’re attending those events, to really minimize that skin-to-skin contact where there can be transmission of monkeypox,” Ferrer said.
Some in San Francisco have also been sounding the alarm on the city’s monkeypox response, questioning why so few vaccines are available for a growing number of people at risk.
The San Francisco AIDS Foundation this week said it received only 60 doses of the Jynneos vaccine in June. “We don’t want to scare you, but we’re now seeing cases on a regular basis. And we’re going to start seeing a lot more cases if we don’t act swiftly and boldly,” wrote Tyler TerMeer, the CEO of the San Francisco AIDS Foundation.
“Our country appears again to be woefully underprepared to respond to a virus,” tweeted Assemblymember Matt Haney (D-San Francisco). “We desperately need the federal government to deploy and distribute more doses … so we can get them out now.”
Adam Sukhija-Cohen, the director of advocacy and policy research for the AIDS Healthcare Foundation, said his organization is uniquely equipped to reach gay and bisexual men to administer vaccines, but so far L.A. County has not asked for their support.
An additional 140,000 doses of vaccine will soon be made available nationwide, followed by 98,000 more doses later in July or in August, Ferrer said. But that still means L.A. County can still only expect to get a few thousand doses in the short-term, and will still be short of a supply to meet demand, Ferrer said.
“The hope is that sometime by late August, there’s a lot more vaccine that’s available for distribution,” Ferrer said. “We’re going to have limited availability throughout much of the summer, which is why it’ll be targeted to those at the very highest risk.”
The strain of monkeypox in the global outbreak — known as the West African strain — is rarely fatal. But there are some people who can suffer significant complications, such as people with weakened immune systems and people who have had a history of eczema. Rare complications can include lesions that appear in the eye, which endanger vision.
While some in the LGBTQ community are warily comparing monkeypox to the beginning of the HIV/AIDS epidemic, Stuart Burstin, the AIDS Healthcare Foundation’s Interim National Director of Infectious Diseases, said there is one major difference: the visible lesions.
“You can see it, you can prevent it,” Burstin said. “Right now we have a window of opportunity. … It’s important to jump on top of it, but it’s not helpful to try to raise more fear and trepidation; prevention is the key.”
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