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By Jacqueline Howard, CNN
The monkeypox virus has spread rapidly in clusters across the United States — at some music festivals, pool parties and bathhouses — and now public health officials in areas where infections are high want more vaccines to be available to help control transmission, which seems to happen when people touch each other intimately, skin to skin.
“There are two different sides to this response,” Lori Tremmel Freeman, executive director of the National Association of County and City Health Officials, told CNN.
“One is heavily focused, rather narrowly, on events that are happening that can be hotbeds of the spread,” Freeman said, including big dance parties and pool parties.
“After Pride month, for example, our health services in some parts of the country really had their hands full because there were big events being held where people had a lot of anonymous partners and there weren’t even no ability to track how or when they were exposed,” Freeman said.
Second, “we are certainly in a phase right now where we have to manage the existing amount of vaccines and really focus on new cases in people at high risk,” she added. “So don’t do prevention efforts yet – just focus on the number of cases.”
These cases are on the increase. The number of probable or confirmed cases of monkeypox in the United States more than doubled in a single week, from 866 to 1,814 between July 11 and July 16.
Having more vaccine doses in cities and counties across the country — especially those where cases are rising — could help slow the spread of the virus, Freeman said.
Although monkeypox is not a sexually transmitted disease, it is spread through skin-to-skin contact, and in the current outbreak the virus has primarily spread among men who have sex with men.
The CDC estimates that more than 1.5 million men who have sex with men are eligible for the monkeypox vaccine in the United States.
On Tuesday, more than 190,000 doses of the Jynneos vaccine — a two-dose regimen manufactured by Bavarian Nordic for the prevention of monkeypox and smallpox — were withdrawn from the Strategic National Stockpile to support local monkeypox response efforts, according to the US Department of Health and Human Services.
But some local health officials told CNN that was not enough to meet demand.
“The numbers are obviously increasing”
For health officials in Dallas County, Texas, the summer began with a monkeypox investigation.
In early June, the state identified its first case of monkeypox in the global outbreak of the rare disease. The patient was a Dallas County resident who had recently traveled to Mexico.
Separately, in the days that followed, two more cases of monkeypox were identified in Dallas County residents who had recently traveled to Spain and Mexico.
Still, the number of cases in Dallas County has remained at just a handful — all of whom have reported international travel histories and identified as men who have sex with men.
But about a month later, the county’s case count spiked.
“Our first cases were related to overseas travel, and then now we’ve had local events,” Dr. Philip Huang, director of the Dallas County Department of Health and Human Services, told CNN on Wednesday. of the conference of the National Association of County and City Health Officials.
“We try to control it and contain it, but the numbers are obviously increasing,” he said.
Over the July 4 weekend, health officials identified a confirmed case of monkeypox in a person visiting the Daddyland Festival, a four-day circuit of dance parties with live DJs, nightclub events and live music. evenings by the pool.
The person said they attended festival events and private parties while infectious, according to Dallas County Health and Human Services, which added that “there is a local and community transmission issue for anyone who has attended these events and participated in activities that pose a high risk for transmission of monkeypox.”
At the Daddyland festival, “thousands of people, mostly men who have sex with men, came from all over the country and across the state. They came to party, and this party had a lot of close contact,” Huang said.
Around the same time, county health officials were notified of an out-of-state visitor with confirmed monkeypox who reported multiple sexual encounters in the sauna of the private men’s club Club Dallas between June 22 and 25. The person identified as a man who has sex with men.
“It’s not predisposed to men who have sex with men,” Huang said. “But there are circumstances and events that have resulted in that being where we see most of the cases and transmissions.”
On Friday, 29 cases of monkeypox were confirmed in Dallas County residents, and health officials issued public advisories about potential exposure at Daddyland Festival and Club Dallas. Most of those affected have swollen lymph nodes and lesions or pustules on the skin characteristic of monkeypox, Huang said.
“It would be really important for the people who attended to be responsible, to monitor themselves if they attended these events, and if they are part of this group, maybe not to participate in these events at the moment until let this be resolved,” Huang told CNN.
“For the general population, unless you attend these kinds of events or with people who attended and have close contact, the risk is very low,” Huang said. “If you’re going to the event and there’s a bunch of people there, then you have a higher risk.”
Public health officials emphasize that anyone who comes into contact with someone with an active monkeypox infection may be at risk of becoming infected with the virus – regardless of sexual orientation – and that the disease should not not be stigmatized.
“Anything that’s stigmatized, people won’t want to report it,” Patrick McGough, executive director of the Oklahoma City-County Health Department, told CNN on Wednesday at the public health conference. His condition has a total of three probable or confirmed cases of monkeypox, according to CDC data.
There remains concern that more people will be infected with monkeypox but will not be tested. These cases may then not be reported.
“There’s the anonymous nature of a lot of sex and the stigma,” Freeman said.
“There’s also the education around monkeypox in general: not everyone understands what it is or how you get it,” she said. “At the community level, we have a lot of work to do with health education and promoting testing.”
For example, “in California, we hear that bathhouses continue to be an area where they focus their health education efforts, as these focus particularly on men who have sex with men. other men, with many unnamed partners, in one setting,” Freeman says.
But as more people get tested, more cases could be identified and “we’ll know more about its extent”.
Additionally, it remains unclear whether the virus is primarily spread sexually or through other forms of skin-to-skin contact.
“We’re really trying to figure out what skin-to-skin contact means and how long it takes to transmit it,” McGough said. “It appears to be cluster events where there is a lot of skin-to-skin or sexual contact, but it’s not a sexually exclusive disease, nor is it limited to one group like men who have sex with men.”
Kissing, sex or just rubbing are all examples of how the virus appears to be spreading from person to person, based on contact tracing surveys in the current outbreak, McGough said, and “there goes without saying” that the spread occurs when the infected person has a rash or pustules on the skin.
“The availability of vaccines at this time is still limited”
Local health departments across the United States are learning more about how the monkeypox virus spreads through contact tracing, the practice of identifying and interviewing contacts of people who are tested. positive.
Testing for the monkeypox virus “hasn’t really been a major limitation in Dallas County so far,” nor has the timing of results, according to Huang. But he said there was certainly room for improvement in vaccination.
“There is still no vaccine available,” Huang said, at least outside of the country’s biggest cities.
“Vaccine availability at this time is still limited,” he said. “Texas was not one of the high priority communities like New York, Los Angeles and Chicago initially that received larger amounts of vaccines.”
The Los Angeles County Department of Public Health announced that starting Wednesday, the monkeypox vaccine will be available for men who have sex with men and for transgender people who have been diagnosed with gonorrhea or syphilis in the past year, are on pre-exposure to HIV prophylaxis, or have frequented or worked at a place in the past 21 days where they had sex anonymously or with multiple partners, such as saunas, public baths or sex parties.
LA County received an additional 9,000 doses of the Jynneos vaccine last week and expects another 7,000 this week.
Meanwhile, Dallas County health officials have had to limit vaccinations to “persons with actual close skin-to-skin contact with someone who has tested and confirmed positive,” Huang said. With more vaccine supply, “we would be able to open it up to more high-risk people or attend an event.”
He added that just over 100 doses have been administered in his county.
The financial burden of monkeypox
Along with the need for more vaccines, there could be additional costs to local health departments, McGough said.
In Dallas County, “we are looking to get additional manpower to help with some of the monitoring. We are monitoring people who have been exposed for about 21 days after exposure for symptoms” , Huang said. “But if we can get more vaccines, then we can start giving this more widely to people at high risk. It looks like it’s going to take a while.”
In Oklahoma City, where McGough is based, the health department is helping monkeypox patients self-isolate by providing meals and other resources as needed, and staff are checking infected patients to monitor their symptoms and respond to their potential health needs.
If monkeypox cases increase, “it’s going to be a financial burden,” McGough said. “We have to prepare for it if it happens.”
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