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Monkeypox cases have more than doubled in the past week in California and the Bay Area, where health officials are joining a global scramble to contain the outbreak while the virus still circulates on limited social networks.
California had reported 95 monkeypox cases as of Friday, up from 40 the week before, according to the Centers for Disease Control and Prevention. About 460 cases had been reported nationwide through Friday, up from 150 the week before.
More than two dozen confirmed or suspected cases have already been reported in the Bay Area, including 16 in San Francisco alone as of Friday, although that number is only updated once a week and is almost certainly higher by now, health officials said.
The infectious disease, a cousin of smallpox, manifests as skin lesions and is transmitted from person to person through intimate contact. Most people make a full recovery without treatment, but monkeypox can cause serious illness in children and some other vulnerable groups. Even for those who are not seriously ill, it can take weeks to get over it, causing discomfort and pain.
To date, nearly all cases have been reported in gay or bisexual men, most of whom are believed to have been exposed through sexual or other close contact with an infected individual. The risk to the general public remains very low, local and federal health officials say.
Nothing like COVID, monkeypox is not a threat at the same crisis level right now — and almost certainly never will be, experts say. However, the outbreak is at a critical stage where public health officials have a chance to eradicate it before cases spread further and potentially affect more vulnerable people.
“Monkeypox is not the same problem (as COVID). However, if there is an opportunity to control an emerging disease, it is important that we try,” said Dr. Seth Blumberg, infectious disease expert at UCSF. “We can’t call it off. We now need the political and social will to bring the disease under control.”
It’s possible that if monkeypox becomes widespread, it could become endemic in the United States and threaten the general population, although many health experts said the outcome is unlikely given the nature of the virus and its spread, as well as the existence of effective vaccines around to stop it.
Monkeypox could also establish itself as a recurring threat, triggering new outbreaks every few years, especially if it takes hold in US animal populations. Or it could be among the sexually transmitted infections, including syphilis and gonorrhea, which affect certain communities and have proven tenacious to control.
“It’s going to suck if monkeypox goes on the list of STDs for people to worry about,” said San Francisco Supervisor Rafael Mandelman, who called a hearing this month to determine the city’s response to monkeypox in the US discuss public health. “We must move quickly with vaccination and stop the spread now.”
In the Bay Area, pressure is mounting on public health officials to make vaccines — which can work for monkeypox before and after exposure to the virus — more widely available and conduct more extensive surveillance to quickly determine if the disease is currently spreading beyond communities spread affected.
Most tests are performed by state labs, which corroborate the results with the CDC. Stanford began providing lab tests for monkeypox two weeks ago in anticipation that the outbreak and demand for surveillance could increase rapidly, Dr. Benjamin Pinsky, director of the Stanford Clinical Viral Laboratory.
Vaccination efforts across the country are currently being held up by a lack of supplies. Two vaccines are approved to prevent monkeypox, although the preferred product – called Jynneos – is much less available. The second vaccine, called ACAM2000, has side effects that could be worse than the disease itself for some people.
The US last week announced plans to rapidly ramp up its vaccination efforts with Jynneos. To date, about 66,000 doses have been shipped to states with cases of monkeypox; Another 240,000 doses are expected to be distributed in the coming weeks, and at least 1.6 million total doses should be available by the end of the year, according to the CDC. On Friday, the US health agency said it had ordered an additional 2.5 million doses that will be available later this year and into 2023.
California, which has about a quarter of all cases in the US, is expected to receive about 15,000 doses by late last week or early this week. Jynneos is given in two doses 28 days apart.
Bay Area counties reported receiving anywhere from 10 to more than 500 doses in San Francisco. That’s not enough to offer a shot to everyone who wants it, so local health officials say they’re currently only targeting those with known exposure. This includes people identified through contact tracing of reported cases, people who learn informally that a partner has been recently diagnosed, or people who have attended an event or venue associated with one or more cases of monkeypox stand.
“We don’t have enough for everyone,” said Frank Strona, chief of monkeypox incident management for the San Francisco Department of Public Health. Strona said more than 200 doses had been administered in the city as of Friday morning. “We expect to have more batches every few days,” he said.
Once another vaccine becomes available, officials hope to offer it to people who are at risk of infection but don’t necessarily have a known exposure. The vaccine may never be needed for the general public if the outbreak is contained.
Monkeypox tends to cause flu-like symptoms and a typical rash with dense, fluid-filled lesions. Most people are sick for two to four weeks and do not need treatment, although a few medications are available for severe cases. A handful of deaths have been reported worldwide this year, but none in the US
This year’s global outbreak, which has so far infected more than 5,000 people, has stunned infectious disease experts, who have never seen the virus spread far beyond the West African countries where it is endemic. The United States usually has a few travel-related cases every few years, but previously only one outbreak had been reported: 47 cases were identified in 2003, all linked to rodents imported from Ghana.
It’s not clear why monkeypox broke out suddenly, although experts suspect it could be a combination of mutating the virus to make it more transmissible and finding traction in groups where it could spread quickly and easily.
Monkeypox is primarily transmitted through direct, sustained contact. People are most at risk when exposed to the fluid in the lesions, e.g. B. by touching the rash of an infected person or by sharing bed linen or towels with an infected person. The virus can also be transmitted from person to person through respiratory droplets, but only at close range – it does not spread through the air of restaurants and grocery stores.
In the US, 271 of the first 305 cases involved men, according to the CDC, and more than 70% were men who had sex with men. Several large clusters have been traced to events or venues — including private sex parties and clubs or bathhouses — where people have had sex with multiple partners.
“A small number of people have a large number of sexual contacts, and that can lead to very rapid and early spread,” said Dr. Jason Andrews, infectious disease expert at Stanford. “But that doesn’t necessarily mean it’s going to be sustained.”
Health officials are finding that unlike HIV and some other sexually transmitted infections, there’s no link between specific sexual practices and the spread of monkeypox — the virus happened to first take hold on gay networks. It can spread just as easily among heterosexual partners or among close household contacts.
Andrews said he suspects the global outbreak may be slowing after weeks of explosive growth. He and other infectious disease experts noted that because of a long incubation period for monkeypox, cases diagnosed now are likely due to exposure a week or two ago.
The possibility remains that the virus will gain a foothold in the general population. “The most worrying outcome would be if it continues to spread as an endemic infection across all age groups or through incidental contact routes,” Andrews said. “I don’t think we have strong evidence of that right now, but we have to prepare for it.”
Erin Allday is a contributor to the San Francisco Chronicle. Email: [email protected] Twitter: @erinallday
