Bay Area health officials scramble to contain monkeypox outbreak

Monkeypox cases have more than doubled over the past week in California and the Bay Area, where health officials are joining a global scramble to contain the outbreak as the virus still circulates in networks limited social.

California had reported 95 cases of monkeypox on Friday, down from 40 the previous week, according to the Centers for Disease Control and Prevention. About 460 cases were reported nationwide on Friday, up from 150 the previous week.

In the Bay Area, more than two dozen confirmed or suspected cases have already been reported, including 16 in San Francisco alone on Friday, though that number is only updated once a week and is almost certainly higher. now, health officials said.

The infectious disease, a cousin of smallpox, is manifested by skin lesions and is transmitted by intimate contact from person to person. Most people recover completely 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 recover and cause discomfort and pain.

So far, 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 person. The risk to the general public remains very low, according to local and federal health authorities.

Monkeypox has nothing to do with COVID, and is not currently – and almost certainly never will be – a threat on the same crisis level, experts say. But the outbreak is at a critical stage where health officials have a chance to stamp it out before cases spread further and potentially affect those most vulnerable.

“Monkeypox is not the same magnitude of a problem (as COVID). That said, if there is an opportunity to control an emerging disease, it is important that we try to do so,” said Dr Seth Blumberg , infectious disease expert at UCSF. “We can’t blow this away. We need the political and societal will to control the disease now.”

It is possible that monkeypox, if allowed to circulate widely, could become endemic in the United States and threaten the general population, although many health experts have said the outcome is unlikely given the nature of the disease. virus and how it is spread, as well as the existence of effective vaccines. to stop it.

Monkeypox could also establish itself as a recurring threat that triggers new outbreaks every few years, especially if it becomes entrenched in US animal populations. Or it could join the ranks of sexually transmitted infections, including syphilis and gonorrhea, which plague certain communities and have proven stubborn to control.

“It will suck if monkeypox joins the list of STIs people need to worry about,” said San Francisco Supervisor Rafael Mandelman, who called a hearing this month to discuss the public health response to monkeypox town. “We need to act quickly on vaccination and stop the spread now.”

In the Bay Area, pressure is mounting on health officials to make vaccines — which for monkeypox, may work before and after exposure to the virus — more widely available, and to conduct more extensive surveillance to determine quickly if the disease spreads beyond currently affected communities.

Most tests are done by state labs, which confirm the results with the CDC. Stanford began providing lab testing for monkeypox two weeks ago in anticipation of the rapidly growing epidemic and demand for surveillance, said Dr. Benjamin Pinsky, head of the Stanford Clinical Viral Laboratory.

Vaccination efforts across the country are currently hampered by lack of supply. Two vaccines are licensed for the prevention of monkeypox, although the preferred product – called Jynneos – comes in a much shorter supply. The second vaccine, called ACAM2000, has side effects that for some people could be worse than the disease itself.

Last week, the United States announced its intention to rapidly scale up its vaccination efforts with Jynneos. So far, approximately 66,000 doses have been delivered to states with monkeypox cases; An additional 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 U.S. Health and Human Services Agency said it has ordered an additional 2.5 million doses, which will be available later this year and into 2023.

California, which has about a quarter of all cases in the United States, is expected to receive about 15,000 doses by the end of last week or early this week. Jynneos is given in two doses 28 days apart.

Bay Area counties reported receiving between 10 doses and more than 500, in San Francisco. That’s not enough to offer the vaccination to everyone who might want it, so local health officials say they’re only targeting those with known exposure at this time. This includes people identified through contact tracing of reported cases, people who hear informally that a partner has recently been diagnosed, or those who have attended an event or location associated with one or more cases of monkeypox. .

“We don’t have enough for everyone,” said Frank Strona, incident management manager for the San Francisco Department of Public Health’s monkeypox response. Strona said more than 200 doses were administered in the city on Friday morning. “We expect more batches every few days,” he said.

Once the vaccine becomes available again, officials said, they hope to offer it to people at risk of being infected but who 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 characteristic rash, with dense, fluid-filled lesions. Most people are sick for two to four weeks and do not need treatment, although some drugs are available for severe cases. Worldwide, a handful of deaths have been reported this year, but none in the United States

This year’s global outbreak, which has so far infected more than 5,000 people, has baffled infectious disease experts who have never seen the virus spread far beyond countries in East Africa. West where it is endemic. The United States would typically see a few travel-associated cases every few years, but had previously reported only one outbreak: in 2003, 47 cases were identified, all linked to rodents imported from Ghana.

It’s unclear why monkeypox suddenly took off, although experts suspect it could be a combination of the virus mutating to become more transmissible and finding traction in groups where it could spread quickly and easily.

Monkeypox is mainly transmitted by direct and sustained contact. People are at higher risk if they are exposed to the fluid inside the lesions, for example by touching an infected person’s rash or by sharing bedding or towels with an infected person. The virus can also be passed from person to person through respiratory droplets, but only at short distances – it does not spread through the air of restaurants and grocery stores.

In the United States, 271 of the first 305 cases were in men and more than 70% were men who have sex with men, according to the CDC. Several large groups have been traced to events or places – 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, which can cause very rapid and early spread,” said Stanford infectious disease expert Dr. Jason Andrews. “But that doesn’t necessarily mean it will be maintained that way.”

Health officials note that unlike HIV and some other sexually transmitted infections, there is no link between particular sexual practices and the spread of monkeypox – the virus simply took hold first in gay networks. It can spread just as easily between heterosexual partners or between close family contacts.

Andrews said he suspects the global outbreak may be starting to slow after weeks of explosive growth. He and other infectious disease experts noted that due to a long incubation period for monkeypox, currently diagnosed cases are likely due to exposure a week or two earlier.

The possibility remains for the virus to take hold in the wider population. “The most concerning outcome would be if it spreads more widely as an endemic infection at all ages, or through casual contact routes,” Andrews said. “I don’t think we have strong evidence of that happening right now, but we have to prepare for it.”

Erin Allday is a staff writer for the San Francisco Chronicle. Email: [email protected]: @erinallday

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