Local health officials say monkeypox virus spreads in ‘cluster juveniles’, but vaccines can help stop it.

“There are two different sides to this response,” Lori Tremmel Freeman, chief executive of the National Association of County and City Health Officials, told CNN.

“One focuses very much, rather narrowly, on events that are happening that can be hotspots of spread,” including big dance parties and pool parties, Freeman said.

“With Pride Month approaching, for example, our health departments in certain areas of the country were really full because there were big events being held where people had many anonymous partners and there wasn’t even an ability to keep track of how and when they were,” Freeman said.

Second, “we are certainly now at a point where we have to manage the current amount of the vaccine and really focus on new cases in high-risk individuals,” she added. “So, not quite a preventative effort has been made yet – but focus on the number of cases.”

The numbers of these cases are on the rise. The number of probable or confirmed monkeypox cases in the United States more than doubled in one week, jumping from 866 to 1,814 between July 11 and 16.

The latest count from the US Centers for Disease Control and Prevention showed that more than 2,000 probable or confirmed cases of monkeypox have been reported across the country.

Freeman said providing more doses of the vaccine to cities and counties across the country — especially those with high cases — could help slow the spread of the virus.

Although monkeypox is not a sexually transmitted disease, it is spread by skin-to-skin contact, and in the current outbreak, the virus is mostly spread among men who have sex with men.

The Centers for Disease Control and Prevention (CDC) estimates that more than 1.5 million men who have sex with men are eligible for the monkeypox vaccine in the United States.

As of Tuesday, more than 190,000 doses of the Jynneos vaccine — a two-dose regimen made by Bavarian Nordic to prevent monkeypox and smallpox — have been withdrawn from the Strategic National Stockpile to support local monkeypox response efforts, according to the U.S. Department of Health and Human Services.

But some local health officials told CNN that this was not enough to meet demand.

“The numbers are clearly increasing.”

For health officials in Dallas County, Texas, the summer began with monkeypox screening.

In early June, the country identified its first case of monkeypox as part of a 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.

However, the number of cases in Dallas County remained at only a handful — all of whom reported a history of international travel and identified themselves as men who had sex with men.

But after about a month, the number of cases in the county rose.

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Philip Huang, director of the Dallas County Department of Health and Human Services, told CNN Wednesday at a conference of the National Association of County and City Health Officials.

“We are trying to control and contain it, but the numbers are clearly increasing,” he said.

Over the 4th of July weekend, health officials identified a confirmed case of monkeypox in a person visiting the Daddyland Festival, a four-day episode of ballroom dancing with live DJs, nightclub events and pool parties.

The person reported attending festival events and special parties during infection, according to Dallas County Health and Human Services, which added that “there is a concern of local and community transmission for anyone who has attended these events and participated in activities that pose a significant risk of monkeypox transmission.”

At the Daddy Land Festival, Huang said, “thousands of people, mostly men who have sex with men, were attending from all over the country and all over the state. They were coming to party, and this party had a lot of close connections.”

At about that time, county health officials were notified of an out-of-state visitor with confirmed monkeypox who reported multiple sexual encounters in the sauna at the private men’s club Dallas Club between June 22 and 25. have sex with men.
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“He’s not in favor of men who have sex with men,” Huang said. “But there are circumstances and events that made that where we see most cases and transfer them.”

As of Friday, 29 cases of monkeypox have been confirmed in Dallas County residents, and health officials have issued public notices about potential exposure at the Daddyland Festival and Dallas Club. Huang said most of those infected developed swollen lymph nodes and lesions or blisters on the skin characteristic of monkeypox.

“It’s going to be really important for people who have attended these events to be responsible, to monitor themselves if they have attended these events, and if they are in that group, maybe they postpone participation in these events for the time being until this issue is resolved,” Huang told CNN. that.

Across Texas, 81 probable or confirmed cases have been reported, according to CDC data.

“For the general public, unless you are attending these kinds of events or with people who have attended these events and have been in close contact, the risk is very low,” Huang said. “If you go to the event and there is a group of people who are in it, you have a higher risk.”

Sex and stigma

Public health officials stress that anyone who comes into contact with someone with an active monkeypox infection can be at risk of contracting the virus — regardless of their sexual orientation — and that the disease should not be stigmatized.

“Anything with a stigma, people won’t want to report it,” Patrick McGough, executive director of the Oklahoma City-County Department of Health, told CNN at a public health conference on Wednesday. According to CDC data, his case has a total of three probable or confirmed cases of monkeypox.

There is still some concern that more people may get monkeypox but they have not been tested. These cases can then go unreported.

“There is an unknown nature to a lot of sex and stigma,” Freeman said.

“There’s also education about 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 in health education and testing promotion.”

For example, “In California, we hear that restrooms are still an area where they focus health education efforts because those restrooms focus specifically on men who have sex with other men, with many anonymous partners, in one place,” Freeman said.

But as more people are tested, more cases can be identified, and “we’ll find out more about how widespread it is.”

In addition, it remains unclear whether the virus is mostly spread through sexual transmission or through other forms of skin-to-skin contact.

“We’re really trying to understand what skin-to-skin contact means and how long it takes for it to travel,” McGough said. “They seem to be group events where there is a lot of skin contact or sexual contact, but it’s not an exclusively sexual disease, and it’s not limited to one group like MSM.”

McGough said that kissing, intercourse or just rubbing are all examples of the ways the virus appears to spread from person to person, based on contact-tracing investigations into the current outbreak, and it “makes sense” that the spread would occur when an infected person develops a rash or blisters on their skin. Skin.

“Availability of the vaccine at this time is still limited.”

Local health departments across the United States are learning more about how monkeypox spreads through contact tracing, and the practice of identifying and interviewing people who have tested positive for the virus.

In addition, the US Department of Health and Human Services announced last month that monkeypox testing would expand to five commercial laboratories: Aegis Science, Labcorp, Mayo Clinic Laboratories, Quest Diagnostics, and Sonic Healthcare.

According to Huang, monkeypox testing “wasn’t really a major limitation in Dallas County yet,” and the timeline wasn’t turning out the results. But he said there could certainly be room for improvement in vaccination.

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“There is no vaccine available yet,” Huang said, at least outside of the country’s largest cities.

“Availability of the vaccine at the moment is still limited,” he said. “Texas wasn’t one of the high-priority communities like New York, Los Angeles, and Chicago initially who got higher amounts of the vaccine.”

The Los Angeles County Department of Public Health announced that, starting Wednesday, the monkeypox vaccine will be available to men who have sex with men and to transgender people diagnosed with gonorrhea or syphilis in the past year, who are in pre-exposure to HIV. . Prevention, have attended or worked in a place in the past 21 days where they had anonymous sex or sex with multiple partners, such as saunas, baths, or sex parties.

Los Angeles County received an additional 9,000 doses of the Jynneos vaccine last week and expects 7,000 more this week.

Meanwhile, Dallas County health officials have had to limit vaccinations to “people who have physical direct skin-to-skin contact with a person who has tested positive for infection,” Huang said. With more vaccines made available, “we will be able to open it up to more people who are at higher risk, or who have attended an event.”

He added that just over 100 doses had been given in his county.

The financial burden of monkeypox

Besides the need for more vaccinations, there could be additional costs to local health departments, McGough said.

“We’re looking at getting additional manpower to help do some surveillance. We’re monitoring people who have been exposed for about 21 days after they have symptoms,” Huang said in Dallas County. “But if we can get more vaccines, then we can start giving that vaccine more widely to people at higher risk. It looks like it’s going to take some time.”

In Oklahoma City, where McGough is based, the Department of Health is helping monkeypox patients isolate by providing meals and other resources if needed, and staff check infected patients to monitor their symptoms and take care of their potential health needs.

If monkeypox cases were to rise, McGough said, “it would be a huge financial burden.” “We have to prepare for that if that happens.”

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