What do you know about monkeypox in San Francisco now

The number of monkeypox cases is increasing in San Francisco, with the city reporting 197 cases as of Tuesday, compared to 141 just a few days ago. Despite the growing demand, vaccines are still in short supply. On Wednesday, people waited in line at San Francisco General for up to nine hours to get Jynneos, the only shot specifically approved to prevent monkeypox, while many researchers were turned away from a vaccine. No deaths have been reported in the outbreak in the United States so far, although the rash caused by the virus can be painful and last for two to four weeks.

To get perspective on the situation in the city, we emailed an infectious disease expert at the University of California, San Francisco, Dr. Monica Gandhi, whose work on HIV has informed her view on monkeypox.

SFGATE: How worried are you about monkeypox in San Francisco?
Dr. Monica Gandhi: I am concerned about the most affected population, men who have sex with men (MSM) with multiple sexual partners, and are very excited to get vaccinated as soon as possible. I’m not too concerned for the general population as the risk factors for this infection seem to be well defined (of the 197 cases in Florida, the vast majority of cases were in men who have sex with men).

Svagat: Do you think there are countless cases of monkeypox?
Gandhi: Monkeypox usually appears with the lesions and I think awareness has been raised so I hope the number of cases will not be reduced drastically at this point. Our testing capacity has increased, which is also important.

Svagat: The San Francisco Department of Public Health ordered 35,000 vaccines, but received only 3,580 in an initial shipment and 4,163 more vaccines this week. How worried are you about the shortage?
Gandhi: I’m so concerned about the monkeypox vaccine shortage, and I wrote an article in The Atlantic on June 24 lamenting the vaccine supply shortages and how we’re not reacting to this outbreak. A month later, I’m horrified that we still don’t have the vaccine we need.

Jynneos, the only vaccine approved specifically to prevent monkeypox, is in short supply in San Francisco where demand for the vaccine is high.

Bill O’Leary/Washington Post via Getty Images

Svagat: How should we allocate vaccines in this time of tight supply?
Gandhi: The usual dosing strategy for monkeypox vaccine is one dose followed by a second dose four weeks later. I would advocate the first-dose strategy that was used for the COVID vaccine in the UK, Canada and India at the start of the vaccine launch when supplies were limited. This means that we give one dose now to get as many doses as possible to the MSM followed by the second dose as the vaccine supply increases. I also think we should delay vaccinating those who received the smallpox vaccine (which ended around 1970 in the US, so for those born before that) because those individuals would still likely have some protection against monkeypox. Then, when the vaccine supply increases, we can expand the doses to all MSM who want to be vaccinated. Finally, if we start to see significant increases in monkeypox infections in heterosexual populations (which is not happening now), the vaccine would be offered more widely to all sexually active individuals at that time.

Svagat: Who is most likely to get monkeypox and who should be vaccinated?
Gandhi: Currently, all men who have sex with men who have multiple sexual partners and who have not had the smallpox vaccine (most were born in 1970). Later, we’ll likely extend this to men who have sex with men with more limited sexual partners and those who have had the smallpox vaccine.

Svagat: I’ve heard conflicting information about whether focusing monkeypox coverage on the LGBTQ community is beneficial or harmful. What’s your opinion?
Gandhi: I think the focus on the LGBTQ community is very helpful. Just as MSM have a higher risk of contracting HIV, and older adults are at a higher risk of developing complications and death related to COVID, it is important to identify which populations are most at risk of developing monkeypox so that we can prioritize messages and resources directed towards those groups. With HIV, it was not helpful to say that all risk factors were the same (eg, anal sex is more dangerous than oral sex) and that all groups were at risk, and the same was true for monkeypox.

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