Calls grow for more action on monkeypox
As disease spreads, lack of vaccine and outreach frustrate LGBTQ community.
Community health and LGBTQ rights leaders in California are demanding a much more aggressive response to monkeypox from government and health agencies, saying shortages of vaccines and limited public outreach are exacerbating the outbreaks.
Confirmed cases of monkeypox across California have climbed by 65% in the last week, from 85 to 141. There were 47 confirmed and probable cases of the virus in Los Angeles County as of Thursday — an almost 60% increase since last week — and in San Francisco, cases have more than doubled in a similar time frame, rising from 16 to 40.
While monkeypox is nowhere near as contagious as the coronavirus, officials said they are concerned about the increase in infections. The cases in both counties are spreading primarily among men who have sex with other men, health officials said, as has been the trend since the outbreak began in early May.
Monkeypox is primarily transmitted by skin-to-skin contact with someone who has a rash and pus-filled skin sores, which are filled with the virus. In some cases, the rash has appeared first in the genital area and in or around the anus. Symptoms can include fever, aches, chills, exhaustion, sore throat and swollen lymph nodes, and the skin lesions can be so intense that patients are prescribed painkillers.
Transmission likely accelerated at Pride events attended by gay and bisexual men in June. The month is a season of travel for many gay and bisexual men, with Pride events held in major cities — in California, the U.S. and abroad — every weekend in June. This weekend, the city of Long Beach is hosting its Pride parade and celebrations. As reports of infection and exposure have increased, there is a clamor for vaccinations, and widespread frustration about the inability to get the shots.
“What we need most immediately is warnings and public announcements by the county Department of Public Health — which we have not had,” said Michael Weinstein, president of the L.A.-based AIDS Healthcare Foundation. “We’re not treating this seriously enough.”
Local health officials say their job is severely limited by the shortage of monkeypox vaccines, which they hope can soon be ramped up with promised federal shipments.
“Until about a couple of days ago, we only had 1,000 doses” of the Jynneos vaccine in L.A. County, said Barbara Ferrer, the county’s
public health director. “We’re doing everything we can to have an equitable distribution of what is, at the moment, a scarce supply of this vaccine.”
Ferrer said that initial allotment has nearly been exhausted, but 6,000 recently arrived additional doses will allow some expansion — but not nearly enough to meet demand. Ferrer said she expected vaccine supplies would be scarce at least through August.
As of last week, the L.A. County Department of Public Health was limiting Jynneos vaccine doses to people confirmed by officials as having intermediate- or high-risk contact with a confirmed monkeypox case, or people who attended an event where there was high risk of exposure to someone with confirmed monkeypox through skin-to-skin or sexual contact.
Ferrer said her department on Friday will announce a broadening of eligibility for the vaccine to people identified by a healthcare provider as being at higher risk for monkeypox.
Ferrer did also say that the county health department has been using social media to alert people about monkeypox. The Jynneos vaccine can help prevent monkeypox illness even after a person is exposed to the virus. But Weinstein said he would like to see much more messaging and prevention education, especially for those most vulnerable.
“I understand the concern about stigmatizing gay men, but if our concern about not stigmatizing [these groups] trumps actually informing them, that’s a major problem,” Weinstein said.
“We have to urge the county as well as the federal government to do community engagement. The way we got a handle on HIV in this country was to engage with communities.”
The Jynneos vaccine is administered in two doses, 28 days apart.
A person is considered protected two weeks after the second dose, meaning that it takes about six weeks after the first dose for a person to be considered fully vaccinated. It can take one to two weeks before a person exposed to monkeypox develops symptoms.
It is possible for someone to develop a pus-filled skin sore and not be aware of it, and it’s also possible for someone to develop such sores in their mouth, making it possible they could breathe out the virus and infect other people during close contact, such as cuddling, kissing or sex. Touching clothing or fabric that previously touched the virus can also spread monkeypox.
The illness can last two to four weeks. The rash can progress across the body, and eventually scab over before the scabs fall off. People are not contagious once all scabs have fallen off.
Ferrer urged people who have any signs or symptoms of monkeypox to see a healthcare provider immediately.
While some in the LGBTQ community are warily comparing monkeypox to the beginning of the HIV/AIDS epidemic, Stuart Burstin, the AIDS Healthcare Foundation’s interim national director of infectious diseases, said there is one major difference: the visible lesions.
“You can see it, you can prevent it,” Burstin said. “Right now we have a window of opportunity . ... It’s important to jump on top of it, but it’s not helpful to try to raise more fear and trepidation; prevention is the key.”