Cases of monkeypox have more than doubled in the past week in California and the Bay Area, where health officials are joining a global battle to contain the outbreak as the virus still circulates within limited social networks.
California reported 95 cases of monkeypox as of Friday, up from 40 the previous week, according to the Centers for Disease Control and Prevention. About 460 cases were reported across the country as of Friday, up from 150 the previous week.
More than two dozen confirmed or suspected cases have already been reported in the Bay Area, with 16 in San Francisco alone as of Friday, though that number is updated only 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 spread through intimate person-to-person contact. Most people recover completely without treatment, but monkeypox can cause severe 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.
Almost all cases so far have been reported among gay or bisexual men, most of whom are believed to have been exposed through sexual or other intimate contact with someone who was infected. The risk to the general public remains very low, local and federal health officials say.
Monkeypox is nothing like COVID and is not currently — and almost certainly never will be — a crisis-level threat, experts say. But the outbreak is at a critical stage when health officials have an opportunity to quell it before cases spread further and potentially affect more vulnerable people.
“Monkeypox is not a problem on the same scale (as COVID). However, if there is an opportunity to control an emerging disease, it is important to try to do so,” said Dr. Seth Blumberg, an infectious disease expert at UCSF. “We can’t blow this off. We need political and public 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 said that outcome was unlikely given the nature of the virus and how it spreads, as and the existence of effective vaccines to stop it.
Monkeypox may also establish itself as a recurring threat, triggering new outbreaks every few years, especially if it becomes introduced into US animal populations. Or it could join the ranks of sexually transmitted infections, including syphilis and gonorrhea, that plague certain communities and have proven stubborn to control.
“It would be sickening if monkeypox were to join the list of STIs that people should be concerned about,” said San Francisco Supervisor Rafael Mandelman, who called a hearing this month to discuss the city’s public health response to monkeypox. smallpox. “We must act quickly with vaccination and stop the spread now.”
In the Bay Area, pressure is growing on health officials to make the vaccines — which for monkeypox can work before and after exposure to the virus — more widely available and to conduct more surveillance to quickly determine whether the disease is spreading outside communities in currently affected.
Most tests are performed by state labs that confirm CDC results. Stanford began providing laboratory tests for monkeypox two weeks ago in anticipation that the outbreak and demand for surveillance could grow rapidly, said Dr. Benjamin Pinsky, head of Stanford’s Clinical Virology Laboratory.
Vaccination efforts across the country are currently hampered by a lack of supply. Two vaccines are approved to prevent monkeypox, although the preferred product – called Jynneos – is in much smaller quantities. The second vaccine, called ACAM2000, has side effects that for some people can be worse than the disease itself.
Last week, the US announced plans to rapidly scale up its vaccination efforts with Jynneos. So far, about 66,000 doses have been delivered to countries with cases of monkeypox; an additional 240,000 doses are expected to come out 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 and Human Services Agency said it had 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 U.S. cases, is expected to receive about 15,000 doses by late last or early this week. Jynneos is given in two doses given every 28 days.
Bay Area counties reported receiving anywhere from 10 doses to more than 500 in San Francisco. That’s not enough to offer vaccination to everyone who might want it, so local health officials say they’re only targeting those with known exposure right now. This includes people identified through contact tracing of reported cases, people who informally heard that their partner was recently diagnosed, or those who attended an event or location associated with one or more cases of monkeypox.
“We don’t have enough for everybody,” said Frank Strona, chief of incident management for the San Francisco Department of Public Health’s monkeypox response. Strona said more than 200 doses had been administered in the city as of Friday morning. “We expect more batches every few days,” he said.
Once more vaccine becomes available, officials said, they hope to offer it to people at risk of infection but who may not necessarily have had some 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 firm, fluid-filled lesions. Most people are sick for two to four weeks and do not need treatment, although there are several medications for severe cases. Globally, several deaths have been reported this year, but none in the US
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 much beyond the West African countries where it is endemic. The United States typically sees a few travel-related cases every few years, but only one outbreak had previously been reported: 47 cases were identified in 2003, all linked to rodents imported from Ghana.
It is not clear why monkeypox suddenly spread, although experts suspect it may be a combination of the virus mutating to become more transmissible and finding strength in groups where it can spread quickly and easily.
Monkeypox is primarily transmitted through direct, prolonged contact. People are at greatest risk if they are exposed to the fluid in the lesions, such as by touching an infected person’s rash or sharing bedding or towels with someone who is infected. The virus can also pass 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 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 had sex with multiple partners.
“A small number of people have a large number of sexual contacts, and that can cause very rapid and early spread,” said Dr. Jason Andrews, an infectious disease expert at Stanford. “But that doesn’t necessarily mean it’s going to stay that way.”
Health officials note that unlike HIV and some other sexually transmitted infections, there is no connection between certain sexual practices and the spread of monkeypox — the virus simply took root in gay networks first. It can spread just as easily among heterosexual partners or among close household contacts.
Andrews said he suspects the global epidemic may begin to slow after weeks of explosive growth. He and other infectious disease experts noted that because of monkeypox’s long incubation period, cases diagnosed now are likely from exposure a week or two earlier.
The possibility remains that the virus will become established in a wider population. “The most worrisome outcome would be if it spread more widely as an endemic infection across all ages or through casual contact routes,” Andrews said. “I don’t think we have strong evidence that that’s happening right now, but we have to prepare for it.”
Erin Allday is a contributor to the San Francisco Chronicle. Email: [email protected] Twitter: @erinallday