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Monkeypox cases drop significantly, but full vaccination lags

As has been the case nationwide, the rate of new monkeypox infections in San Diego County has continued to fall since early August, with the region’s most recent update showing the weekly totals falling to just 4 last week.

While that most recent total is likely to increase a bit — it can take three weeks after infection for symptoms to appear — the flow of new cases has slowed, but not stopped. New notifications are trickling into the official record one-by-one in recent weeks, pushing the outbreak total to 431 as of Wednesday. It’s a pace that the U.S. Centers for Disease Control and Prevention recently said it believes will be present for a long time, stating in a technical report that “low-level transmission could continue indefinitely.”

Monkeypox activity nationwide is far, far less robust today than it was just a few months ago. According to CDC records, the nation’s seven-day moving average of new cases hit 583 on Aug. 1, but had fallen to just 63 by Oct. 12. Locally, cases peaked at 57 the week of Aug. 8 before falling into the teens by late September and 4 last week.

But vaccination progress has been slow after an initial onrush of demand when outbreaks started in the spring. According to the CDC, about 615,000 Americans have received at least one dose of the JYNNEOS vaccine out of an estimated 1.7 million men considered to be at the highest risk of infection.

Locally, a little more than 15,000 at highest risk have had at least one dose with only a little more than 8,000 having received both doses needed for full protection, according to county records. That’s out of more than 60,000 across San Diego County estimated to need vaccination.

It’s a puzzling situation, given that a recent CDC field report observed that monkeypox infection rates were 14 times higher among men aged 18 to 49 who had been vaccinated at least 14 days before having the kinds of close contact known to transmit the virus.

Dr. Seema Shah, medical director of the county health department’s epidemiology and immunization branch, said Thursday that her office was sending out emails to about 3,300 local residents who received a first dose but were overdue for a second. Some, she said, are only a few days overdue, but others have waited more than a month.

“There are a number of individuals who are even, you know, 45 days out that haven’t come in for a second,” Shah said. “There is a lot of vaccine available, and we really want to get ahead of this.”

The current environment, noted Dr. Davey Smith, a translational research virologist at UC San Diego, is not seen as one that is capable of driving the number of new cases to zero. Vaccination, combined with changes in behaviors that transmit the disease, have surely been critical to bringing the numbers down to their current low levels, but have not yet become universal enough worldwide to stop the virus in its tracks.

“Basically they think it’s going to be percolating along for a long time, which is a bummer, and the reason is that they don’t think they’re going to get enough vaccinations in men who have sex with men, the highest risk people, to really knock it out,” Smith said.

Low levels of cases, he said, pose a risk that the virus will break out of its current demographic group, and those experiencing homelessness are generally at the highest risk, just as they have been in the past with coronavirus, hepatitis A and other communicable diseases.

Of course, predictions can be wrong. A significant surge in vaccination could sap monkeypox’s staying power.

Eligibility criteria, Shah noted, have broadened since the first cases began trickling in this summer. Those criteria, posted on the county’s website, remain largely based on a person’s level of intimate contact, with an emphais on “gay or bisexual men or any men or transgender people who have sex with men or transgender people.” Also included are people “of any gender or sexual orientation who engage in commercial and/or transactional sex,” those with HIV or living with someone who has HIV and also people who have had skin-to-skin or intimate contact with someone suspected of or confirmed to have had monkeypox.

“If we want to continue to mitigate the spread, more people need to get vaccinated, and the criteria for eligibility are more open than they were at the beginning,” Shah said. “If you feel like you fit into one of those categories, then absolutely go get vaccinated.”

A full list of resources, including locations where free vaccination is available, can be found by clicking the “monkeypox” heading at sandiegocounty.gov.

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