The U.K., Germany and parts of Canada are starting to see fewer new monkeypox cases, suggesting a slowing down of outbreaks that have exploded across countries where the virus is not endemic.
In the U.S., the outbreak in New York City, where a third of the U.S. cases are, may also be on the decline, according to new data from the city’s health department. And the Philadelphia Health Department received confirmation from the Centers for Disease Control and Prevention (CDC) that the federal government has reversed its decision to cut the number of vaccines to the city. Philadelphia has 257 reported cases of monkeypox in the city, a 26% increase over the past seven days.
Nationally, NPR reports gay bars and other queer venues are working to disseminate information about how to stay safe from monkeypox, without adding to rising stigma over how the disease is transmitted.
But within the positive news are other new data on what the World Health Organization (WHO) and Biden administration have designated a health emergency.
There are 15,909 cases in the U.S. as of August 23, with cases in all 50 states as well as D.C. and Puerto Rico. Wyoming was the last state to report a case on August 22.
In the tri-state there are now 443 cases in Pennsylvania, 420 in New Jersey and 19 in Delaware. New York leads the nation with 3,019 cases. Other hot spots are California with 2,663 cases, Florida with 1,638, Texas with 1,340, Georgia with 1,220 and Illinois with 970.
Over the last month, the number of reported cases has increased from 97 per day in July to more than 1,300 per day as of Aug. 10, according to the CDC.
The majority of monkeypox cases have been transmitted via prolonged skin-to-skin contact. Over 98 percent of U.S. cases are among men who have sex with men, including people who identify as gay, bisexual, transgender and nonbinary.
The CDC continues to stress there is no evidence monkeypox is a sexually transmitted disease and that anyone can be infected through close prolonged contact. While the virus is not a sexually transmitted infection, a study in the New England Journal of Medicine estimated 95% of monkeypox infections were being acquired through sex, particularly sex between men.
Globally there are 44,503 cases in 96 countries, only seven of which have endemic monkeypox. The U.S. continues to lead the world in cases, with the next highest case counts being in Spain, the U.K., Germany, Brazil, France and Canada.
In a press briefing on August 17, Dr. Rosamund Lewis, WHO’s technical lead for monkeypox, detailed reports of breakthrough monkeypox cases in people who were given a prophylactic monkeypox vaccine after being exposed to the virus. Lewis said, “We have known from the beginning that this vaccine would not be a silver bullet, that it would not meet all the expectations that are being put on it and that we don’t have firm efficacy data or effectiveness data in this context.”
She explained that as with all vaccines, most recently those for COVID-19, there is not 100% efficacy. She said, “The fact that we’re beginning to see some breakthrough cases is also really important information because it tells us that the vaccine is not 100% effective in any given circumstance, whether preventive or post-exposure. We cannot expect 100% effectiveness at the moment based on this emerging information.”
Lewis continued, “What we’re seeing are breakthrough cases, which are not really surprises, but it reminds us that vaccine is not a silver bullet, that every person who feels that they are a risk, and appreciates their own level of risk, and wishes to lower their own level of risk have many interventions at their disposal, which includes vaccination where available but also protection from activities where they may be at risk.”
Despite this new data from WHO, vaccines remain integral to the containment of the outbreak, which makes the latest news from the Philadelphia Department of Public Health (PDPH) particularly welcome.
In a press release August 22, the PDPH explained that they had received confirmation from the CDC that Philadelphia “will now receive 3,305 vials of JYNNEOS vaccine in addition to the 720 vial allotment announced last week.”
Distribution of vials will occur between August 22nd and September 30th in three portions, PDPH said, adding, “The Health Department successfully placed its first of the three orders of 1,120 vials and will order the second portion once 85% of the first order has been administered.”
Health Commissioner, Dr. Cheryl Bettigole said she “is deeply grateful to our federal partners for this additional allocation of vaccine, which is so greatly needed in Philadelphia right now. Coupled with the shift to the dose conserving intradermal approach, this gives us the opportunity to vaccinate far more Philadelphians at high risk of infection and hopefully to prevent the outbreak from spreading further.”
PDPH said it “continues to engage with community partners to design the most equitable distribution strategy and will disclose details in the near future.”
One of those partners is the Mazzoni Center, which told PGN on August 23 that as of August 22, Mazzoni is “doing the 1/5th dosing — though 5 doses per vial is not guaranteed. More likely 3 or 4 doses, but still expands availability.”
Between July 22, the first date Mazzoni had doses available, through August 19, the health center has administered 642 doses of vaccine and has 100 more vials available.
PGN asked the PDPH if there were plans to address the seeming racial biases in vaccine distribution that PGN and other local outlets have reported. James Kyle, a spokesperson for the department told PGN, “The latest delivery was only requested [Monday] and we do not have those extra doses yet. In the meantime, to be clear, as the statement suggests, we are keenly aware of the deficiencies you mentioned and are currently engaging with our community partners to put together the most equitable distribution strategy.”
Kyle said, “The plan has not yet been fully formulated. As soon as it has been finalized, we will be disclosing the details.”
Larry Benjamin, Director of Communications at Mazzoni, told PGN that on August 22, “We had a press conference with Rep. Malcolm Kenyatta, Philadelphia Health Commissioner Dr. Cheryl Bettigole and regional director of U.S. Health and Human Services, Dr. Ala Stanford.”
In that meeting, some of the concerns about racial bias and equitability were raised, as CBS news reported. President and Executive Officer of Mazzoni Center Sultan Shakir said, “We must make sure quality care is getting to those who need it most.”
Stanford, who started the Black Doctors Consortium to deal with vaccine inequities during the COVID pandemic, is now regional director for HHS. Stanford said, “Unfortunately, it’s a story we’ve seen before. We have to have trusted messengers, leaders, providers administering the vaccine, doing the educating, making the community more aware.”
Kenyatta noted “It is not a gay disease. It can impact anybody, but in the LGBTQ community, there is a long history here of understanding what can happen.”
After meeting with Stanford and Bettigole, Benjamin told PGN, “We’ve been assured that more vaccines have been allocated and that doses will continue to be available. We’re working with the city and other health care providers to get clearer information out to the public and to create systems to vaccinate at-risk groups who aren’t connected to traditional healthcare.”
Benjamin added, “On the clinical side, there is continued interest and demand from patients for the vaccine. Our healthcare team is performing regular clinical evaluations for symptomatic folks.”
For more info on how to get vaccinated, contact Mazzoni Center at (215) 563-0652 or the PDPH at (215) 686-5200.