Organizers of two large pre-Pride dance parties have alerted attendees that people known or suspected to have monkeypox were present at the events. Steamworks bathhouse in Berkeley has also warned patrons about potential exposure. On July 5, the San Francisco Department of Public Health updated its count of known or probable monkeypox cases to 40, more than doubling since last week.
Comfort and Joy, the queer community and arts collective that hosted the Afterglow party on Saturday, June 25, sent an email blast last week stating that it had received a "plausible report" that an attendee tested positive for monkeypox. Organizers of the Electroloxx pride party on June 24 posted a similar alert on the event's Facebook page Tuesday afternoon.
In an email message dated July 5, Steamworks management said the Berkeley Department of Public Health informed them that "over the past month, some of our members have been either a confirmed or a probable case of monkeypox." These members visited the bathhouse May 27-29, June 3-4, June 10, and June 17.
Ken Rowe, co-owner of Eros sex club, which reopened in the Tenderloin June 24, said they have not received any notifications about monkeypox cases from DPH.
The hosts "took a really smart, proactive approach," Frank Strona, who leads the San Francisco Department of Public Health's monkeypox incident management team, told the Bay Area Reporter in a July 5 interview. "We think it's great that they reached out."
San Francisco DPH is urging anyone with new rashes or sores to seek medical care and get tested for monkeypox. People at high risk may be eligible for a vaccine, but the supply is currently limited.
"If you had a lot of close physical intimate contact that puts you at the higher risk level, we want to get you vaccinated first," Strona said. "Then, as we get more vaccine in from the state, we'll be expanding it so that more and more people who fall into those next areas of risk would be included."
Jarrod Stanley of Comfort & Joy stated in an email that the group's first concern is the community's health and safety.
"We received one report via an anonymous email that a single attendee at our June 25 Afterglow Pride event is now showing clear signs of monkeypox. This same notification was sent to the organizers of two other Pride weekend events. After brief due diligence, we determined the report to be plausible. To best protect our friends and community members, we elected to make a public announcement about the potential exposure. C&J has not received any additional notifications of monkeypox cases related to our event," Stanley wrote.
Stanley added that monkeypox can affect anyone, "and it's critical that we not stigmatize the queer community during this outbreak."
"Social ills such as this thrive in a climate of shame. It is up to all of us to create an environment where individuals feel safe and comfortable coming forward about their symptoms or potential exposure," Stanley added. "The CDC and SFDPH depend on accurate case counts to prioritize the limited vaccine supply to areas of greatest need. If you are experiencing symptoms of monkeypox, please contact your healthcare provider as soon as possible and limit your exposure to other people."
Representatives Electroloxx did not immediately respond to emailed requests for comment.
Steamworks advised its members who were there on those days to self-monitor for symptoms.
A growing outbreak
The current monkeypox outbreak was first reported in the United Kingdom in early May. As of July 5, the Centers for Disease Control and Prevention has identified 560 cases in the U.S. California has reported the most cases, at 111, including 16 in San Francisco (before the latest update), five in Alameda County, and at least one each in Santa Clara, San Mateo, and Santa Cruz counties. Worldwide, the CDC has tallied more than 5,300 cases in non-endemic countries.
While anyone can get monkeypox through close personal contact, the virus is primarily spreading within networks of gay, bisexual, and transgender men who have sex with men. Many of these men reported multiple recent sex partners or attended venues and events where sex and other intimate contact takes place. Only a small number of cases have been identified among women.
However, because of limited testing and the challenges of contact tracing when people have sex with casual partners or attend large gatherings, many experts think the latest case counts do not reflect the full extent of the outbreak.
Monkeypox, which is related to smallpox but less severe, causes flu-like symptoms, swollen lymph nodes and a rash that can appear anywhere on the body. In the current outbreak, many men have lesions on the genitals or in the anal area. These may resemble common sexually transmitted infections such as herpes or syphilis. People with monkeypox usually recover without treatment, but the sores may be painful and those with severe disease can develop complications.
The monkeypox virus spreads through close personal contact, including skin-to-skin contact, kissing, and respiratory transmission at close range. But it does not spread through the air over longer distances like the coronavirus that causes COVID-19, according to the CDC. It can also spread via clothing, bedding, or surfaces that come in contact with fluid from the lesions. It is not yet known whether monkeypox is transmitted in semen, but it does spread through contact with sores during sex.
Limited vaccine supply
Last week, the DPH began offering monkeypox vaccines to a wider range of at-risk gay and bisexual men and transgender people in an effort to stem the city's growing outbreak, but supplies are very limited.
"The vaccine is going to be our most important tool for really getting this under control," San Francisco Health Officer Dr. Susan Philip told the B.A.R.
Smallpox vaccination can prevent monkeypox too. The virus has an incubation period of up to three weeks, so vaccines can be used for both post-exposure and pre-exposure prophylaxis. Monkeypox can be contained through targeted vaccination of close contacts of known cases, but because contact tracing can be difficult or incomplete, a broader strategy involves vaccinating people who are likely to have been recently exposed. Broader still is vaccinating individuals at risk for future infection in communities where the virus is circulating.
The city's rollout is part of an enhanced vaccine strategy released by the White House and the Department of Health and Human Services on June 28. HHS officials said 56,000 doses of a new monkeypox vaccine, known as Jynneos, have been allocated to affected communities. The agency expects to have 1.6 million Jynneos doses by the end of the year. (The United States maintains a stockpile of an older smallpox vaccine, known as ACAM2000, but it can cause adverse side effects and is not safe for people with HIV.)
San Francisco has received 560 Jynneos vaccine doses as of this week, according to DPH. It is administered as two doses a month apart. The city is prioritizing people at highest risk, including those who have had close contact with someone who has monkeypox and those who have received a notification from a venue or event about potential exposure.
While people who attended the Afterglow or Electroloxx parties fall within the DPH criteria, Strona said the alerts are an invitation to assess one's risk. Vaccinating everyone who was at a dance party with hundreds of people is impractical at this time, given limited availability.
"We're really encouraging folks to self-assess their behavior," he said. "It's one thing if you go to an event like a sex party, but the likelihood of proximity in that kind of environment is very different than a dance. If you didn't engage in more intimate close physical contact at the venue, then you're likely in a place where you can wait and see. If you did have closer intimate contact — more than just dancing around and maybe brushing against somebody — at that point follow the recommendations around seeking a vaccine."
Health officials urge anyone with a rash or other possible monkeypox symptoms to seek medical care and get tested. Currently, testing is done by swabbing lesions, and there is no test for potentially exposed but asymptomatic people. Avoid sex, other close contact and social gatherings until the results are known. People who do test positive are advised to isolate for three weeks. The virus is considered infectious until the sores heal completely and scabs fall off.
In San Francisco, people who do not have a regular health care provider can contact City Clinic on Seventh Street or the San Francisco AIDS Foundation's Magnet sexual health center in the Castro.
"What we're trying to do is disrupt the chain [of transmission] in the community," Strona said. "Think twice. If you don't feel good, stay home. If you have unusual symptoms, talk to your providers. If you are not at the highest risk, sit back for a minute and let those who are at greater risk get vaccinated. This is a great opportunity for gay, bi, trans and other men who have sex with men to really step up. We take care of ourselves and each other by being aware and by leaving room for others who are at greater risk to take care of themselves."
Click here for the latest updates on vaccine eligibility and locations.
To contact City Clinic, click here or call its new phone number, 628-217-6600. To contact SFAF's Magnet clinic at Strut, click here or call 415-581-1600.
Updated, 7/6/22: This article has been updated with comments from Comfort & Joy and additional information.
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