Federal officials foresee potential mpox resurgence as local health experts urge vaccination

  • by John Ferrannini, Assistant Editor
  • Wednesday April 26, 2023
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The San Francisco Department of Public Health is expected to offer mpox vaccines at community events leading up to Pride in June. Photo: Gooch
The San Francisco Department of Public Health is expected to offer mpox vaccines at community events leading up to Pride in June. Photo: Gooch

San Francisco's public health community continues to urge people to get vaccinated for mpox after a federal Centers for Disease Control and Prevention report concluded that the United States may see a worse outbreak of the disease this year than in 2022. Locally, mpox vaccinations are expected to be offered at community events leading up to Pride in June.

But both the San Francisco Department of Public Health and the San Francisco AIDS Foundation stressed to the Bay Area Reporter that last year's vaccination efforts paid dividends — the city hasn't seen a case since January 20, according to DPH's seven-day rolling average — and also put the city on a better track to face a potential resurgence.

"Last year, SFDPH and the community came together to stop the spread of mpox, and over 50,000 doses of the vaccine have been administered in San Francisco," the department stated to the B.A.R. "Forty-two percent of all people living with HIV in San Francisco, and 65% of people who had received PrEP at SF City Clinic prior to June 2022 had received at least one dose of mpox vaccine as of November 4, 2022. This is significantly higher than CDC's nationwide estimate, that nationwide, 23% of the 'at-risk' population has been vaccinated."

In the report the CDC published March 30, prognosticators predict with "moderate confidence" that because of those low national numbers — and in nine mostly Southern states, the percentage of the at-risk population that's fully vaccinated is in the single-digits — "if mpox reintroduction occurs and no additional vaccination or sexual behavior adaptations occur, the risk of a resurgent mpox outbreak is greater than 35% in most jurisdictions in the United States."

"Resurgent outbreaks in these communities could be as large or larger than the 2022 outbreak. This is because immunity is relatively low in populations who are highly affected," the report continued. "In jurisdictions where immunity is higher in these populations, the risk is anticipated to be low over the next year, although a renewed outbreak could occur. These jurisdictions include most jurisdictions that had large mpox outbreaks in 2022, such as California, the District of Columbia (DC), Illinois, and New York."

Tyler TerMeer, a gay Black man who is the CEO of the San Francisco AIDS Foundation, told the B.A.R., "I think we want to exercise an appropriate amount of caution and prevent fear but be grounded."

During last year's outbreak, which started in the spring, SFAF was in the forefront of calling for greater supplies of the Jynneos vaccine. The mpox outbreak in the Bay Area mostly affected men who have sex with men and their sexual partners. The vaccine, which was distributed by the federal government, was slow to arrive but eventually there were enough supplies so that anyone could get vaccinated.

"I've had a couple internal and community convos about whether or not we should have a significant concern about an mpox surge," TerMeer said. "We are really asking folks who didn't get their second dose to get vaccinated."

The Jynneos vaccine requires two doses, ideally given about a month apart. But health officials said that people who have not yet gotten that second shot should do so.

The city stopped publishing vaccination data December 31, and never tracked the prevalence of vaccine uptake in men who have sex with men and people with multiple sex partners. As of that date 28,874 residents were reported vaccinated.

The daily rolling seven-day average of residents being newly vaccinated, which peaked at 739 on August 15, fell to just five by the end of the year, when DPH stopped collecting data.

"Here locally we have seen a significant decrease since the height of the mpox outbreak and we haven't seen any confirmed cases at Strut since the height of what happened previously. But with Pride and festivals coming up, it's very important that folks who didn't receive both doses check in," TerMeer said, referring to SFAF's community health center in the Castro where the Magnet sexual health center is located. "It's an important time to incorporate mpox vaccination into your sexual health routine as we head toward Pride and the summer season."

Vaccination urged

The health department also tied the need to get vaccinated to the upcoming summer season.

"SFDPH looks forward to offering the mpox vaccine at community events in the lead-up to SF Pride," the department stated. "The virus has not gone away, and it is still important for people to protect themselves. We expect that we will see occasional cases in San Francisco. Anyone who wants protection from mpox may receive the vaccine.

"We strongly recommend and encourage vaccination for all people living with HIV, anyone taking or eligible to take HIV PrEP, and all men, trans people, and nonbinary people who have sex with men, trans people, or nonbinary people," DPH stated.

TerMeer said that Magnet is offering vaccinations every day and that it's "significantly easier" than last year, when video of long lines of people seeking a then-tight vaccine supply — sometimes lining up in the wee hours of the morning — dominated news coverage.

"I think if someone needs an mpox-related appointment at SF General [Hospital] or Magnet, there's no longer a waiting list-type system," TerMeer said. "I think if you need it, you can get it."

The health department stated that it will "remain vigilant in responding to outbreaks as needed."

"Health systems, community clinics such as San Francisco AIDS Foundation's Strut clinic, and SFDPH-affiliated sites, including our sexual health clinic SF City Clinic, will continue to offer vaccines, tests and other mpox resources," it stated.

The Jynneos vaccine was originally developed to prevent infection with the smallpox virus, which is related to the mpox virus. When faced with a shortage during last summer's outbreak, the Biden administration allowed the remaining doses to be split into fifths and injected in the forearm, instead of in the muscle. This remains the way Jynneos is administered.

The department maintains an FAQ webpage that also links to a page that shows upcoming vaccination appointments available in San Francisco for mpox, the flu, and COVID-19.

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