Six weeks after the first monkeypox case was identified in San Francisco, nearly all cases in the city are still occurring among gay and bisexual men, according to a report presented at the July 19 Health Commission meeting.
Meanwhile, Mayor London Breed on Tuesday sent a letter to U.S. Health and Human Services Secretary Xavier Becerra, stating that the current outbreak in San Francisco is largely affecting the LGBTQ community. She asked for more resources "to support our queer community, most critically with vaccine access."
The San Francisco Department of Public Health updated the city's monkeypox tally to 141 cases — more than double the number reported a week ago. The Centers for Disease Control and Prevention raised the national tally to 2,108, with all but seven states reporting cases.
Although anyone can get monkeypox through close physical contact, the overwhelming majority of cases in the current outbreak have been gay, bisexual, and other men who have sex with men.
The monkeypox virus spreads primarily through skin-to-skin contact and bodily fluids. Transmission via contaminated bedding, towels, or surfaces is "much less common," San Francisco AIDS Foundation medical director Dr. Hyman Scott said at a virtual town hall July 12. It is not yet known whether monkeypox is transmitted in semen, but the virus does spread through contact with sores during sex.
At Tuesday's meeting of the oversight body for the city's public health department, San Francisco health officer Dr. Susan Philip presented some long-awaited details about who is getting monkeypox in the city.
Nearly all cases (97.7%) are cisgender men, with the rest identifying as trans men. Most (88.4%) identify as gay or same-gender-loving, 1.2% as bisexual, and 1.2% as heterosexual or straight; this information is missing for about 9%.
Nearly half of the men with monkeypox are white (47.7%), somewhat exceeding their share of the city's overall population. Black men (7.0%) are also slightly overrepresented. But Latino men account for 29.1% of cases, nearly double their share of the population. In contrast, only 5.8% are Asian, falling far below their population percentage.
Philip did not report on HIV status, but according to more detailed analyses from the United Kingdom and Europe, around a quarter to half of people with monkeypox are living with HIV, and many of the HIV-negative men are using PrEP.
No cisgender or transgender women with monkeypox have been reported to DPH so far. There are also no people under age 18 in the city's current case count. This allays fears that the outbreak is spreading beyond gay men's sexual networks — a concern because young children and pregnant women are more likely to develop severe disease.
Vaccines remain in short supply
Smallpox vaccines can prevent monkeypox too. Because the monkeypox virus has a long incubation period, they can be used as both post-exposure prophylaxis for several days after exposure and as pre-exposure prophylaxis for individuals at risk. But the new Jynneos vaccine, which involves two injections given a month apart, is currently in short supply.
The U.S. Department of Health and Human Services is distributing 144,000 Jynneos doses and anticipates the arrival of 1.9 million doses during the first half of 2023, according to Philip.
San Francisco has received 3,580 doses, most of which have been distributed to local clinics, and the allocation is expected to rise to 4,163 this week, Philip said. So far, more than 2,700 people have been vaccinated.
LGBTQ and HIV advocates held a rally on Monday, July 18, to demand more vaccines from the federal government and the state. "Four thousand doses next week is not enough for San Francisco," said Tom Temprano, a gay man who's the new political director for the statewide LGBTQ advocacy organization Equality California. "We need 40,000 doses. We aren't seeing the urgency that is necessary to keep us safe."
Clinics are currently administering first doses, hoping to receive enough additional supply to give out second shots on time.
"We only feel confident that we will provide people with the correct protection if they get [both] doses on schedule," Dr. Peter Marks, director of the federal Food and Drug Administration's Center for Biologics Evaluation and Research, said during a July 15 media briefing. "We do not want people to alter their behavior thinking they're protected when they're not. A single dose of this vaccine will not provide the kind of protection over time that is necessary if people continue risky behavior."
A walk-up vaccine clinic at Zuckerberg San Francisco General Hospital and Trauma Center was forced to close late last week after running out of doses; it expects to be able to reopen on July 20. SFAF held a vaccine clinic on July 17, but it was only able to accommodate 500 of the 3,700 people on its waiting list, according to Laura Thomas, SFAF's director of HIV and harm reduction policy.
People currently eligible for vaccines include contacts of a person with monkeypox; those who received a notice from an event or venue about potential exposure; sex workers of any gender; and gay, bisexual, and other men who have sex with men and trans people who have had more than one sex partner in the past two weeks.
"Many San Franciscans need the protection offered by the monkeypox vaccine and should receive it," Philip said. But while doses are in short supply, those at greatest risk are being prioritized. "The goal is for everyone who wants a vaccine to receive a vaccine," she added. "Given the limited supply and HHS estimates, it may take six to nine months to reach this goal."
Health officials urge anyone with a rash or other possible monkeypox symptoms to seek medical care and get tested. Those who don't have a regular provider can contact City Clinic on Seventh Street or SFAF's Magnet sexual health clinic in the Castro. Refrain from sex and other close physical contact until the results are known. People who test positive should avoid close contact until their sores heal completely, which takes about three weeks.
For the latest updates on vaccine eligibility and locations, click here.
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.
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