CA releases new guidelines for those with monkeypox

  • by Cynthia Laird, News Editor
  • Friday August 19, 2022
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Dr. Tomás Aragón is the director of the California Department of Public Health. Photo: Courtesy CADPH
Dr. Tomás Aragón is the director of the California Department of Public Health. Photo: Courtesy CADPH

A top California public health official on Friday told reporters that new guidelines for people who contract monkeypox provide more specificity than national guidance, in an effort to be of more practical use. Meanwhile, nonprofit service providers from across the Golden State are seeking an emergency infusion of nearly $40 million from state lawmakers to support their monkeypox response activities.

At the same time, Dr. Tomás Aragón, director of the California Department of Public Health and the state's public health officer, said that health departments around the state have shifted to intradermal administration of the Jynneos vaccine in an effort to provide immunizations to more people. One vial of the vaccine is now used for five doses. San Francisco announced it was beginning the new vaccine administration August 18.

"This is transition week," Aragón said on the call. He said that despite some medical professionals who are skeptical of the new dosing regimen, the immunity level is the same. Intradermal vaccinations are given just under the skin, similar to how people have received tuberculosis skin tests.

Going forward, when health officials note the number of vaccines, they will be referring to doses. "The federal government has moved from counting vials to counting doses," Aragón said. "We do our calculations on doses."

As of August 18, California reported 2,660 probable or confirmed cases of monkeypox, which Aragón said the state is now referring to as MPX to avoid using the word "monkey." Those cases were in 36 local health jurisdictions. There have been 62 hospitalizations and no deaths, he said.

Aragón also made it clear that state officials are prioritizing reducing stigma, especially toward the LGBTQ community. The vast majority of monkeypox cases are among men who have sex with men. He discussed recent reports that show Latinos and Blacks are being disproportionately affected but noted that the number of Latinos affected so far, about 38.8%, lines up with their representation in the state.

"I am hearing that in San Francisco there's a higher proportion of Latinos than in their population," he added.

In San Francisco, as of August 10, Latinos comprised 28% of monkeypox cases, while they comprise only 15.7% of the city's population, according to U.S. Census figures from 2021.

The Bay Area Reporter asked Aragón about the progress of using the state's My Turn vaccination appointment system used for COVID for monkeypox vaccines. Dr. Susan Philip, San Francisco's health officer, told the Board of Supervisors at its special August 8 meeting that the system change should be in place by the end of the month.

"We're working on that right now," Aragón said, adding that there were challenges due to the state often not knowing how much of the monkeypox vaccine would be available.

In Long Beach, the city's health department has transitioned to the My Turn system effective August 19. According to a news release, the change will help manage efficient and equitable vaccine distribution as supply increases.

New guidelines

Regarding the new guidelines issued August 18 about how people should isolate if they contract monkeypox, Aragón said the goal is focused on home isolation. Asked what the difference is between state guidelines and those issued by the federal Centers for Disease Control and Prevention, he said, "We get a little more specific on what people can do."

People who have contracted monkeypox should isolate at home until the lesions are completely healed and a fresh layer of skin has formed at lesion sites, CDPH stated in the new guidance.

CDPH stated that persons with MPX who live with other people should take several precautions at home until all skin lesions are healed (i.e., scabs have fallen off, a fresh layer of skin has formed at the lesion sites), and other symptoms have been resolved for at least 48 hours.

People should keep skin lesions covered. They should stay in a separate room and use a separate bathroom, if possible. If the same bathroom must be used by others, it should be cleaned and disinfected after use by the person with monkeypox.

When in the same room, both the person with MPX, as well as other household members, should wear a respirator or a well-fitting mask when in close contact (e.g., within six feet) for more than a brief encounter.

Clean and disinfect frequently touched items following CDC guidance. If cleaning and disinfection is done by someone other than the person with MPX, that person should wear, at a minimum, disposable gloves and a respirator. If cleaning and disinfection is done by someone other than the person with monkeypox, that person should wear, at a minimum, disposable gloves and a respirator.

Disinfect or launder items that have been worn or handled by the person with MPX, following CDC guidance. Persons with MPX should handle their own laundry, if possible, and shaking of linens should be avoided. If laundry is done by someone other than the person with MPX, that person should not shake laundry, and, at a minimum, should cover arms, and use disposable gloves and a respirator.

How it spreads

While anyone can get monkeypox, the current outbreak is primarily affecting men who have sex with men and their sexual partners.

In its guidelines, CDPH stated that monkeypox can spread person-to-person through: direct skin-to-skin contact with the lesions or scabs, or direct contact with body fluids such as drainage from skin lesions or saliva that was in contact with oral lesions; respiratory secretions, such as saliva, during prolonged, face-to-face contact or during intimate physical contact, such as kissing, cuddling, or sex; and touching items (such as objects, surfaces, clothing, and linens such as bedding and towels) that previously touched lesions or body fluids from people with monkeypox.

More rarely, handling contaminated linens could release monkeypox virus into the air, potentially enabling inhalation of virus. The virus can survive for varying lengths of time on surfaces or objects (though it is still unknown as to how long the virus remains on different types of surfaces), the CDPH guidelines stated.

State officials stated that they are still learning about how monkeypox is spread in this current outbreak. "However, it is thought that the most common route of transmission during the 2022 global monkeypox outbreak is direct (i.e., skin-to-skin) contact with monkeypox lesions, including but not limited to contact that occurs during sexual activity and close contact within households," CDPH stated in the guidelines.

Monkeypox lesions are infectious at all stages until lesion scabs separate and a fresh layer of skin has formed at lesion sites, CDPH stated. Lesions may be present in locations that are not externally visible such as the mouth, throat, anus, or vagina. Monkeypox virus may be present in other body fluids, including blood, urine, feces, and semen. However, it is not known if or how transmission can occur via those routes, the guidelines stated.

More help requested

Meanwhile, Los Angeles-based APLA Health this week called for increased state and federal resources to address the monkeypox outbreak.

A news release stated that APLA Health led a group of over 50 organizations in sending a letter to Governor Gavin Newsom and legislative leaders. Because the current legislative session ends later this month, APLA Health and the other organizations urged lawmakers to "take immediate action" to halt the course of the current outbreak and prevent monkeypox from "becoming further entrenched in the LGBTQ+ community and other vulnerable communities across California," the release noted.

The letter asks for $38.5 million to support monkeypox response activities at CDPH and local health departments. This includes scaling up outreach and education efforts, vaccine clinics, emergency staffing, improving data collection, and accelerating access to treatment.

The organizations want the state to provide reimbursement for monkeypox vaccine administration. While vaccines are distributed by the federal government, APLA Health stated that there is no dedicated funding for the "significant costs associated with vaccine administration at community clinics like APLA Health with large numbers of LGBTQ+ patients," the release stated.

The state should also require paid leave and financial support for those affected by monkeypox, the letter stated. Similar to COVID-19, California should provide disability and paid leave benefits for those who need to take time off work to be vaccinated, seek testing, isolate due to a positive diagnosis, or care for a family member or loved one affected by the virus.

The organizations also want the state to make publicly available demographic data for those affected by monkeypox. The letter referenced information that shows, as the B.A.R. recently reported, Black and Latino LGBTQ+ community members in some parts of the country are receiving a fraction of the limited vaccine supply in comparison with their white counterparts.

APLA Health also continues to ramp up pressure on the federal government to improve its response to the monkeypox outbreak, the release stated. On July 20, APLA Health CEO Craig E. Thompson was joined by Assembly Speaker Anthony Rendon (D-Los Angeles), Los Angeles County Supervisor Hilda Solis, and local LGBTQ+ leaders for a news conference to demand stronger leadership from the federal government. APLA Health also endorsed a letter from more than 100 members of Congress urging the Biden administration to dedicate $100 million to support monkeypox response efforts.

This week, APLA Health strongly supported a letter from Congressman Adam Schiff (D-Los Angeles) and 10 members of the LA County congressional delegation to U.S. Health and Human Services Secretary Xavier Becerra highlighting the urgent need to procure and distribute additional monkeypox vaccine doses — particularly for areas like LA County that have been hardest hit by the current outbreak.

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