Mpox is at a low ebb in San Francisco, but public health experts caution that the virus has not gone away, and they urge gay and bisexual men to take precautions, including getting both doses of the vaccine.
"Cases of mpox in San Francisco remain low, however, we remain watchful as we want to make sure that everyone can enjoy a happy and healthy Pride and summer," San Francisco Health Officer Dr. Susan Philip told the Bay Area Reporter. "As the summer months and celebrations surrounding Pride approach, now is the ideal time for people to ensure they are protected."
Mpox cases declined dramatically late last summer, thanks to a combination of behavior change, vaccination, and natural immunity after infection. Since May 2022, the Centers for Disease Control and Prevention has tallied 30,487 mpox cases in the United States, including 846 in San Francisco. But only four cases have been reported in the city this year, two in January, one in April, and one in May.
However, a recent uptick in cases shows that the virus continues to circulate at a low level.
As the B.A.R. previously reported, health officials in Chicago have identified a cluster of 45 mpox cases, mostly among men who have sex with men, starting in late April, with five new cases last week. France, Spain, and the United Kingdom have also reported small increases in recent months, but no similar clusters have been reported this year in other U.S. cities.
While anyone can get mpox through close contact, the virus mainly spreads through sex. The overwhelming majority of cases in the United States have been among gay, bisexual, and other men who have sex with men and their sexual partners.
Mpox causes a rash that can occur anywhere on the body. Many people develop sores — sometimes extremely painful — on the genitals or in the rectum or throat. Some also have flu-like symptoms and swollen lymph nodes. People with HIV who have a low CD4 T-cell count are particularly prone to severe illness. A majority of the 42 people who have died of mpox in the United States have been Black gay men with AIDS, according to the CDC.
Mpox vaccines
The best way to prevent mpox, experts say, is to get two doses of the Jynneos vaccine administered at least a month apart. It takes about two weeks after the second dose to develop maximum immunity. People who received their first dose last year can still get the second dose now.
"It's never too late to get the second dose or start the series," White House mpox deputy coordinator Dr. Demetre Daskalakis, a gay man, told the B.A.R.
Vaccine supplies were extremely limited last summer, leading providers to switch to an intradermal technique that allows a single subcutaneous injection to be split among five people. But supplies are now ample, and most providers are again offering traditional subcutaneous vaccines.
More than half of the people in the Chicago mpox cluster were vaccinated, raising concerns about effectiveness and how long protection lasts.
A recent analysis in the CDC's Morbidity and Mortality Weekly Report found that vaccine effectiveness was 75% for one dose and 86% for two doses, with "substantial" and "comparable" protection regardless of administration method. Other studies, however, have seen lower effectiveness, especially for immunocompromised people. Given when these studies were conducted, they can't say much about whether vaccine protection wanes over time.
A bigger concern is that many people at risk for mpox have not yet gotten vaccinated.
More than 1.2 million Jynneos doses have been administered in the United States, but only about a quarter of eligible individuals are fully vaccinated and 37% have received one dose, according to the CDC. Black and Latino men who have sex with men, transgender people, and people experiencing homelessness are less likely to be vaccinated.
The vaccination rate is higher in San Francisco, with 42% of HIV-positive people and 65% of HIV-negative people on PrEP having received at least one dose, the DPH told the B.A.R. in April. But this leaves a lot of room for improvement.
Health officials strongly urge those at risk to get vaccinated, or to get their second dose if they've only had one. At this point, experts do not recommend boosters, nor do they recommend subcutaneous shots for those who received intradermal vaccines. This advice includes people who have already had mpox, as there have been some reported cases of reinfection after recovery.
Even if the vaccine does not provide complete protection against infection, it is likely to prevent serious illness. What's more, increased vaccination not only protects individuals, it also helps keep mpox under control at the community level.
"Vaccination makes getting and spreading mpox less likely and may decrease the chances of severe illness, hospitalization, and death," Daskalakis said during a May 18 media briefing. "Though no vaccine is perfect, even imperfect immunity in many people means a lot of immunity in the population, and the result is that we are less likely to have outbreaks."
DPH recommends two doses of the Jynneos vaccine for all people living with HIV, anyone taking or eligible to take PrEP, and "all men, trans people, and nonbinary people who have sex with men, trans people, or nonbinary people," according to Philip. Anyone outside those groups who wants protection can also request the vaccine.
Vaccines are available through local health systems and community clinics, such as City Clinic and the San Francisco AIDS Foundation's Strut clinic. Go to sf.gov/information/mpox-vaccine for more information about vaccination sites.
Health officials do not advise avoiding events or closing venues, but they do urge people at risk to take precautions, such as limiting the number of sex partners and not sharing sex toys or fetish gear. Condoms may offer some protection.
"Since no vaccine is 100% effective, it is important for individuals to reduce their risk of potential exposures to mpox both before and after being vaccinated," Philip said.
Regardless of vaccination status or prior infection, people who have a rash, sores, or other mpox symptoms should get tested and refrain from sex and other close contact. Most people with mpox recover without treatment, but the antiviral medication TPOXX (tecovirimat) can be used for more severe cases. People diagnosed with mpox should avoid contact for about three weeks, until the sores fully heal.
"Mpox transmission in the United States continues to be low, but people at risk for mpox should use the full toolkit to prevent the disease: vaccine, testing, and good information," Daskalakis said. Plus, he added, "People should make sure that they are up to date on other items on the sexual health checklist, including HIV and sexually transmitted infection testing, treatment, and prevention."
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