Most new mpox cases in San Francisco are among the unvaccinated, the city's Department of Public Health told the Bay Area Reporter in a recent interview.
Dr. Julia Janssen from SF DPH's HIV/STI Prevention and Control Section said that as of November 13, 33% of San Francisco's cases in the past two months were in people who had been fully vaccinated, and 10% were in people who had been partially vaccinated. That means 57% of mpox cases occurred in people who were not vaccinated. In other words, nearly 70% of mpox cases are among those unvaccinated or partially vaccinated.
"Most people in San Francisco who are getting mpox are not fully vaccinated," Janssen said.
Janssen said that those who've been vaccinated but nonetheless develop an mpox infection generally have better outcomes than those who did not get the Jynneos vaccine. It is given in two doses spaced a month apart.
"Receiving the full two-dose series is one of the most effective ways to prevent mpox infection and can reduce illness severity, hospitalization and death," Janssen said.
To that effect, nobody thus far who was vaccinated has been hospitalized in San Francisco, Janssen said. The city has also seen no deaths.
As the B.A.R. reported October 31, that month saw the most reported cases in the city since the summer 2022 outbreak. According to DPH's most recent data, there were 20 cases in September, 22 in October, and two in November thus far.
These numbers are nonetheless significantly lower than last summer. For example, on July 31, 2022, the city's seven-day rolling average of new cases was 20.4 cases per day.
A vaccination drive among gay and bisexual men, and others at risk for infection with the mpox virus, is credited for bringing down those numbers — and vaccination is being promoted by DPH as the way to fight the uptick. The virus has largely affected men who have sex with men and their sexual partners since its outbreak in the spring of 2022.
While one dose of the Jynneos vaccine offers some protection, health officials said receiving both doses provides the best protection against the disease.
According to the San Francisco Department of Public Health in an October statement, "no vaccine is 100% effective and people who have been vaccinated may still get mpox, but vaccination may decrease illness severity and reduce the risk of hospitalization."
Over 50,000 doses of Jynneos were distributed last year in San Francisco, the city's DPH stated, covering 42% of all people living with HIV in the city and 65% of people who had received PrEP at San Francisco City Clinic prior to June 2022.
Still, Dr. Stephanie Cohen, a straight ally who is the section director for HIV/STI prevention with the health department, previously told the B.A.R. that 40% of those who received the first dose of mpox vaccine didn't return for a second.
A California Department of Public Health news release last month stated that "while anyone can get mpox and preventive measures should be taken by all, vaccines are recommended for those at highest risk," and urged a number of groups to consider vaccination if they are not vaccinated already. These include people who know or suspect exposure to someone who has had the mpox virus; people whose sexual partners have been diagnosed with mpox in the last two weeks; and people who are gay, bisexual, or other men who have sex with men.
Additionally, transgender, nonbinary, or gender-diverse people who've had a sexually transmitted infection in the last six months are recommended for the vaccine, as are people who, in the last six months, have had sex "at a commercial sex venue" such as a bathhouse, or "sex in connection with a large commercial event or in the San Francisco Bay Area or Los Angeles, where higher transmission is occurring."
The state also encouraged vaccination for those who've exchanged sex for "money or other items," people who have more than one sex partner regardless of sexual orientation, people who have HIV or are otherwise immunosuppressed, people who work in laboratory or other settings where they may be exposed to the mpox virus, people who have a sex partner who is in any of the aforementioned groups or scenarios, and people who "anticipate" being part of any of the aforementioned groups or scenarios.
The release stated that other prevention strategies in addition to vaccination include "having open conversations" with sexual partners and health providers about symptoms and possible exposure; and "being aware" of new sores or rashes. Health officials advise people to not share bedding, towels, clothing, utensils or cups with someone who has mpox; nor should they hug, kiss, cuddle, or have sex with people who have mpox or were exposed within the last three weeks.
Other guidance includes washing hands frequently with soap and water or alcohol-based hand sanitizer; and using a mask, gown, and gloves while caring for people who have mpox.
Where to get mpox shot
Janssen said that the vaccine is "widely available."
"We have many places across the city where people can get vaccinated and we want to make sure people can go to the place most convenient for them," she said, adding that there's a website at myturn.ca.gov where people can make vaccine appointments.
Vaccines are also available at San Francisco City Clinic at 356 Seventh Street and at the Magnet clinic at Strut at 470 Castro Street, which is run by the San Francisco AIDS Foundation.
Jorge Roman, MSN, FNP-BC, AAHIVS, is the senior director of clinical services at the AIDS foundation. Roman told the B.A.R. that there's an abundance of vaccine doses available.
"Although current rates of mpox cases are not at the same levels seen last year, there has been a steady increase in cases both in California and around the country," Roman stated. "We're continuing to encourage people who may be at risk of mpox to receive both doses of the vaccine in order to prevent infection and serious illness. It is important to receive both doses in the two-dose series in order to be best protected. We have plenty of doses of the Jynneos vaccine on hand for the community, and it's easy and convenient to get vaccinated."
Symptoms start between three and 21 days after exposure to the mpox virus. They can include flu-like symptoms and/or rashes on the face, body, genitalia, arms and legs.
Most reported U.S. cases were in California, New York, Florida, and Texas, according to Centers for Disease Control and Prevention data, which showed that there were 38 mpox deaths nationwide between May 2022 and March 2023, during which time there were 30,235 cases. For the 24 decedents who had HIV for whom data was available, all had a CD4 count of less than 50.
For information on the mpox vaccine, go to sf.gov/information/mpox-vaccine.
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