San Francisco health officials have now identified three confirmed and three probable cases of monkeypox, the SF Department of Public Health announced Wednesday, June 15. Alameda County reported its first case on June 9.
While the San Francisco health department is not providing details about the cases, citing patient confidentiality, Dr. Andrea Tenner, director of public health emergency preparedness and response, said that the local epidemiology "is similar to what we're seeing globally."
As of June 16, the federal Centers for Disease Control and Prevention has reported 100 confirmed cases of monkeypox in 20 states and Washington, D.C. There have been 19 cases in California, Dr. Phil Peters of the state Department of Public Health said during a June 16 webinar for LGBTQ organizations. Worldwide, the tally has risen to more than 2,000 cases, according to Peters.
While anyone can get monkeypox through close personal contact, most cases to date have been gay, bisexual, and other men who have sex with men. Many reported international travel, and some visited saunas or attended large gatherings, including a Pride festival in the Canary Islands. None of the California cases are cisgender women, Peters noted.
With Pride season underway, the predominance of cases among gay and bi men has spurred a concerted effort among public health officials and advocates to raise awareness in the most affected communities while guarding against the kind of stigma seen during the early years of the AIDS epidemic.
Monkeypox prevention
The monkeypox virus is transmitted through close contact, which can include skin-to-skin contact, kissing, and contact with contaminated clothes or bedding. It also can be transmitted via respiratory droplets at close range. It is not clear whether monkeypox is directly transmitted through semen or vaginal fluid, but it can spread through contact with sores during sex.
The CDC clarified last week that monkeypox does not spread through the air over longer distances like the coronavirus that causes COVID-19. The monkeypox virus "is not known to linger in the air and is not transmitted during short periods of shared airspace," the agency stated. It can be transmitted between people who live in the same household and to caregivers, but it does not spread via casual conversation, passing someone in a grocery store or touching items like doorknobs, according to the CDC.
"It's relatively low risk for the average population because you have to have pretty significant contact with somebody to contract monkeypox. This is different from something like COVID where [the virus] could be aerosolized," Tenner told the Bay Area Reporter. "If you're in a place where you might be crammed in and can't avoid skin-to-skin contact, wear long-sleeved clothes and try to cover skin as much as possible."
Monkeypox, which is less severe than smallpox, causes flu-like symptoms, swollen lymph nodes, and a rash that can occur on the face, in the mouth or anywhere on the body. The virus has an incubation period of up to three weeks before symptom onset, and the illness typically lasts two to four weeks. Transmission can happen until the sores are completely healed and the scabs fall off.
But the new cases do not always follow the classic pattern. Some people have fewer and smaller sores, often on the genitals or in the anal area, which can resemble common sexually transmitted diseases like herpes or syphilis. These cases can be "a bit more subtle" and might be missed if people aren't looking for them, Tenner said.
People who feel sick or have a rash or sores should seek medical attention and avoid gatherings. In San Francisco, people who do not have a regular provider can contact City Clinic on Seventh Street or the San Francisco AIDS Foundation's Magnet sexual health center in the Castro.
Currently, state laboratories test for orthopox (the virus family that includes smallpox and monkeypox), but confirmation of a monkeypox diagnosis is done centrally at the CDC. While cases that have not yet been confirmed are reported as "probable," health officials assume they are monkeypox and proceed accordingly.
"There's a bit of a bottleneck that's causing delays in final confirmation, but orthopox labs are coming back quickly," Tenner said. "We will start contact tracing, as it's unlikely it would be anything else."
People diagnosed with monkeypox are advised to isolate at home, avoid sex and other intimate contact, and refrain from going to venues like bars or gyms. They are urged to inform known contacts and cooperate with contact tracing efforts.
People with monkeypox usually recover without treatment. The new cases have mostly been mild, with no confirmed deaths so far. Antiviral medications used to treat smallpox can also be used for monkeypox, and some of the California cases have received treatment, according to Peters.
Smallpox vaccination prevents monkeypox as well, and the virus can be contained through targeted vaccination of close contacts. Because monkeypox has a long incubation period, vaccination within four days after exposure can prevent infection, and vaccination within two weeks can reduce symptoms, according to the CDC. People over age 50 or so may have some immunity from prior smallpox vaccination, but they should not assume they're fully protected, Peters said.
Currently, a recently approved vaccine called Jynneos is being administered to high-risk contacts of known cases. As the vaccine supply ramps up, health officials hope to make it available to people who are at high risk for exposure or who may have been exposed but don't have a known link to a confirmed case. In Quebec, Canada, the vaccine is already being offered to men who have had sex with two or more male partners within the past two weeks.
"I think that's the direction we're going in, but we have to make sure there's adequate supply to meet the demand," Peters said.
While promoting awareness, SF DPH is not calling on organizers to cancel events.
"Coming out of the pandemic, people want to celebrate, and I think they can," Tenner told the B.A.R. "The risk to the general public is low — it's really more about gauging your risk as an individual and trying to modify risk behaviors."
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.
Updated, 6/16/22: This article has been updated with new CDC figures.
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