Five cases of monkeypox have now been detected in Santa Barbara County, an increase of two since August 9, Dr. Henning Ansorg reported in an update to the County Board of Supervisors on Tuesday. The response to the international outbreak of a West African strain of monkeypox, which the California Public Health Department has abbreviated to Mpox to avoid stigmatization, said Ansorg, has been somewhat chaotic, though new vaccine protocols are making a little more protection available.
In Santa Barbara County, said Dr. Ansorg, the county’s health officer, results from four tests were pending today — and could raise the county’s case count as high as nine — while vaccines have been given to 35 people who have been exposed. Further, as many as 1,100 people could soon be vaccinated against the disease, now that the Food and Drug Administration has issued an emergency authorization that allows doctors to split one dose of the Jynneos vaccine into five.
Though 1,733 cases were confirmed in California and 36 of the people infected are hospitalized, Ansorg stated, “The risk to the general population is very low. Mpox is much less contagious than COVID or smallpox.”
The county has 10 courses of a treatment developed for smallpox called tecovirimat, or Tpoxx, which is being permitted for use in severe cases of Mpox as an Investigational New Drug.
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Case Reports
While the risk to the general public may be low, the medical literature state that monkeypox is predominantly occurring among the gay and bisexual male community, though heterosexual men and women have become infected, as well as children.
A July analysis in the New England Journal of Medicine looked at 528 cases between April and June 2022 in 16 countries. It found 98 percent were gay or bisexual men, about 41 percent of whom had a well-controlled HIV infection. Their median age was 38 years old.
Sexual activity was the suspected source of transmission in 95 percent of cases. Of the 95 percent who had rashes, 73 percent were anogenital — in the anal or genital region — and 41 percent were mucosal. Some patients had a single lesion, leading the authors to caution that monkeypox could be misidentified as a different sexually transmitted infection.
Symptoms that commonly preceded a rash were fever, swollen lymph nodes, lethargy, myalgia, and headache.
Ansorg explained on Tuesday that the virus was transmitted through close skin-to-skin contact, or by close face-to-face contact, such as kissing or cuddling. Mpox also spread through “fomites,” or objects that touched the infectious rash or body fluids, like clothing, linens, or eating utensils. The literature indicates that pox viruses can live on drier, colder surfaces for up to two weeks.
Mpox is not spread by brief social contacts like shaking hands, saying hello, or passing next to someone, Ansorg added: “But having said that, it is still spreading quite significantly.” Worldwide, the count was up to 30,000 people infected; 9,000 have been infected in the U.S.
He noted that people infected with Mpox could go to the grocery store, “but be sure your clothing covers the lesions, and don’t go if you have a fever.”
Vaccines
In a discussion with Supervisor Joan Hartmann, Ansorg confirmed that having had a smallpox vaccine, perhaps as far back as the 1960s, conferred some immunity. The strength of protection from an old vaccine would vary and would be unpredictable, he later told the Santa Barbara Independent, but “there is the chance of at least some protection.” Smallpox was declared eradicated worldwide in 1980.
Hartmann also asked about the future risk from cases of polio in New York. Ansorg replied that his reading indicated the polio findings in New York City’s wastewater were similar to findings in London and Israel, and they were actually from an oral live virus vaccine that isn’t given in the U.S. any longer. The N.Y.C. health department stated a man in Rockland County north of Manhattan was diagnosed with paralytic polio on July 21, and poliovirus was also detected in the sewage of neighboring Orange County. Both counties have relatively low polio vaccination rates of about 60 percent.
“If anybody is traveling to remote places in the world, I would definitely recommend a booster shot to be fully protected,” said Ansorg, who lamented the number of people who were not fully vaccinated as children.
Africa has yet to receive any of the Jynneos vaccine, said Zain Rizvi and Aly Bancroft of Public Citizen’s Access to Medicines Program in an opinion piece last week at MedPage Today. The medical world paid little attention to the disease when it affected “only poor people of color.… Where could we have been if tools like Jynneos had been studied locally, manufactured regionally, and distributed systematically to affected populations in endemic countries before this outbreak?” They argued that the U.S. could help stand up manufacturing through the transfer of technology to places like Africa to head off similar global outbreaks by working together.
Webinar and Vaccine Clinics
On Wednesday, August 17, at 7 p.m., Ansorg will be among the participants of a virtual town hall meeting on Mpox here, which is sponsored by Planned Parenthood and Pacific Pride Foundation.
Pacific Pride will also hold vaccination clinics this week and next. Doses are limited, the nonprofit cautioned, and eligibility criteria include known close contacts of existing monkeypox-infected individuals, and people with risk factors who have been exposed. Check with Santa Barbara County Public Health Department at (805) 681-5280 or PHDDiseaseControl@sbcphd.org to verify eligibility. For the vaccination clinics, only eligible people over age 18 may participate, and they take place in Santa Barbara on August 18, 5-8 p.m., at 608 Anacapa Street, and in Santa Maria on August 25, 5-8 p.m., 105 North Lincoln Street. More information is available at Pacific Pride’s website.
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