With plenty of vaccine on hand, Sonoma County doesn’t expect repeat of mpox outbreaks this summer

Dr. Jessica August, a Kaiser Permanente infectious disease expert, hasn’t seen a local mpox virus case since September, following an outbreak last summer that took many by surprise.

Back then it was called monkeypox, a rare viral disease that occurred mostly in central and western Africa. U.S. health officials were slow to respond, and the lack of vaccine left many waiting in long lines.

But this year, local infectious disease experts say they’re ready for it.

“We in the county and at Kaiser Permanente, we have vaccinated hundreds and hundreds of people and we continue to vaccinate,” August said. “With vaccinations, this year we’re in a much different place. I hope we won’t see a fraction of what we saw last year.”

On Thursday, the World Health Organization reportedly declared the global mpox emergency over, with the international organization citing a continued decline in reported cases, which fell by 90% in the past three months compared to the previous three-month period.

But health officials said this week that the virus is still circulating, particularly among those with compromised immune systems, a group that is strongly urged to get vaccinated.

On Wednesday, the CDC reported a “cluster” of new cases have popped up in the Chicago area, with more than 50% of these infections among people who were previously vaccinated.

“Getting vaccinated is still very important,” the CDC said. “No vaccine is 100% effective, and infections after vaccination are possible, but they may be milder and less likely to result in hospitalization.”

In Sonoma County, there have been 49 confirmed or probable cases of mpox since three local cases were first detected in June and July, according to the county’s mpox dashboard. Most of those cases occurred over the summer, with 47 between early July and the third week of October.

As with COVID-19, the county also tracks mpox virus in wastewater. There’s been no detection of mpox at the Santa Rosa wastewater treatment plant since January.

The mpox virus is a member of the orthopoxvirus, a genus of viruses that also includes the variola virus (which causes smallpox) and cowpox virus. Mpox is not related to chickenpox.

Mpox often appears as a rash that can look like pimples or blisters that appear on the face, inside the mouth and on other parts of the body, like the hands, feet, chest, genitals or anus. Symptoms include flu-like symptoms, such as fever and low energy.

The virus is spread several ways and usually involves very close or physical contact, including intimate skin-to-skin contact; sexual contact; exposure to contaminated materials such as towels, bedding and clothing; and potentially through large respiratory droplets.

Local health officials advise the following:

•Avoid close physical contact with people who have symptoms, including sores or rashes.

•Ask your intimate partner, including sexual partners, whether they’ve had any of the symptoms.

•Those who think they may have been exposed to someone with mpox symptoms should contact their medical provider.

• If you develop a possible mpox rash, try to cover the rash and avoid letting it come into contact with others while you confirm what it is.

Mpox vaccination requires two doses, with the second dose given after 28 days of the first. The vaccine is strongly recommended for all people living with HIV.

Health officials say men who have sex with men face the greatest risk for the mpox virus. However, a person’s sexuality and sexual orientation are a factor in transmission, and anyone who has direct contact, particularly skin-to-skin contact, with an infected person can contract the disease

On Wednesday, San Francisco public health officials advised all those who want protection from mpox to receive both doses of the mpox vaccine to prevent a rise in cases this summer.

Dr. Gary Green, a local infectious disease expert with Sutter Health, said he hasn’t seen a local case of mpox since last fall. Green runs Sutter’s local HIV clinic, as well at its Pre-exposure prophylaxis, or PrEP, clinic. PrEP is an effective HIV prevention method used to reduce the risk of HIV transmission through sex or sharing needles.

Green said the mpox vaccine is administered to all patients who participate in Sutter’s HIV and PrEP clinics. “About 99% of these clinic patients, mainly gay men, agree and want the (mpox) vaccine,” Green said. “We’ve embedded that into the standard of care, as part of our vaccine strategies.”

Green said the county has been able to keep its mpox infection numbers low largely because of the local vaccine effort. He said he expects more chlamydia, gonorrhea and syphilis than mpox this summer.

“But we’ll be looking for mpox,” he said.

August, the Kaiser Permanente specialist, said she’s confident there’s more than enough supply of vaccine.

There are two ways of administering the vaccine, subcutaneous and intradermal. An intradermal injection is given between two outer layers of the skin, mostly in the forearm between the arm and elbow. Subcutaneous applications are given between the skin and the muscle, most commonly between the elbow and shoulder.

August said that last year, when the supply of vaccine was still low, intradermal injections were used because subcutaneous injections required five times more vaccine. The downside was that intradermal injections left a visible mark on the skin, a stigmatizing sign that mpox was affecting mostly gay men.

“Now we have lots of (vaccine) supply, there’s the option to go back to subcutaneous shots,” August said.

For more information about mpox, visit the county Public Health Division’s mpox website.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.