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Federal officials hopeful about monkeypox trajectory

CDC officials hopeful that vaccination, prevention efforts are helping stem the outbreak

Residents line up at one of three walk-up D.C. Health Department monkeypox vaccination clinics in Washington earlier this month.
Residents line up at one of three walk-up D.C. Health Department monkeypox vaccination clinics in Washington earlier this month. (Bill Clark/CQ Roll Call file photo)

Federal health officials expressed cautious optimism Friday about the trajectory and spread of the monkeypox outbreak, emphasizing that increased vaccination, harm reduction behaviors and educational and outreach efforts appear to be helping to curb the spread.

“We’ve started to see globally that we may be turning a corner,” Rochelle Walensky, director of the Centers for Disease Control and Prevention, said during a White House Monkeypox Response Team briefing.

Walensky pointed to drops in cases in some European countries and local reports from major U.S. cities including New York, Chicago and San Francisco. “We’re watching this with cautious optimism, and really hopeful that many of our harm reduction messages and our vaccines are getting out there and working,” she said. 

Walensky said the U.S. had reported 17,000 cases of monkeypox as of Thursday — out of the more than 46,700 cases detected globally — and she acknowledged that overall case numbers were still increasing in the U.S., though the rate of that rise has dropped.

“We are still seeing increases, and, we are, of course, a very diverse country, and things are not even across the country,” she said.

The federal monkeypox response has included both expanded vaccination and public messaging efforts focused on men who have sex with men, a group that has experienced the lion’s share of cases during the current U.S. outbreak.

The White House has lauded the distribution of Jynneos, a two-dose vaccine used for monkeypox and smallpox prevention in adults, but acknowledged that it is still seeking to address gaps in equity.

“We are soon approaching the point where most people at highest risk will have access to two doses of Jynneos,” said Dawn O’Connell, Health and Human Services assistant secretary for preparedness and response. “Our work is far from over, but this is a step in the right direction as we continue to fight the spread of the virus.”

O’Connell estimates that the government will receive another 150,000 vials of the vaccine from its supplier — or up to 750,000 doses — as early as late September. This, along with a separate agreement announced last week to produce the drug domestically, would fulfill a 2.5 million vial order from this summer, she said.

Walensky and O’Connell said the ample supply means that it is no longer necessary for any jurisdictions to use delayed second shots as a dose sparing mechanism. 

But vaccine uptake so far has been primarily focused on the first dose, with about 53 percent of recipients so far ages 25 to 39, said Walensky. 

Bob Fenton, the White House national monkeypox response coordinator, said the administration has made it clear to jurisdictions that they are able to distribute additional vaccines once a jurisdiction has attested to using more than 85 percent of its vials. Fenton said about one-fifth of jurisdictions have reached this point so far.

Since the vaccine’s emergency use authorization earlier this month, providers are permitted to administer multiple doses from a single vial, and Fenton said federal health leaders told his team this week that they could now get between 4.5 and five doses on average per vial. 

Walensky said that while the vials may contain up to five doses, amounts will vary and may be limited to just one, saying she recognized that providers might not be able to get five doses out of all vials.

 “We have built in a buffer as we’ve been allocating and distributing” to try to ensure that people get the doses they need, she said. 

Changing behavior

The briefing followed the release of two CDC Morbidity and Mortality Weekly Reports that survey changes in behavior for men who have sex with men after the White House declared monkeypox a national public health emergency on Aug. 4. The reports also model how behavior changes could affect the trajectory of the viral pandemic.

The modeling report suggests that reducing one-time sexual partnerships by 40 percent could reduce the spread of monkeypox and people affected by 20 percent to 31 percent. The report suggests reducing one-time partnerships would have a stronger impact if combined with other mitigation methods, such as increased vaccination, testing and treatment of symptoms.

One-time partnerships account for 50 percent of daily monkeypox virus transmission, and CDC modeling suggests men who have sex with men who had more than one partner in the prior three weeks are at 1.8 to 6.9 times the risk for acquiring monkeypox compared to those with one partner.

A nationwide survey, conducted Aug. 5 through 15 and also published Friday, looked at the sexual behavior changes among 824 men who have sex with men in response to monkeypox concerns.

About half of respondents reported changing their sexual behavior after hearing about the monkeypox outbreak. About 48 percent of men reduced their number of sexual partners, about 50 percent reduced one-time sexual encounters, 50 percent reported reducing sex arranged through dating apps or sex venues and about 50 percent reduced their participation in group sex.

Three survey participants reported being diagnosed with monkeypox, and 91 of 798 who answered this question said they knew someone who had contracted the disease.

About 53 percent of respondents said they were “somewhat concerned” or “very concerned” about monkeypox, but more than 82 percent that they were confident they could protect themselves from the disease.

Nearly 1 in 5 respondents said they had received at least one dose of the monkeypox vaccine, with uptake highest among Hispanic or Latino men, at 27.1 percent. Uptake was lowest among non-Hispanic Black or African American men, at 11.5 percent, and non-Hispanic white men, at 17.7 percent.

“We continue to encourage jurisdictions to focus vaccination efforts on getting vaccines out equitably to individuals at highest risk of contracting the virus. That’s why we are working closely with places like Atlanta and New Orleans to prepare for events like Black Pride and Southern Decadence,” said Fenton, referring to two upcoming LGBTQ pride events. He said public health officials distributed hundreds of vaccine doses at LGBTQ pride activities in Charlotte, N.C., last week.

Vaccine uptake was also higher among men who reported having two or more sexual partners in the previous 14 days, at about 30 percent, and was 31.5 percent for men who had group sex in the previous three months. About 14 percent of men who had one or no partners during that time period were vaccinated.

Among the 662 people who reported not having received the monkeypox vaccine, 28.5 percent said they had tried to seek a vaccine. 

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