Falling monkeypox cases have health officials ‘cautiously optimistic’
Globally, new cases fell 21% from last week, the World Health Organization reported on Thursday.
Although public health experts have applauded the slowdown in new infections, they have warned that the virus continues to pose a risk – especially in small communities outside of US urban centers and in developing countries amid shortages of vaccines, limited surveillance and insufficient testing – and could increasingly spill over beyond the gay and bisexual community. Epidemiologists and health officials also report continued challenges with the White House’s new vaccine strategy to expand the number of doses available.
“There are signs that the epidemic is slowing in Europe, where a combination of effective public health measures, behavior change and vaccination are helping to prevent transmission,” WHO Director-General Tedros said on Thursday. Adhanom Ghebreyesus. But he warned that new cases were continuing to rise in places like Latin America, where awareness of the virus is lower and access to vaccines limited.
Anne Rimoin, an epidemiologist at the University of California, Los Angeles who studied the monkeypox outbreak, said a drop in cases is expected after growing awareness and a push for vaccinations. “Whether it’s going to be maintained or not, we just don’t know,” she said. “It is premature to declare any victory.”
On Friday, Biden administration officials hailed the “downtrend” in monkeypox cases in major U.S. cities as a positive sign, but avoided questioning whether the national outbreak had peaked.
“I want to be cautiously optimistic,” said Rochelle Walensky, director of the Centers for Disease Control and Prevention, acknowledging that more work is needed to contain the virus. “Week after week, our numbers keep going up, [but] the rate of increase is lower…and things are not even across the country.
For example, new cases of the virus in some regions are exceeding urban centers. Monkeypox cases in Georgia soared 66% between Aug. 10 and 24, a two-week period in which cases only climbed 41% in New York, the epicenter of the US outbreak. United States, according to local and state health department data.
New York City Health Commissioner Ashwin Vasan said his team hopes the virus will recede, after nearly 2,900 New Yorkers have been infected in the past three months. About 40 new cases a day were diagnosed in New York last week, up from more than 70 cases a day earlier this month.
“Over the past few days, we’ve seen cases start to drop and transmission slow down,” Vasan testified before the New York City Council on Wednesday, attributing the increase in vaccinations to the change in sexual behaviors. “All of this is clearly taking root and having a positive effect on slowing this outbreak.” Officials from cities like San Francisco and Chicago echoed similar messages this week.
The CDC reported this week that gay men have changed their risky sexual behaviors due to the outbreak, citing an online survey that found around half of men who have sex with men said they had reduced casual sexual encounters as well than sex with partners met on dating apps or in sex venues. Experts say the outbreak in the United States was likely accelerated by a surge of dance parties and casual sex during June Pride month activities, and the CDC previously found that 94% of cases were associated to sexual or intimate contact.
“Behavioral change, combined with vaccination, can help slow the spread and end the monkeypox epidemic,” CDC spokesperson Kristen Nordlund said in a statement. She noted that the US data contains information from many jurisdictions, “some of which continue to have an acceleration in case numbers, and continued vigilance and action remain important.”
Walensky and other officials said Friday they plan to boost vaccinations and messages to LGTBQ communities at upcoming gatherings that could accelerate new clusters of infections, such as New Orleans’ Southern Decadence festival that is expected to draw tens of thousands over Labor Day weekend. They also said they were watching with suspicion the return of students to campuses, another potential driver of new cases.
State and local health officials are pushing for the Biden administration to provide more support for the response, saying they need more funds to raise awareness About the virus, hire additional staff to conduct testing and conduct contact tracing, and make new investments to bolster health services that have been stretched thin by two years of battling the coronavirus.
“We appreciate the efforts of federal agencies to provide maximum flexibility to use the additional COVID-19 funding to address this public health emergency,” wrote Michael Fraser, executive director of the Association of State Health Officials. and Territories, to the White House in a letter shared with The Washington Post. “However, given the scope and scale of the outbreak…it is clear that this short-term solution is not viable in the long term.”
Fraser told the Post that an additional $500 million to $1 billion would be needed to fund the national and local response to monkeypox over the next 12 months. He suggested the Biden administration work out an emergency funding package with Congress or make more funds available through the CDC’s Infectious Disease Rapid Response Reserve Fund.
Experts also continue to raise concerns about the Biden administration’s vaccine strategy to expand the limited supply by splitting each single-use vial into five doses via a different injection method. The plan, quickly finalized on August 9, was hailed by some local officials as an innovative way to meet growing demand. But many state and local officials face logistical challenges implementing it.
“I have now heard several reports from my state and local colleagues that it is very difficult to extract five doses from a single vial of vaccine,” Johns Hopkins epidemiologist Caitlin Rivers wrote in a post on its Substack page last week, criticizing the abrupt change in strategy. “Taken together, national and local health authorities now have up to a third less of doses for use in their communities than they were before the switch to intradermal administration.
The chairman of the Senate health committee also urged the Department of Health and Human Services to address “alarming” vaccine supply gaps, both for the current monkeypox response and for future outbreaks.
“The administration must do more to address existing and unacceptable vaccine supply shortages, institute comprehensive distribution and communications strategies, and develop long-term supply plans,” wrote Sen. Patty Murray (D- Wash.) in a letter Tuesday to Dawn O’Connell, the HHS assistant secretary who oversees the vaccine stockpile.
[Inside America’s monkeypox crisis — and the mistakes that made it worse]
The White House on Friday defended its vaccination strategy, saying about 75% of jurisdictions nationwide have already adopted the new approach and 20% plan to do so. Dividing each vial into five doses will allow the United States to “deliver over 3 million doses of vaccine … almost enough vaccine to reach the entire at-risk population,” O’Connell said Friday. CDC officials previously estimated that at least 3.2 million doses of the vaccine would be needed to cover gay and bisexual men whom officials consider most at risk.
But Biden officials have said they are open to adjusting their vaccination strategy as they collect more real data on the effectiveness of splitting doses.
“We’re really trying to move the thinking from ‘how many vaccines can you get out of the vial’ to ‘how many arms can you vaccinate’ because that will give us a lot more information,” said Demetre Daskalakis, deputy coordinator. from the White House for the monkeypox response.
Administration officials also said that despite weeks of complaints about limited vaccine availability, many local officials have yet to fully utilize their vaccine supply. As of Wednesday, only 11 of the nation’s 67 jurisdictions have attested to using at least 85% of their vaccine supply, according to a White House official who spoke on condition of anonymity to discuss ongoing policy and internal conversations. .
After cases spiked in June and July, the Biden administration revamped its monkeypox strategy and delegated a new team from the White House to coordinate the federal response. In the interviews, Biden officials highlighted their follow-up work to prevent possible outbreaks, such as a recent incident in which a daycare worker in Illinois tested positive for monkeypox, potentially exposing about 60 people, including several dozen children. The worker also served as a home care aide for an elderly person.
The situation alarmed the White House and Biden officials, fearing an outbreak among children, rushed dozens of vaccines to those potentially exposed. Three weeks later, there have been no further infections linked to the daycare worker, Champaign-Urbana Public Health District Administrator Julie Pryde told The Post.
Lena H. Sun contributed to this report.