May 1, 2024 – Mary Foote, MD, MPH, has vivid memories of patients “doubling over in pain” during mpox Outbreak in spring and summer 2022.
Patients were “crying and begging to come in to get anything that would help with their symptoms,” recalls Foote, an infectious disease specialist and medical director of the New York City Department of Health and Sanitation. “We did everything we could think of to control symptoms.”
Although the variety of cases is nowhere near the tens of hundreds of cases seen during this outbreak, cases of Mpox have increased in the primary few months of 2024 in comparison with the identical time last 12 months, based on the CDC. While Foote said health care staff could also be a bit “overcautious” immediately, she is worried that a surge in Mpox cases is coming in the summertime.
“Just looking at the trends over the last few months, there's certainly a good chance we could see more cases in the summer,” said Foote, who can be a member of the Infectious Diseases Society of America. “But we're obviously in a much better position than we were in 2022, when we really had no testing, no treatment infrastructure and no vaccine.”
She said she was concerned that Mpox was “out of sight and out of mind” for most individuals now, two years after the 2022 surge. But, she warned, there are still people vulnerable to becoming “very, very sick” from the virus.
“I just want people to know that there are still very serious cases,” said Foote, adding that one person died of MPOX this 12 months.
There were about 570 mpox cases In the United States, for instance, there have been fewer than 300 cases this 12 months through March 28 in comparison with the identical period last 12 months, based on CDC figures.
Although statewide numbers declined in 2023, Los Angeles County saw more cases of MPOX last summer. The increase in cases coincided with the beginning of seasonal LGBTQ+ Pride events, the Los Angeles County Public Health Department said, and most of those infected were unvaccinated.
The department is preparing for a possible outbreak of cases this summer. They plan to support and enhance vaccination campaigns for MPOX mpox awareness between the general public and healthcare providers.
Why are some people at higher risk?
Members of the LGBTQ+ community have been at higher risk for MPOX in recent times, but why?
There are “certain social networks where we now know that the virus can spread very easily through skin-to-skin contact, including the kind of skin-to-skin contact that occurs during sex,” Foote said. “Once it gets into a certain social network, it can spread more effectively.”
Unlike smallpox, which may be transmitted through respiration, sneezing and coughing, smallpox generally requires physical contact.
Mpox “does not spread to any significant extent through the respiratory tract. It requires close contact,” said Stephen Morse, PhD, an epidemiologist at the Mailman School of Public Health at Columbia University in New York City. “That's why the disease is most prevalent in certain populations.”
Gay and bisexual men who have sex with men are particularly at risk.
“There are different health concerns for LGBTQ+ people,” said Jona Tanguay, MMSc, president-elect of GLMA: Health professionals promote LGBTQ+ equality“The reasons this happens on this community are since the sexual networks are very different, the context wherein sex takes place may be very different, and there are things in queer communities that don't exist in heterosexual communities.”
For example, “research shows that sexualized drug use is not a phenomenon that occurs among heterosexual people.”
Mpox vaccine is being distributed further
The only FDA approved Mpox vaccineJynneos, was available under an FDA emergency use authorization during and after the 2022 outbreak. At that time, the vaccine was distributed through limited channels such as health departments and specialty clinics.
Since last October, however, the CDC has only recommended routine use, which means that people at risk Mpox vaccine in drugstores and doctor's offices. In early April, the vaccine manufacturer confirmed that the vaccine was commercially available in the United States.
“I feel this may expand access,” said Tanguay. As with many other infectious diseases, the more people get vaccinated, the better the protection for the population. “I feel that's great.”
Foote praised the federal government for its plans to keep distribution channels open over the summer to give pharmacies and doctor's offices time to stock and administer the vaccine.
Marginalized people are more at risk
It remains important to focus on those at highest risk, including people with weakened immune systems living with HIV, people who use sexualized drugs, and also transgender people – especially trans women, Tanguay said. “It's essential to succeed in these highly marginalized communities to guard them as best as possible with the vaccine.”
“It has nothing to do directly with the biology of that identity. It's just that they face many alternative types of discrimination,” Tanguay said. Trans women of color can face racism, misogyny and transphobia all at the same time. “And that's why their health outcomes are likely to be a lot worse – they're in danger for thus many other things.”
People facing economic hardship have less access to health care, Tanguay said, so a more widely available Mpox vaccine “is just not going to enhance access for individuals with very low incomes.” Many members of this community do not have a primary care doctor, but making the vaccine available in pharmacies could help.
“We are keeping track of it, but I’m not sounding the alarm about Mpox in 2024,” Tanguay said. “But I still recommend that every one my patients get vaccinated.” Two doses are required for maximum protection with the Mpox vaccine.
Foote's final message: If you haven't received the vaccine yet or haven't completed the two doses, “come on over.” If you get symptoms that might indicate Mpox, “please, please come on over.”
“We can get you began on treatment early,” Foote said. “We have evidence that starting treatment early in people at high risk can protect them from the worst outcomes.”