Health Trends

D.C. monkeypox cases decline but public health experts advise caution


Regional public health experts are fine tuning their approach to getting monkeypox vaccine into arms, even as D.C. reports a steady decline in new cases.

New cases of monkeypox have declined 20 percent on average per week since the peak in mid-July, Anil Mangla, the state epidemiologist at D.C. Health, said in an interview Friday, a trend the Centers for Disease Control and Prevention identified in some states with larger outbreaks, such as New York and California.

“There’s light the end of the tunnel when it comes to monkeypox in D.C.,” Mangla said. However, he said officials are “erring on the side of caution” with an aggressive vaccination effort and close monitoring of universities, which could see a bump in cases as students return to campus.

As demand for the vaccine has waned in the District, officials last month expanded eligibility and amended procedures in an effort to undercut stigma associated with a virus that has overwhelmingly impacted men who have sex with men but can infect anyone. Virginia expanded eligibility guidelines shortly after D.C., despite a national shortage in vaccine and federal approval of an intradermal injection method to stretch doses.

Several months into a global outbreak of monkeypox, federal data show nearly 20,000 people had tested positive in the United States as of Thursday. There were 436 cases in the District as of Thursday, and 534 in Maryland and 353 in Virginia as of Friday, data show.

The District, which has received more vaccine than its neighbors, has administered nearly 24,000 doses of Jynneos, the only vaccine approved to treat monkeypox.

At one of three walk-up clinics held every Friday, the lunchtime crowd was thin. Over the course of an hour, two men — both of whom spoke to The Washington Post on the condition of anonymity to protect their privacy — received first doses of the two-dose regimen.

“I was a little sad to not see more people here,” said one man. He was invited to make an appointment after preregistering online, but said going to a walk-up clinic on his own schedule was simply easier.

He praised the smooth process but wondered if demand was down because people were unaware of where to get vaccinated or could not access the sites.

D.C. public health removed intrusive questions from the registration process and made vaccine available to all people of any sexual orientation or gender who have had multiple sexual partners in the past two weeks, in accordance with CDC guidance.

Officials ‘cautiously optimistic’ about falling monkeypox cases

In an effort to learn from their experiences deploying coronavirus vaccine, they also quickly enlisted community partners to host clinics for people underserved by the medical establishment. Black people also make up a significant segment of people testing positive for monkeypox across the region.

In the District, White people account for about 37 percent of cases and Black people account for 36 percent; 55 percent of people getting vaccinated are White and 20 percent are Black, city data show. Maryland case data shows Black people account for 58 percent of cases and White people account for 16 percent, with 20 percent not reporting. In Virginia, 39 percent of cases reported are among Black people and 26 percent are among White people, but White people are far more likely to be vaccinated.

The Biden administration on Friday asked Congress for more than $4.5 billion in emergency funds to respond to monkeypox as part of a broader $47 billion request.

National Black Gay Men Advocacy Coalition, which includes Us Helping Us, a D.C.-based organization that provides medical, behavioral health and social services to Black gay and bisexual men and Black transgender women, applauded federal efforts to ramp up the public health response.

“The U.S. public health response was slow to recognize the impact of MPV among Black gay and bisexual men. Our community is paying the price for that inaction,” the NBGMAC said in a statement this week. “NBGMAC applauds and honors the resilience of Black gay and bisexual men across the nation who are actively seeking MPV testing, vaccination, and treatment, despite unacceptable shortages and other structural barriers.”

Maryland public health officials this week launched a preregistration system for monkeypox vaccine. The state has received 14,539 doses of vaccine and has administered 3,470 doses, leaving more than 11,000 doses unaccounted for.

Although rates of infection are slowing in some states with larger outbreaks and D.C., the CDC this week reported that some states, including Virginia, are “experiencing accelerating growth.”

Virginia has given out 7,741 doses, mostly in Northern Virginia which has the highest population and highest concentration of cases, state data show.

Stuart Ray, a professor of medicine in the division of infectious diseases at Johns Hopkins, noted that more vaccine is needed across the country and not enough testing is being done to capture all cases.

“When people are worried about getting monkeypox in the grocery store, I say they are probably OK if they don’t cuddle or kiss six shoppers,” he said. “This is not a highly transmissible virus but there are ways to control risk.”

Monkeypox is primarily spread through close skin-to-skin contact.

Although places like D.C. may be recording a reduction in cases and vaccine demand, he said — as with coronavirus — monkeypox may spread to unprepared communities.

“This is one of the reasons why I wouldn’t want to be the CDC director,” Ray said. “Great preparation makes it look like a nonevent. The challenge here is it might smolder out, but it also might go into its next year and we don’t know which way this virus is headed.”

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