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Monkeypox

The Gay Party Circuit: End-of-summer fun or monkeypox super-spreaders?

Many events consist of gay men engaging in shirtless dancing in close proximity creating ideal opportunities for monkeypox being transmitted

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Washington Blade file photo by Daniel Truitt

WASHINGTON – This is the time of year when gay men say farewell to summer with trips to the beach and resort towns for festivities, parties, and other revelry consisting of shirtless dancing and various forms of intimate contact — now a potential health risk as super-spreader events amid a monkeypox outbreak that continues to spread among men who have sex with men.

With the number of reported cases of monkeypox in the United States reaching 12,689 and demand for vaccines failing to keep up with supply, questions remain about taking precautions like those seen during the coronavirus epidemic as health experts and event organizers point to existing guidance to ensure a reasonable degree of safety.

Wes Combs, president of the CAMP Rehoboth board of directors, said his organization from the beginning of the monkeypox outbreak has been engaging with health officials at the state level in Delaware about what people should be looking for in terms of symptoms, as well as information about how people in high-risk categories can sign up to get vaccinations.

“As is everywhere in the country right now, where LGBTQ communities have big populations people are concerned, so we have received a number of calls about more information about monkeypox, about whether or not people can get vaccinated at CAMP Rehoboth,” Combs said.

A monkeypox town hall hosted by CAMP Rehoboth in conjunction with Delaware state health officials took place Tuesday, providing an opportunity to offer the latest information and answer questions about the monkeypox outbreak. CAMP Rehoboth announced it has been identified as one of two additional sites for vaccinations in addition to what the Department of Health provides from its health centers.

Rehoboth is among the many places in the United States where gay men are expected to flock to celebrate, along with Fire Island and Provincetown on the East Coast, making vaccinations against monkeypox in high demand at a time when the Biden administration is facing criticism for not making them more widely accessible. (Gay cruises for the summer, however, may not be among these events. A Carnival Cruise Line spokesperson said the charters team has no LGBTQ cruises coming up.)

Brad Perkins, chief medical officer at Karius, Inc., when asked about appropriate guidance for these end-of-summer events advised “trying to encourage community awareness and responsibility to isolate yourself and not infect others if you believe that you’ve been exposed or know that you’re infected.”

“But the longer game here is that we don’t want this disease to become endemic in the United States,” Perkins added. “And I think there’s a short-term threat, there’s a long term threat, both of them are really important [and] I think should weigh on decisions like the one you’re suggesting people need to make.”

Perkins said Karius, which works on advanced molecular technology for diagnosis of infectious diseases, is seeking to apply microbial cell-free DNA technology to create monkeypox tests earlier than options currently available, which require a sample from already developed skin lesions. The proposed testing has detected the virus in hospital patients, Perkins said, and following research over the course of the next few months may be available on an outpatient basis.

In Rehoboth, Combs said CAMP Rehoboth as a result of work with state officials is set to obtain 200 doses of JYNNEOS vaccine and, per guidance from the Centers for Disease Control & Prevention, plans to distribute them in a two-dose regimen, with the first dose set for Aug. 23 and second one on Sept. 28. As of Tuesday, Combs said CAMP Rehoboth has already scheduled appointments for 135 shots in the two-doze regimen, which is more than two-thirds of the total available shots.

“We are in talks with the state to [see] if they are able to get additional doses to create a larger vaccination site that’s capable of having more people vaccinated,” Combs added. “Right now, it’s one person every five minutes — over the span of from nine o’clock to three — and that’s the rate based on the number of doses. But if we can get more, we will do more, and we tell that to the state.”

Many of these end-of-summer events consist of gay men engaging in shirtless dancing in close proximity with each other as well as other intimate contact, creating ideal opportunities for a disease transmitted by skin-to-skin contact.

Be honest: While participants aren’t engaging in sexual activity as part of these events per se, they can lead to sexual encounters in the aftermath with a causal partner (or causal partners should these participants elect to have group sex to close out the night).

The CDC has guidance on its website for safer sex and social gatherings amid the monkeypox outbreak, which suggests festivals, events, and concerts where attendees are fully clothed and unlikely to share skin-to-skin contact are safer, as well as being mindful of activities (even kissing) that might spread monkeypox. Enclosed spaces, such as private and public sex parties where intimate and often anonymous sexual contact with multiple partners occurs, the CDC says, may have a higher likelihood of spreading monkeypox.

During the COVID epidemic, many group events required proof of vaccination and were even cancelled in an effort to mitigate the spread of the dangerous and potentially fatal disease. The same, however, cannot be said about events during the monkeypox outbreak, where the disease can be painful, but not fatal, and the availability of vaccines has not kept up with demand.

Combs said he’s unaware of any event being cancelled in Rehoboth due to monkeypox and, in fact, its biggest fundraiser of the year, the annual Sundance dance party is on track to happen over Labor Day weekend. Additionally, Combs said he cannot foresee a proof of vaccination requirement “largely because the availability of vaccines is so difficult to get right now, and there’s…high demand and low supply.”

“Certainly we understand what worked well with COVID, and that was getting information education out to the public about how this virus is transmitted and providing as much access to vaccines as possible,” Combs said. “So the one thing that is different is the number of vaccines available seems to be much lower, so I know that there’s lots of pressure being placed on the government at all levels to ensure that they get more supply to meet the demand that appears to be there.”

Perkins, asked whether precautions taken during COVID would be appropriate for monkeypox, drew a distinction between the two diseases, pointing out “the sort of positive take on monkeypox is that we’re somewhat prepared for this threat, mostly through efforts to prepare for smallpox.”

“Certainly, the most relevant one I think the community at this point is if you think you have been exposed, or, particularly if you’ve been exposed and you’re ill, getting vaccine, accessing the vaccine that’s available, or at least discussing being vaccinated as prophylaxis or at least, if not prophylaxis, prevention of infection, at least decreasing the severity of illness if it does occur,” Perkins said. “I think as is you know, it’s one of the good news stories of the efforts that have been taken to date.”

Although to date the transmission of monkeypox has been overwhelmingly among men who have sex with men, Perkins predicted that could change.

“In fact, we’re starting to see more cases outside that circle,” Perkins said. “I would expect that that will increase unless we control this epidemic. I think that will be a certainty moving forward that we’ll see a broader distribution of cases, because certainly the transmission of this infection, unlike HIV…includes routes of transmission that are non-sexual.”

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Monkeypox

LA County Public Health expands Monkeypox vaccination eligibility

Eligible residents can go to a Public vaccinating site or visit Myturn.ca.gov to find other vaccinating sites near you

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Photo Credit: County of Los Angeles

LOS ANGELES – The Los Angeles County Department of Public Health has expanded eligibility to the monkeypox vaccine to closely align with the Centers for Disease Control and Prevention’s recent expansion, which includes persons in select occupational groups whose jobs may expose them to orthopoxviruses (such as monkeypox).

Monkeypox vaccine will be available to residents who self-attest to being in the following groups:

  • Gay, bisexual or other men who have sex with men or transgender people who have sex with men or other transgender people
  • Persons of any gender or sexual orientation who engage in commercial and/or transactional sex
  • Persons living with HIV, especially persons with uncontrolled or advanced HIV disease
  • Persons who had skin-to-skin or intimate contact with someone with suspected or confirmed monkeypox, including those who have not yet been confirmed by Public Health
  • (NEW) Sexual partners of people in any of the above groups
  • (NEW) People who anticipate being in any of the above groups

Monkeypox vaccine is also available for persons in select occupational groups whose may be exposed to orthopoxviruses including:

  • Research laboratory personnel working with orthopoxviruses
  • Clinical laboratory personnel performing diagnostic testing for orthopoxviruses
  • Designated public health response team members
  • Health care personnel who administer ACAM2000 (Smallpox [Vaccinia] Vaccine)
  • Designated health care workers who care for persons with suspected or confirmed orthopoxvirus infections, including clinicians and environmental services personnel

Note that the risk of monkeypox transmission remains very low for health care workers if appropriate personal protective equipment is worn and other infection control practices are followed.

Eligible residents can go to a Public vaccinating site or visit Myturn.ca.gov to find other vaccinating sites near you.

Residents do not need to show ID in order to get a vaccine at sites run by Public Health. However, because residents may need to show vaccination record and ID if you travel or visit certain venues, it is recommended that when getting a vaccine that residents provide the name that is on their ID.

Residents who met prior eligibility criteria can still get vaccinated (see below for prior criteria).

Gay or bisexual men or transgender people who:

  • Had multiple or anonymous sex partners in the past 14 days
  • Had skin-to-skin or intimate contact with persons at venues or events in the past 14 days
  • Had a history of early syphilis or gonorrhea in the past 12 months
  • Are on HIV pre-exposure prophylaxis (PrEP)
  • Had anonymous sex or sex with multiple partners in the past 21 days in a commercial sex venue or other venue.

Residents who have monkeypox symptoms or are currently under isolation for monkeypox, should not come to the vaccination clinics or walk-up sites. If residents think they have monkeypox, they should speak with a provider and get tested. If residents do not have a provider, residents can call the Public Health Call Center for more information on monkeypox, including general information, testing, treatment, and vaccines at (833) 540-0473 (open 7 days a week 8am – 8:30pm).

For more information, please visit: http://publichealth.lacounty.gov/monkeypox/.   

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Monkeypox

Los Angeles County Supervisors approve sick leave for monkeypox

Both coronavirus and the monkeypox outbreak has disproportionately affected essential workers, who are predominantly Black and Latino

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The Los Angeles County Board of Supervisors meeting room (Photo Credit: County of Los Angeles)

LOS ANGELES – The Los Angeles County Board of Supervisors unanimously passed a motion Tuesday, sponsored by Supervisors Hilda Solis and Sheila Kuehl, which directs County attorneys to report back to the board in three weeks on how the County could implement a paid sick leave policy for people who contract monkeypox, or other new and emerging infectious diseases.

The Board also is urging California Governor Gavin Newsom to extend the state’s coronavirus supplemental paid sick leave by signing the AB-152 COVID-19 relief leave bill.

Supervisor Solis prior to the vote pointed out that both coronavirus pandemic and the monkeypox outbreak has disproportionately affected essential workers, who are predominantly Black and Latino.

Solis further noted that without a form of paid sick leave, are in most cases, unable to take the recommended five to 10 days to isolate for COVID-19 — much less the two to four weeks needed to isolate for the duration of a monkeypox diagnosis as recommended by the Centers for Disease Control and Prevention as well as the County Dept. of Public Health .

During a monkeypox townhall hosted by the Blade in East Los Angeles last week, which was also attended by Supervisor Solis, Sherrill Brown, M.D, AltaMed’s Medical Director of Infection Prevention, in her presentation noted the need for economic relief.

In her practice treating primarily Latino monkeypox cases at AltaMed clinics in Los Angeles and Orange Counties, she told the townhall attendees she was hearing some of her patients were having difficulty with the required isolation protocols because of their economic needs.

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Monkeypox

Unvaccinated 14 times more likely to contract monkeypox

Racial disparities persist in new cases of monkeypox as Black & Latino people are overrepresented in the numbers

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White House Monkeypox Response Team and Public Health Officials (Screenshot/YouTube)

WASHINGTON – U.S. health officials are celebrating preliminary data on the vaccine used in the monkeypox outbreak, which has led them to conclude eligible persons who didn’t get a shot were 14 times more likely to become infected than those who are vaccinated.

The new data, as described by health officials on the White House monkeypox task force during a call with reporters on Wednesday, comes as the overall number of new cases of monkeypox is in sharp decline, although considerable racial disparities persist in the remaining cases as Black and Latino people are overrepresented in the numbers.

Rochelle Walensky, director of the Centers for Disease Control & Prevention, said during the conference call the preliminary data — collected from 32 states between July 2022 and September 2022 — provides an early shapshot of the effectiveness of the vaccine and cause for optimism on the path forward.

“These new data provide us with a level of cautious optimism that the vaccine is working as intended,” Walkensky said. “These early findings and similar results from studies and other countries suggest even one dose of the monkeypox vaccine offers at least some initial protection against infection.”

Walensky during the conference call admitted the data is incomplete in numerous ways. For example, the data is based on information on individuals who have obtained only the first shot as opposed to both shots in the two-shot vaccination process. (The data showing positive results from individuals who have only one shot contradicts previous warnings from the same U.S. health officials that one shot of the monkeypox vaccine was insufficient.)

The data also makes no distinction between individuals who have obtained a shot through subcutaneous injection, a more traditional approach to vaccine administration, as opposed to intradermal injection, which is a newer approach adopted in the U.S. guidance amid the early vaccine shortage. Skeptics of the new approach have said data is limited to support the idea the intradermal injection is effective, particularly among immunocompromised people with HIV who have been at higher risk of contracting monkeypox.

Not enumerated as part of the data were underlying numbers leading health officials to conclude the unvaccinated were 14 times more likely to contract monkeypox as opposed to those with a shot, as well as any limiting principle on the definition of eligible persons. Also unclear from the data is whether individual practices in sexual behavior had any role in the results.

Despite the positive data on the monkeypox vaccine based on one shot, U.S. health officials warned during the conference call the two-shot approach to vaccine administration is consistent with their guidance and more effective.

Demetre Daskalakis, the Biden administration’s face of LGBTQ outreach for monkeypox and deputy coordinator for the White House monkeypox task force, made the case that for individuals at risk obtaining a second dose is “really important.”

“So we see some response after the first [shot] in the laboratory, but the really high responses that we want to really get — that you know, level 10 forcefield as opposed to the level five forcefield — doesn’t happen until the second dose,” Daskalakis said. “So the important message is this just tells us to keep on trucking forward because we need that second dose at arms that people haven’t gotten the first should start their series of two vaccines.”

Also during the call, health officials said they would be expanding opportunities for vaccines as pre exposure prophylaxis, as opposed to practices in certain regions granting vaccines in their limited supply to individuals who meet certain criteria or have had risk of exposure.

The Centers of Disease Control & Prevention, officials said, is also updating its guidance to allow injection of the vaccines in places other than a patient’s arm.

Daskalakis said fear of stigma about getting a noticeable shot in the forearm after obtaining a monkeypox vaccine was a key part of the decision to issue the new guidance on implementation.

“Many jurisdictions and advocates have told us that some people declined vaccine to monkeypox because of the stigma associated with the visible but temporary mark often left on their forearm,” Daskalakis said. “New guidance from CDC allows people who don’t want to risk a visible mark on their forearm to offer a vaccine on their skin by their shoulder or their upper back. Those are areas more frequently covered by clothes.”

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