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Monkeypox

U. S. Health experts weigh declaring monkeypox an STD

Monkeypox being spread through sex, not brief skin-to-skin contact- Key points in the messaging includes “monkeypox can affect anyone”

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Edrick and Gustavo (Photographer: Harrison J. Bahe/www.bahephotography.com)

WASHINGTON – Amid fears monkeypox would spread at an increased rate at the end of summer as gay men gather in close quarters for dance parties and other celebrations, health experts are starting to emphasize that the current outbreak isn’t spreading through minimal skin-to-skin contact, such as brushing up against a fellow shirtless dance partner, but rather through sexual activity and overwhelmingly among men who have sex with men.

With reported cases of monkeypox in the United States this week reaching 15,505, according to data from the Centers for Disease Control, a number of health experts who spoke to the Blade talked about outright declaring monkeypox a sexually transmitted disease as part of this messaging — although they acknowledge such a label would have pros and cons.

Juan Carlos Loubriel, senior director of community health at the D.C.-based Whitman-Walker Health, was among the health experts making the distinction between the negligible risks of transmitting monkeypox through brief skin-to-skin contact as opposed to sexual activity.

“I’ll say that we need to provide the real facts to our community that indicates right now that the majority of the cases are sexually transmitted, right?” Loubriel said. “So transmission is not occurring by casual touch, right? That’s what we know as of today … So the majority of the cases [are] by prolonged skin-to-skin contact, and during sex there is a lot of skin-to-skin contact.”

As health experts at large are beginning to make a distinction in how the disease is transmitted, the Biden administration has also taken up messaging that downplays the risk of monkeypox transmission through minimal skin-to-skin contact.

Demetre Daskalakis, who is the face of the LGBTQ outreach for the Biden administration as deputy coordinator of the White House monkeypox task force, made colorful remarks Friday during a conference call with reporters downplaying the risk of contracting monkeypox through brief contact, quoting a senior policy adviser at the CDC who has studied LGBTQ health issues.

“I think I’m going to quote my friend Robbie Goldstein that sex involves friction, and friction seems to be how this happens,” Daskalakis said. “So, I think, that from the perspective of events, the real risk at an event is low. Of course, you have to gauge that risk based on what you’re doing, so if there’s a lot of clothes out dancing and friction, that could be a mechanism of transmission, but just brushing by someone, I’ve said this many times before, just brushing by someone is probably low or no risk.”

Asked by the Blade during the call about any consideration on declaring monkeypox a sexually transmitted disease, Daskalakis said it’s “really important that the decision around monkeypox and whether it’s designated happen thoughtfully from the perspective of other implications.”

“What’s really important from the perspective of our communication on the ground is that our harm reduction and safer sex guidance really does mention the importance of sexual transmission or the associated transmission of the virus, and also provides guidance necessary, like reminding people that condoms may have a role — not necessarily the full role — in preventing monkeypox, but also reminds folks that skin-to-skin contact in the context of sex can be really a part of how transmission occurs,” he said.

The messaging is consistent with new studies finding cases of monkeypox are overwhelmingly the result of sexual activity. According to a recent report by NBC News, an increasing amount of scientific evidence — such three studies published in peer-reviewed journals, as well as reports from national, regional, and global health authorities — has indicated “experts may have framed monkeypox’s typical transmission route precisely backward.”

“[A]n expanding cadre of experts has come to believe that sex between men itself — both anal as well as oral intercourse — is likely the main driver of global monkeypox transmission,” the NBC News report says. “The skin contact that comes with sex, these experts say, is probably much less of a risk factor.”

With evidence the monkeypox outbreak is overwhelmingly being transmitted through sexual activity and risks from skin-to-skin contact virtually non-existent, experts say discussion on whether or not to label the virus as a sexually transmitted disease are ongoing and controversial.

On one hand, designating monkeypox as a sexually transmitted disease would give the public a clearer idea about the way it’s being transmitted to allay concerns and enable the public to take appropriate precautions. On the other hand, as seen during the height of HIV/AIDS crisis, an emphasis on monkeypox being transmitted among men who have sex with men may have the effect of stigmatizing the community (and the sexual activity) as being responsible for the outbreak.

Loubriel said the issue of whether or not monkeypox should be messaged more as a sexually transmitted disease is “a very good question and also a very big debate around public health, even within the public health sector.”

“The only reason we cannot say it is just sexually transmitted is because we know as a fact that it can be spread by other various avenues like touching clothing, bedding with an infected person or towels being used by someone with monkeypox, potentially contact with respiratory secretions,” Loubriel added. “So that is why it’s probably not been named as a sexually transmitted infection.”

Joseph Lee, a professor of health education at East Carolina University who studies health inequities among LGBTQ people, said there’s “real tension” in finding the right messaging, which he said would strike a balance between being factual while not being stigmatic of the marginalized community affected by monkeypox.

“We see when we have messaging that goes to the general public…that messaging about how a particular group is doing worse triggers negative stereotypes and makes people feel less at risk than they are,” Lee said. “And really importantly, it makes the group at the worst end of that problem feel sometimes like they’re feeling fatalistic or they can’t do anything to protect themselves. You almost feel like you have to give up and you’re just going to get it anyway because the messaging is so clear, how much it’s impacting your community.”

Lee, however, praised communications on monkeypox from the Centers for Disease Control & Prevention, saying the agency has “very useful guidance about promoting equity in monkeypox communication that I actually really like.”

Key points in the guidance, Lee said, is messaging that monkeypox can affect anyone, while going through some of the ways the virus is being transmitted and ways the public can protect itself. The guidance, Lee said, follows the right strategy of articulating a message to the general public, then adding more specific messages about protection against the disease and risk to the communities most vulnerable.

“That’s sort of their big picture strategy that I think is actually the right strategy,” Lee concluded. “How well everyone’s implementing it across the country in our messy, somewhat broken public health system is another question.”

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Monkeypox

Center for Black Equity awarded grant to combat monkeypox

The grant funds the continuing fight against monkeypox misinformation and lack of access to vaccines & resources within minority communities

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Monkeypox JYNNEOS vaccine (Screenshot/YouTube CBS News)

WASHINGTON – The Center for Black Equity (CBE) has received a $50,000 grant supporting the center’s mission to raise awareness about monkeypox in Black and Latinx LGBTQ communities. The grant will also fund the center’s continuing fight against monkeypox misinformation and lack of access to vaccines and resources within these communities.

The grant, which is a part of a partnership with Gilead Pharmaceuticals, requires the CBE to demonstrate that it has the history and capacity to create and implement a community-wide initiative focusing on monkeypox education and boosting vaccination rates in the Black and Latinx LGBTQ communities.

The CBE is a coalition of international LGBTQ community members, Pride organizations, and community-based organizations that have conducted philanthropic and advocacy work in the LGBTQ community for more than 20 years.

Grant funds will be used in efforts to connect Black and Latinx LGBTQ persons with local community-based organizations that will provide accurate and up-to-date information on monkeypox, direct people to vaccination sites, and improve these communities’ access to monkeypox education and vaccines.

The official kickoff of the CBE’s monkeypox initiative started with a nationwide community leader talk.

“We brought together all of the Black Pride leaders from around the country to talk about monkeypox in their communities, what kind of resources they have, what has been the health department response and what do they need to do their work better,” CBE deputy director Kenya Hutton said.

The CBE will continue to host regular talks with community leaders to support the center’s goal of connecting the needs and voices of the Black and Latinx LGBTQ communities on a nationwide level.

“It’s going to get an idea of what it sounds like or what experiences are from community leaders on the ground level,” Hutton said.

Since monkeypox was officially labeled a public health emergency in the U.S., the LGBTQ community has been vocal about the misinformation surrounding the disease as well as limited resources for LGBTQ communities of color. Many have compared the public health response to monkeypox to the early response to the HIV/AIDS epidemic in the 1980s.

“In the beginning, the information seemed to focus on white gay men,” Hutton said. “And even though they keep saying the number of monkeypox cases are decreasing, the numbers are increasing in the Black and Latinx communities.”

The CBE has an interactive map on its website where you can input your zip code and find permanent and pop-up vaccination sites near you. You can also sign up for the CBE’s biweekly newsletter with up-to-date monkeypox information online.

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Monkeypox

GLAAD examines impact of HIV, COVID, & MPV in new report

A new GLAAD report is out. Invisible People: A Retrospective Report On The Impacts of COVID & HIV In The United States

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By Darian Aaron | NEW YORK – On October 6, in a TIME Magazine exclusive, GLAAD released “Invisible People,” a first-of-its-kind report detailing the disruption caused by COVID-19 in the lives of people living with HIV. The 23-page report combines a comprehensive analysis of peer-reviewed scientific literature, qualitative interviews of people living with HIV, affected communities, and community-based organizations (CBOs) serving these populations. 

With research conducted by global market research company Ipsos and completed before the U.S. emergence of the monkeypox virus (MPV), GLAAD has included an MPV addendum to the report that elevates the disproportionate impact of MPV, HIV, and COVID-19 among Black Americans. Through data and first-person narratives, the report highlights the source of medical mistrust in Black communities, examines the lack of access to consistent healthcare during the pandemic, and most recently, inadequate access to the JYNNEOS MPV vaccine, despite the disproportionate occurrence of MPV among Black gay and bisexual men. 

GLAAD President Sarah Kate Ellis draws a parallel between the devastating outcomes for LGBTQ people of color across the three major health crises. 

“LGBTQ people and queer people of color are disproportionately affected in the pandemic, yet data collection didn’t begin for months to help guide responses and resources, and our voices were vastly underreported across the media,” Ellis says. “These are painful parallels to the early days of HIV/AIDS when GLAAD was formed to fight inaccuracy and invisibility.”

As of October 12, the Centers for Disease Control and Prevention (CDC) has confirmed 27,022 MPV cases across the United States. A steady decline in new cases—a national seven-day moving average of 63 cases as of October 12—is attributed to vaccinations and behavioral changes among gay and bisexual men. However, data from the CDC confirms that while Black and Latino gay and bisexual men represent the overwhelming majority of MPV cases, white and Latino men have received their first dose of the vaccine at a much higher rate. 

The inequity in vaccine distribution and the reality that unvaccinated people are 14 times more likely to acquire MPV has exacerbated racial healthcare disparities in Black communities that existed long before the current outbreak. 

Is history repeating itself?  

In a separate interview, pioneering HIV activist Phill Wilson, founder of The Black AIDS Institute, says the “parallels are scary” in the context of the U.S. response to the early HIV/AIDS crisis and the slow response to the threat of MPV among Black gay and bisexual men in 2022. 

“During the early days of the HIV/AIDS pandemic, I used to quote my grandmother—probably your grandmother, too: “When white people get a cold, Black people get pneumonia,” Wilson says. 

“The parallels are scary—first, the denial, then the blaming, then the slow response and missed opportunities. And finally, the disproportionate impact on Black, other POC (people of color), and poor communities,” he adds. 

“All the earliest information about how the COVID-19 pathogen was transmitted said that Black, brown, and poor people would be disproportionately impacted. And yet, those in power did not develop strategies targeting those communities. The opposite happened.” 

A California resident, Wilson provides a first-person account of his vaccination experience in Van Nuys, a suburb of Los Angeles situated in the San Fernando Valley.  

“I showed up at the pop-up vaccination station at about 10:15 in the morning. They didn’t open until 11:00 am. There were already 100 people in line,” Wilson says. “They had 400 vaccines available that day. By the time I left at 3:00 pm, they had closed the line for the day. I counted less than five Black men, four or five Latino men, and maybe one Asian man getting vaccinated. Four hundred, presumably LGBTQ+ people, were vaccinated that day, and less than 3% were BIPOC (Black Indigenous People of Color).” 

To combat the inequity in the MPV vaccine rollout, the CDC has created a Vaccine Equity Pilot Program to reach populations most affected by MPV but less likely to be vaccinated. 

In the report, GLAAD also calls out the inherent homophobia that precipitated the naming of HIV as a “gay disease” in the early days of the epidemic. This stigmatizing language has also been echoed during the recent MPV outbreak because most cases are among gay and bisexual men. 

Ryan Lee, an Atlanta-based writer, was diagnosed with MPV in July and has since recovered. He says he understands why gay men are reluctant to bare the social responsibility of MPV. 

“The burden and shame that gay men have borne regarding our sexual health have created generational trauma and anxieties. And five months of monkeypox have already stoked the bigotry and judgment in those who love telling gay folks how sick and dirty we are,” Lee says. 

“So I understand the reluctance of queer folks to be closely associated with a new illness, but we must recognize monkeypox is currently a disease that disproportionately impacts gay men.”

According to reports published in August, the fear and anxiety experienced by many gay and bisexual men and the refusal of some phlebotomists to administer the MPV vaccine are reminiscent of a dark era in our nation’s history that many hoped never to repeat. 

“There is something spooky about sitting in a folding chair in 2022, surrounded by other gay men in folding chairs, waiting to be vaccinated by healthcare workers who wear personal protective equipment and immediately wipe down each vacated chair with disinfectant,” says Amanda Cary, manager for the gay men’s sexual health clinic at Whitman-Walker in D.C, in a story published in The Washington Post

“Invisible People” lays bare the outcome of slow to no inaction when three health crises converge and target an already marginalized group of people. Through this report, GLAAD continues to elevate the stories and voices of LGBTQ people living with HIV at greater risk for COVID and MPV acquisitions. 

“We have to learn from the lessons of each epidemic to be better prepared for the next,” says Andres Cantero Jr., a study participant. “People living with HIV, like all chronic conditions, should know that we can count on care that keeps us alive and helps prevent the spread of HIV.” 

“We just lost two years,” says Ellis. “We need folks to look up, wake up, and realize that we as a community and a country can walk and chew gum at the same time. We can deal with a major pandemic while not forgetting about our most marginalized folks.”

Read the complete GLAAD report  Invisible People: A Retrospective Report On The Impacts of COVID & HIV In The United States.

*******************

Photo credit: Lee Jones Photography 

Darian Aaron is the MPV project coordinator for GLAAD. He is also communications director of CNP (Counter Narrative Project), and editor-at-large of CNP’s digital publication The Reckoning.

His work can also be read across multiple platforms as a contributor for Q Digital. Follow him on Twitter @darianoutloud

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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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Monkeypox

Supervisor Hahn to host Downey & Long Beach vax pop-ups

“This vaccine is critical to keeping people safe from the MPOX virus and I want to make it as easy as possible for people to get vaccinated”

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Supervisor Hahn's Mpox vaccine pop-up at Hamburger Mary's in Long Beach (Photo Credit: Office of Supervisor Janice Hahn)

DOWNEY, Ca – Los Angeles County Supervisor Janice Hahn will host a series of Mpox vaccine pop-up clinics outside of bars in Downey and Long Beach this coming weekend. These follow a successful Mpox vaccine pop-up that the Supervisor held outside of Hamburger Mary’s in Long Beach earlier this month, where 67 people received a dose.

“This vaccine is critical to keeping people safe from the MPOX virus and I want to make it as easy as possible for people to get vaccinated,” said Supervisor Hahn. “I am partnering with the LA County Department of Public Health, Long Beach Public Health, and the City of Downey to bring these pop-up vaccine clinics to places where people spend their free time and that are considered safe spaces by the LGBTQ+ community.”

Muevelo Fridays is an LGBTQ+ Latino dance party held once a week at The Epic Lounge in Downtown Downey. Falcon and Falcon North are well-established bars serving Long Beach’s LGBTQ+ community. The Falcon is located on East Broadway, home to several other gay bars that attract people from across the region.

“We appreciate that the Supervisor listens to community concerns, especially when it comes to public health, and we’re grateful that she’s using her resources at the county level to bring the mobile testing unit to Downey,” said Downey Councilman Mario Trujillo, who worked with Supervisor Hahn’s office to bring the pop-up to Downey on Friday. “We invite Downey residents and residents from surrounding communities to take advantage of the unit that’s being brought locally for their benefit.”

The vaccine pop-ups are carried out using a cargo van mobile unit. Supervisor Hahn purchased one of these mobile vans to bring COVID-19 vaccines to communities across her district.

On-site vaccination staff are employees of the Los Angeles County and Long Beach public health agencies.             

What:  Supervisor Janice Hahn Mpox vaccine pop-ups

Details:

Friday, September 23, 8pm to 10:30pm
Muevelo Fridays
The Epic Lounge
8239 2nd St., Downey, CA 90241
Saturday, September 24, 8pm to 12am
Falcon
1435 East Broadway, Long Beach, California 90802
Sunday, September 25, 5pm to 9pm
Falcon North
2020 East Artesia Boulevard, Long Beach, California 90805
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