New Monkeypox Cases Plummet, but Racial Gap Remains, White House Says

WASHINGTON — Cases of monkeypox are continuing to decline in the U.S., but the disease is still disproportionately affecting people of color, a White House official said.

“In the U.S., about 27,635 cases were reported as of yesterday,” Demetre Daskalakis, MD, White House National Monkeypox Response deputy coordinator, said at an online briefing Thursday. “We continue to have a decrease over time — we’re about 85% down from where we were at the peak of the outbreak. So that’s a lot of hopeful news, that we continue to see monkeypox going under better and better control.”

On average, new daily monkeypox cases have fallen from a peak of 440 in early August to 48 cases per day.

However, he added, “the outbreak is really concentrated in communities of color, specifically among Black individuals,” and although about 975,000 doses of monkeypox vaccine have been administered, “we are seeing an ongoing disparity among people of color … So a lot of the work that is happening is really designed to address this very important disparity. We are really starting to work with our pharmacy partners to get vaccine actually in retail pharmacies; we know that worked really well during COVID.” According to data posted by the CDC, 44% of U.S. monkeypox cases were among Black individuals, as of October 9, even though they only make up about 14% of the population.

Part of the pharmacy strategy also includes minimizing the assessment questions that people are asked prior to receiving the vaccine, he continued. “Saying, ‘I want the monkeypox vaccine’ at this point should be enough for me to get that vaccine, without further assessment to say ‘Yeah, I’m a gay or bisexual man who has had a couple of sex partners’ or revealing your gender identity.”

Daskalakis emphasized that “although we’re seeing this excellent progress, that progress is threatened by the fact that we don’t have vaccines in some folks’ arms that are at increased risk for monkeypox in the future. And so I think that as we work to get vaccines closer … to where people seek services and care, we are really creating a better force field of protection.”

In addition to offering the vaccine at pharmacies, the administration is making it available at social events, he said. “I think we’re up to around 22 small equity events that are scheduled in individual jurisdictions, and they range anywhere from going to [a] kiki ball and offering vaccines there, to smaller things like going to a bar or a club, or HIV-focused gatherings and interventions that also attract folks who could benefit from the vaccine.”

John Brooks, MD, the chief medical officer for CDC’s monkeypox response, presented a science brief posted by the agency that looked at which parts of the body were most likely to be a source of monkeypox spread. “Among the sources on an infected person that could most easily or most likely be a cause of spread, bar none — it’s the skin lesions,” he said. “That skin-to-skin close contact has been shown very convincingly to transmit. However, there’s also now sufficient evidence to say with authority that exposure to the mouth and throat — and saliva — this too can carry sufficient virus to infect someone, as can exposure to the anorectum.”

On the other hand, although monkeypox DNA can be detected in semen, urine, urethral tissue, and conjunctival tissue, “there has not been sufficient evidence” to say that contact with them can result in transmission, he said.

Infection with contaminated needles is another concern, Brooks said, noting that a study recently published in the CDC’s Morbidity and Mortality Weekly Report found that “if you are pricked or stuck by a needle or a scalpel that was used to unroof a lesion and to sample it on a person’s skin, that sharp, which is contaminated, if it pierces your skin, can transmit the infection.”

Although it was not tested for monkeypox DNA, that’s because the needle “has usually been thrown away by the time we realize the person has been infected,” said Brooks. “But the epidemiologic evidence is so strong … that we’re very concerned about this.” He added that the authors of the article had a message for healthcare providers: “Please don’t use sharps to unroof lesions — if you want to take a sample, just rubbing the top of it with the right kind of swab is sufficient.”

David Boucher, PhD, director of infectious disease response at the HHS Office of the Assistant Secretary of Preparedness and Response, gave an update on monkeypox vaccine availability. “We started with the outbreak with about 1.4 million vials available, and we have shipped out about 900,000 vials to [various] jurisdictions,” while another 200,000 vials of the Jynneos vaccine were shipped back to manufacturer Bavarian Nordic to supply global demand, he said. “That leaves, right now, about 300,000 vials in the [Strategic National Stockpile] available when needed.”

In addition, the federal government has another 5.5 million vials under contract, and Bavarian Nordic will be replacing the 200,000 it took back, said Boucher, “so that means 5.7 million vials coming in to be delivered through June of 2023. Some of those have already started coming in, and they’re pending final release testing — which we’re doing right now — to make sure that we get them in the country as soon as possible.” He added that officials expect about 1 million of those vials to be available “for the October-November-December timeframe.”