The number of cumulative monkey pox cases has more than doubled in Los Angeles County in the past two weeks, as officials rush to better detect the virus and vaccinate more vulnerable communities on a larger scale.
According to data from the Ministry of Health, 1,105 cumulative cases of monkeypox have been reported nationwide as of Friday. As of this week, that total includes the region’s first cases in a prison and a homeless shelter, according to health official Dr. Muntu Davis. The median age of people with confirmed cases of monkey pox in LA County is 35.
Nearly half of the county’s cases for which geographic information is available have been reported in the central county health department’s planning area, including West Hollywood, Hollywood, downtown Los Angeles, Eagle Rock, Highland Park, Echo Park, Silver Lake, Los Feliz and Boyle Heights. About 12% of the inhabitants of the province live in this region.
About 15% of monkey pox cases in LA County are in an area that includes the San Fernando and Santa Clarita valleys, county health data shows. About 22% of the inhabitants of the province live in that region.
The Antelope and San Gabriel valleys have the fewest reported cases.
The disease — characterized by a rash and lesions that may look like pimples, bumps, or blisters — spreads mainly through prolonged skin-to-skin contact with those lesions, which may be in hard-to-see areas or mistaken for other skin problems. The lesions may first appear in the genital area and rectum before spreading to other parts of the body.
“While the number of cases in Los Angeles County is increasing, the risk of infection in the general population remains very low,” Davis said at a briefing Thursday.
About 98% of cases for which gender identity information is available are men, according to county figures. And 98% of cases of known sexual orientation are among people who identify as gay or bisexual, Davis said.
Although the disease can be quite painful, it is rarely fatal. Five people have died worldwide in the outbreak, none of them in the US
“I want to reiterate that we continue to approach this outbreak with the utmost urgency to slow its spread in California,” said Dr. Tomás Aragón, director of public health and health official in California, Friday.
Wastewater tests, which are still useful in estimating the spread of the coronavirus, are now also being used to detect monkey pox.
In late June — about a month after the first California case was confirmed — monkeypox DNA was detected in wastewater in San Francisco, according to the WastewaterSCAN coalition, a group of scientists who have been testing sewage systems for the coronavirus since 2020.
“It helps to understand how widespread this is,” said Stanford professor of civil and environmental engineering Alexandria Boehm, one of the lead researchers on the WastewaterSCAN team.
Monkeypox virus has also been found in LA County wastewater. Samples from the Joint Water Pollution Plant in Carson, which serves approximately 4 million residents and businesses in southern and eastern LA County, showed a small presence on July 31 and for three days during the first week of August, according to data from WastewaterSCAN. The virus has not been found there since, despite the rising disease rates in the province.
By comparison, monkeypox DNA has been detected almost every day since June 27 at two San Francisco wastewater facilities — and at much higher levels than LA County.
Still, Boehm said that doesn’t mean there aren’t more monkeypox in Los Angeles County; it was just hard to detect among the huge sample sizes.
Because LA County’s wastewater supply serves such a large number of people, “you have to think about the sensitivity of detecting monkeypox relative to the number of incidents in the population,” Boehm said. “Just because you don’t detect monkey pox doesn’t mean there’s no one there [in that waste watershed] with monkey pox.”
It’s not immediately clear whether the LA County Department of Public Health has plans to expand testing for monkeypox in wastewater. The province has been monitoring wastewater for the coronavirus for months, including at the Joint Water Pollution Plant, as well as the Hyperion Water Reclamation Plant in Playa del Rey and facilities near Lancaster and Malibu.
“It will take some time to look at and assess the correlations between the concentrations and the case counts. … [But] we are excited to be part of a larger group exploring how to best use wastewater data,” said Barbara Ferrer, director of LA County Public Health.
Last week, LA County had received more than 43,000 doses of the Jynneos monkeypox vaccine. Nearly all — 91% — of those have already been administered, and the county is offering second doses of the two-shot series for the first time this week. People are eligible for their second injection 28 days after their first dose and are considered fully vaccinated two weeks after their second dose.
Another 29,000 doses of the vaccine have just been received, Davis said Thursday. The latest vaccines will be used in the new method of delivering doses intradermally – between layers of skin – rather than subcutaneously, with the injection being injected into the fat under the skin. Thanks to the new strategy, each dose can now be one fifth of the volume of the doses originally dosed, stretching limited stocks.
People eligible for the monkeypox vaccine in LA County are gay or bisexual men and transgender people who have had multiple or anonymous sex partners in the past 14 days. Immunization priority is given to residents who are immunocompromised, including those with advanced or controlled HIV infection.
Previous data from Africa suggest that the Jynneos vaccine is at least 85% effective in preventing monkeypox. Because the vaccine is not 100% effective, health officials still recommend taking steps to reduce the risk of infection. But if an infection still occurs, “hopefully it will make the infection less severe,” Davis said.
Aragón said the state has positioned nearly 3,000 oral and 345 IV versions of Tpoxx treatments. Vaccines are distributed in communities based on the number of cases reported by a province, he said.
He noted that the trendline will begin to flatten or decline in cases when the virus “has a hard time finding susceptible people to infect.” That can happen from people who develop immunity from vaccination or previous infection, or if they “change their behavior and they don’t have as much contact, so that means there are fewer chances for transmission.”
“Those three things coming together will drive the epidemic curve down,” Aragon said.
The California Department of Public Health released updated guidelines this week recommending that people with a confirmed or suspected case of monkey pox should isolate at home until infection has been ruled out or their lesions have completely healed, a new layer of skin has formed, and they have been treated for at least Has been free of other symptoms for 48 hours.
Residents can resume lower-risk activities if they are free of fever, respiratory symptoms, or new lesions for at least 48 hours and any lesions that cannot be covered — such as those on the face — have completely healed. In that case, residents should bandage or cover unhealed lesions, wear a well-fitting mask when around others; and avoid crowded environments, sharing towels or personal items, and direct skin-to-skin contact.
People who have had monkeypox do not need the vaccine because they are immune, according to the provincial health ministry. People who received the first dose of vaccine and later became infected generally do not need the second dose; however, a second dose may be suggested by a healthcare professional.
County officials have begun making vaccinations available to high-risk people in the county’s prison system and among the homeless.
Officials have long said that the risk of monkeypox exposure is primarily caused by intimate skin-to-skin contact, and transmission of the virus has not been seen through surfaces in gyms or other public surfaces in this outbreak.
However, in 2018, there was one documented case of monkeypox transmission in Britain where a health aide was infected with monkeypox after changing “suspectedly contaminated bedding” without wearing a facemask or respirator. The worker had contact with the sheets during a time when the patient had skin lesions but had not yet been diagnosed with monkey pox and had been placed in isolation, according to medical journals.
Davis suggested that workers who clean surfaces in frequently touched environments, such as gym equipment, or wash linens, towels and uniforms, should ensure they adopt reasonable general prevention practices that also protect against COVID-19 and other illnesses.
Workers must wear disposable gloves when cleaning, and workplaces must make handwashing facilities and hand sanitizer available to employees and customers, Davis said.
“We also encourage companies where employees provide personal care services – such as massages or skin treatments – to consider posting signage asking customers or customers to delay services if they experience symptoms, or if they experience new or unexplained skin rashes, bumps, pustules have blisters, or scabs that started out as blisters,” he said.
It is also recommended “that workers visually inspect the area of skin that will be touched. And, of course, under no circumstances should employees touch a rash,” Davis continued.
Residents can apply for the monkeypox vaccine through their regular health care provider or apply online to the provincial health ministry to request a vaccination. They can also call the health office at (833) 540-0473, seven days a week between 8am and 8:30pm
Times staff writer Melody Gutierrez contributed to this report.