We asked a UCSF expert about monkeypox in San Francisco

The number of monkeypox cases in San Francisco is rising, with the city reporting 197 cases on Tuesday, up from 141 cases a few days ago. Despite growing demand, vaccines continue to be in short supply. People lined up at San Francisco General until 9 a.m. on Wednesday to get Jynneos, the only vaccine specifically approved to prevent monkeypox, while many other vaccine applicants were turned away. No deaths have been reported so far in the outbreak in the United States, although the rash caused by the virus can be painful and last two to four weeks.

To get a sense of the situation in the city, we reached out via email to UCSF infectious disease expert Dr. Monica Gandhi, whose work on HIV has informed her perspective on smallpox. monkey.

SFGATE: How concerned are you about monkeypox in San Francisco?
Dr. Monica Gandhi: I am concerned for the most affected population, namely men who have sex with men (MSM) with multiple sexual partners, and very eager to get them vaccinated as soon as possible. I’m not terribly worried about the general population as the risk factors for this infection seem to be fairly well defined (of the 197 in SF, the overwhelming majority of cases have been in men who have sex with men).

SFGATE: Do you think monkeypox cases are underestimated?
Gandhi: Monkeypox usually manifests as lesions and I think awareness has been raised, so hopefully we’re not significantly underestimating cases at this point. Our testing capacity has increased, which is also important.

SFGATE: The San Francisco Department of Public Health requested 35,000 vaccines, but only received 3,580 in an initial shipment and another 4,163 this week. How concerned are you about the shortage?
Gandhi: I am very concerned about the shortage of monkeypox vaccines and wrote an article in the Atlantic on June 24 lamenting our lack of vaccine supply and how we are inadequately responding to this outbreak. A month later, I am appalled that we still do not have the vaccine supply we need.

Jynneos, the only vaccine specifically approved to prevent monkeypox, is in short supply in San Francisco where demand for the vaccine is high.

Bill O’Leary/The Washington Post via Getty Images

SFGATE: How to distribute vaccines in this period of shortage?
Gandhi: The usual dosing strategy for the monkeypox vaccine is one dose followed by a second dose four weeks later. I would advocate the first dose first strategy that was used for the COVID vaccine in the UK, Canada and India at the start of the vaccine rollout when supplies were tight. This means that we give one dose now to distribute as many doses as possible to MSM, followed by the second dose when the vaccine supply increases. I also think we should delay vaccinating those who have been vaccinated against smallpox (which ended around 1970 in the United States, so for those born before that) because those people will likely still have some protection against monkeypox. Then, when the vaccine supply increases, we can expand the doses to all MSM who wish to be vaccinated. Finally, if we start to see significant increases in monkeypox infections in heterosexual populations (which is not currently happening), then the vaccine will be offered more widely to all sexually active people.

SFGATE: Who is most at risk from monkeypox and who should get vaccinated?
Gandhi: For now, all MSM who have multiple sexual partners and who have not been vaccinated against smallpox (especially those born after 1970). Later, we will likely extend this to MSM with more limited sexual partners and those who received the smallpox vaccine.

SFGATE: I’ve heard conflicting information about whether the focus of monkeypox coverage on the LGBTQ population is helpful or harmful. What are your thoughts?
Gandhi: I think the focus on the LGBTQ population is very helpful. Just as men who have sex with men have a higher risk of contracting HIV and older adults have a higher risk of complications and death from COVID, it is important to define the populations most at risk. from monkeypox so we can prioritize. messages and resources targeted to these groups. With HIV it was not helpful to say that all risk factors were the same (e.g. anal sex is riskier than oral sex) and that all groups were at risk and the same is true for monkeypox.

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