Public health experts are on a mission to spread information about a new disease outbreak cropping up in cities around the world: Monkeypox. 

Risk is considered low and, as of last week, less than 100 cases have been identified in the county. 

This week, the Los Angeles LGBT Center hosted a seminar to spread information about the disease and answer questions from concerned LA-area residents. The virtual event featured four physicians: Sonali Kulkarni, MD, MPH, medical director in the Division of HIV and STD Programs (DHSP) at the Los Angeles County (LAC) Department of Public Health; Nava Yeganeh, MD, MPH, pediatric infectious disease physician and medical director of the Vaccine Disease Preventable Control Program; Robert Bolan, MD, medical director of research and education, Los Angeles LGBT Center; and David Herman, MD, medical director of Primary Care, Los Angeles LGBT Center.

They are quick to point out the illness, which can cause painful rashes as well as flu-like respiratory symptoms, is much less deadly and much more difficult to catch than the coronavirus. But there are important benefits to learning more about the disease.

“I do think that the thing that COVID has taught us is, really, to think through everyone’s risk tolerance and the fact that it is different,” Kulkarni said. “So, you know, I think that we want to share this information with you all … and answer your questions so folks can make the most informed decision … when they’re making plans and deciding whether to engage in different activities.”

What is the current status of the outbreak?

LA County Public Health reported 85 cases have been identified in the county since the outbreak began. All of the cases have been reported among “persons who reported being gay, bisexual or other cisgender men who have sex with men,” Kulkarni said. 

“It’s important to know monkeypox can affect any population, but it just appears that right now transmission is taking place primarily among the social networks of gay and bisexual men,” Kulkarni added.

Worldwide, an estimated 9,600 cases have been confirmed in 63 countries since May and that number rises daily.

The good news is that, so far, there have been no hospitalizations or deaths related to the outbreak in Los Angeles; moreover, the United States had not reported any monkeypox-related deaths as of latest reporting.

How do you get monkeypox?

Monkeypox is primarily spread through physical contact, especially through sex, open-mouthed kissing or sweat. It is also possible, though less likely, to spread monkeypox through respiratory droplets, such as sneezes. Unlike COVID-19, which is spread through microscopic aerosols that can linger in the air for minutes, monkeypox is a larger virus requiring “really heavy, big droplets, from close contact,” Kulkarni said.

What are signs of infection?

Monkeypox’s calling card may be a rash, but the first signs of infection are more reminiscent of common respiratory illnesses.

“Folks can have, initially, a fever and headache, muscle aches, swollen lymph nodes in their throat, their groin or other parts of their body,” Kulkarni described, “and then developing into a rash, which can look like bumps, blisters, or pustules — like whiteheads — and then those typically will scab over and people will have a scab, which then, within two to four weeks, will fall off and then healthy skin will replace that.”

The typical course of the illness follows that progression, but U.S. cases observed in this current outbreak have been much less symptomatic, Kulkarni said. Many cases did not include headaches or other “bodily symptoms,” and rashes were more contained, not spreading around the body.

How is the vaccine rollout working?

So far, the federal government has been slow to roll out vaccines, but that process is speeding up as the disease continues to spread in cities around the country. Just 1,000 doses of the JYNNEOS vaccine were provided in the Centers for Disease Control and Prevention (CDC) initial allocation, for a county of 10 million. County Health distributed those to the highest risk residents — people known to have been in direct contact with an infected person. 

Soon after, LA County received its second shipment of 6,000 doses.

“Basically, at this point, what we’re doing is we’re working with community partners for our next phase, which is to help get vaccine [doses] more broadly available to individuals who … do have some higher indications for higher risk for monkeypox,” Kulkarni said. “At this point, we are able to extend it to gay and bisexual men and transgender women with a known diagnosis of rectal gonorrhea or at least syphilis in the past three months, and also working with our local jail system to identify higher risk persons who are incarcerated at the jail.” Those vaccines will be distributed at 25 sites across the county as well as eight public health STD clinics.

Someone who has close contact with an infected person but who receives the JYNNEOS vaccine within four days may avoid contracting the virus; if the vaccine is given between four and 14 days of exposure, the vaccine can help reduce the disease’s severity.

The CDC has indicated LA County will soon receive an additional 9,000 vaccine doses over the next few weeks, Kulkarni said. The Public Health Department has a goal of expanding eligibility once more doses become available.

Is it safe to go to gyms? What about nightclubs?

While picking up monkeypox in the air at a gym is unlikely, physical contact with contaminated fitness equipment is a real threat, according to doctors who spoke at the seminar.

Bolan called it “a pretty obvious likelihood.”

“Monkeypox is a particularly hardy virus … it’s a big virus, as viruses go, and it is known to be able to survive in linens, clothing, and on environmental surfaces, particularly in dark and cool conditions, for up to two weeks or even longer,” Bolan said. “So it’s very important, I think, to pay attention to environmental surfaces like gym surfaces and, you know, workout benches and mats — things that are completely porous … or partly porous.”

Bolan said Clorox wipes and other common household cleaners will do the trick, but it is important to follow directions to really kill the virus.

As for nightclubs, raves and high-contact parties, the risk is higher.

Bolan said events where people are having high levels of physical contact with strangers, including “three to five minutes of open mouth kissing,” or “some bumping and grinding that goes on,” could be more dangerous.

Another doctor, Herman, said there is no guaranteed way to protect yourself if you do decide to go home with someone.

“That’s really where this illness has taken hold,” Herman said. “I mean, just to be honest about it, it is spreading right now through, you know, intimate contact. And so, the reality of the spread of monkeypox is such that, really, if you’re engaged in intimate contact, you are at risk for acquisition.” Herman did say that accessing vaccines once they become more widely available and staying vigilant to monitor for symptoms is important, and that using condoms during intercourse may help keep rashes from spreading in sensitive genital areas.

Should I consider changing my travel plans?

Bolan said he initially scoffed at the suggestion of canceling travel plans, but as European outbreaks tick higher — 2,447 in Spain, 1,735 in the UK, 1,636 in Germany, as of early this week — he became less dismissive.

Kulkarni added that all travel involves a risk calculation right now, with COVID-19 cases on the rise once again, so it is up to individuals to determine their risk/benefit calculation. 

Are there additional resources available?

Yes. Visit publichealth.lacounty.gov/media/monkeypox for information on the current outbreak, vaccine rollout, images of monkeypox rashes and other advice and information. 

emily@smdp.com