Monkeypox outbreak is slowing in the US, but health leaders say critical challenges remain


New cases of monkeypox in the United States have been declining steadily in recent weeks, with reported cases in the first week of September down to about half of what they were at their peak a month ago.

But the recent death of a Los Angeles County resident, the first attributed to monkeypox in the US, is a tragic reminder that the outbreak is ongoing and still poses risks.

“There is some hope that these cases will stabilize. That should be no one’s consolation that this outbreak is over,” David Harvey, executive director of the National Coalition of STD Directors, said at a briefing Tuesday.

“We still have to step up our efforts to respond to this outbreak. And there are many, many data questions, clinical care questions, research questions that remain to be answered about this very unusual outbreak of a virus known for decades that presents very differently in the United States.”

Deaths from monkeypox are extremely rare and often affect infants, pregnant women, and people with weakened immune systems, such as from HIV. This year, the World Health Organization has reported 22 deaths among about 58,000 cases. About 22,000 of those cases have been reported in the US.

“In July, the CDC estimated that it took eight days for cases to double across the country. As of mid-August, the doubling rate was 25 days, showing encouraging signs of progress,” Dr. Demetre Daskalakis, White House deputy monkeypox response coordinator, said last week.

But Harvey and other public health leaders warned Tuesday that people on the front lines of the response, including local health departments, epidemiologists and clinics dealing with sexually transmitted infections, are not adequately resourced. to ensure continuous improvement.

And there is a “very significant immunocompromised population in the United States” that will be at high risk if the outbreak continues, Dr. Cesar Arias, a board member of the Infectious Diseases Society of America and chief of infectious diseases at Methodist Hospital of Houston, he said at the briefing.

Other key areas of concern cited by US public health leaders at Tuesday’s briefing include uneven vaccination, access to testing and incomplete surveillance data.

They called on Congress to immediately make a significant amount of funding available to address the outbreak, defending the Biden administration’s request that about $4 billion in funding be appropriated for monkeypox response in the next government funding bill as one of the “four critical needs” along with support. for Ukraine, response to Covid-19 and recovery from natural disasters.

The push for funding comes a day before federal leaders, including the director of the US Centers for Disease Control and Prevention, Dr. Rochelle Walensky, and the director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, are scheduled to speak before the Senate Committee on Health and Education. , Work and Pensions on the federal response to the monkeypox outbreak.

Public health leaders attribute the declining rate of new cases to vaccination and behavioral changes among those most at risk. Men who have sex with men have been disproportionately affected in the outbreak, with about half having reported taking steps to protect themselves and their partners, according to the CDC.

But for the hopeful trend to continue, continued work and investment is needed, especially to reach underrepresented groups, health leaders say.

“In many ways, the initial, easy work has been done. Now, local health departments need to get more creative to reach deeper into their hardest-to-reach communities with messaging, education, vaccines, testing and treatment,” said Lori Tremmel Freeman, executive director of the National Association of Counties and Cities. Health officials.

Data CDC data shows that people of color make up a disproportionate share of cases, but are underrepresented among vaccinated people.

More than half of new monkeypox cases in the past two months have been among black and Hispanic people, but only about a third of the first doses of vaccines have gone to people in these groups, according to a CNN analysis. from the CDC. data.

The White House Monkeypox Response Team addressed these inequities last month, highlighting efforts to offer vaccines at large-scale events and festivals as a strategy to curb them.

“With the increased supply of vaccines, I think we have a new opportunity in strategy that is to get the vaccine to people rather than trying to get people to find vaccines.” Daskalakis said.

Last week, Daskalakis noted that case rates were slowing in hard-hit parts of the country, including New York, Texas, California and Illinois.

But local public health leaders stressed the need for a broader perspective.

“We can’t take our foot off the gas simply because major cities have the wherewithal to mount a robust response, leaving smaller rural communities to fend for themselves,” Harvey said.

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