CDC study: Florida counties among sites at risk for summer mpox outbreaks

The mpox health emergency is over, but US health officials are aiming to prevent a repeat of last year’s outbreaks.

Mpox infections exploded in the early summer of 2022 in the wake of Pride gatherings. More than 30,000 cases were reported in the US last year, most of them spread during sexual contact between gay and bisexual men. Some 40 people died.

With Pride events planned across the country in the coming weeks, health officials and event organizers say they are optimistic infections will be fewer and less severe this year. Among the reasons are a greater supply of vaccines, more people with immunity, and easier access to a drug to treat mpox.

But they also worry that people think mpox is a problem from last year.

“Out of sight, out of mind,” said Dr. Demetre Daskalakis, who advises the White House on its response to mpox. “But we are beating the drum.”

Last week, the Centers for Disease Control and Prevention issued a health alert to American doctors to watch for new cases. On Thursday, the agency published a modeling study that estimated the likelihood of a mpox resurgence in 50 counties that have been the focus of a government campaign to control sexually transmitted diseases.

The study concluded that 10 of the counties had a 50% or greater chance of mpox outbreaks this year. The calculation was largely based on how many people were considered to be at high risk of infection and what fraction of them had some immunity through vaccination or previous infection.

At the top of the list are Duval County (Jacksonville), Shelby County, Tennessee (Memphis), and Hamilton County, Ohio (Cincinnati), where an estimated 10% or fewer of people with higher risk have immunity.

Another 25 counties have low or medium levels of immunity that put them at higher risk of outbreaks. They include Florida, Palm Beach, Hillsborough, Pinellas and Orange counties.

The study had a variety of limitations, including that scientists don’t know how long immunity lasts from vaccination or previous infections.

So why do the study? To warn people, said Dr. Chris Braden, who leads the CDC’s mpox response.

“This is something important for the jurisdictions to promote the prevention of mpox and for the population to take note and take care of themselves. That’s why we’re doing this,” he said.

Authorities are trying to bring a sense of urgency to a health threat that was seen as a growing crisis last summer but faded by the end of the year.

Formerly known as monkeypox, mpox is caused by a virus from the same family as the one that causes smallpox. It is endemic in parts of Africa, where people have been infected through rodent or small animal bites, but it is not known to spread easily from person to person.

Cases began emerging in Europe and the United States about a year ago, mainly among men who have sex with men, and spiked in dozens of countries in June and July. The infections were rarely fatal, but many people suffered painful skin lesions for weeks.

Countries scrambled to find a vaccine or other countermeasures. At the end of July, the World Health Organization declared a public health emergency. The United States followed with its own in early August.

But then cases began to decline, from an average of nearly 500 a day in August to fewer than 10 by the end of December. Experts attributed the decline to several factors, including government moves to overcome vaccine shortages and efforts by the gay and bisexual community to issue warnings and limit sexual encounters.

The US emergency ended at the end of January and the WHO finalized its declaration earlier this month.

In fact, there’s less of a sense of urgency about mpox than there was last year, said Dan Dimant, a spokesman for NYC Pride. The organization anticipates fewer messaging about the threat at its events next month, though plans could change if the situation worsens.

There were long lines for vaccines during the height of the crisis last year, but demand has faded as cases have declined. The government estimates that 1.7 million people, mostly men who have sex with men, are at high risk of mpox infection, but only about 400,000 have received the recommended two doses of the vaccine.

“We are definitely not where we need to be,” Daskalakis said, during an interview last week at an STD conference in New Orleans.

Some see possible storm clouds on the horizon.

This year cases arose in some European countries and in South Korea. On Thursday, UK officials said a rise in mpox cases in London in the past month showed the virus was not going away.

Nearly 30 people, many of them fully vaccinated, became infected in a recent outbreak in Chicago. (As with COVID-19 and the flu vaccine, vaccinated people can still get mpox, but they are likely to have milder symptoms, officials say.)

Dr. Joseph Cherabie, associate medical director for the St. Louis County Sexual Health Clinic, said people from the area travel to Chicago for events, so outbreaks there can have a ripple effect elsewhere. .

“We are several weeks behind Chicago. Chicago is usually our go-to,” Cherabie said.

Chicago health officials are taking steps to prevent further spread at an “International Mr. Leather” gathering this weekend.

Event organizers strongly advise attendees to get vaccinated. Chicago health officials collected messages on social media, including one showing three candles and a leather paddle reading: “Before you play with leather or wax, get yourself mpox vax.”

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