AP

Mpox has faded in the US. Who deserves the credit?

Jan 10, 2023, 6:34 AM | Updated: 6:37 am

NEW YORK (AP) — Less than six months ago, mpox was an exploding health crisis. What had been an obscure disease from Africa was ripping through European and U.S. gay communities. Precious doses of an unproven vaccine were in short supply. International officials declared health emergencies.

Today, reports of new cases are down to a trickle in the U.S. Health officials are shutting down emergency mobilizations. The threat seems to have virtually disappeared from the public consciousness.

“We’re in a remarkably different place,” said Dr. William Schaffner, a Vanderbilt University infectious diseases expert. “It’s really impressive how that peak has come down to very, very low levels.”

So who deserves the credit? It’s an unsettled question, but experts cite a combination of factors.

Some commend public health officials. Others say more of the credit should go to members of the gay and bisexual community who took their own steps to reduce disease spread when the threat became clear. Some wonder if characteristics of the virus itself played a role.

“It’s a mixed story” in which some things could have gone better but others went well, said Dr. Tom Frieden, a former director of the U.S. Centers for Disease Control and Prevention.

CASES SOAR, THEN FALL

Mpox, formerly known as monkeypox, is a rare disease caused by infection with a virus that’s in the same family as the one that causes smallpox. It is endemic in parts of Africa, where people have been infected through bites from rodents or small animals, but it was not known to spread easily among people.

Mpox cases began emerging in Europe and the U.S. in May, mostly among men who have sex with men. Cases escalated rapidly in dozens of countries in June and July, around the time of gay pride events. The infections were rarely fatal, but many people suffered painful skin lesions for weeks.

In late July, the World Health Organization declared an international health crisis. In early August, the U.S. declared a public health emergency.

Soon after, the outbreak began diminishing. The daily average of newly reported U.S. cases went from nearly 500 in August to about 100 in October. Now, there are fewer than five new U.S. cases per day. (Europe has seen a similar drop.)

Experts said a combination of factors likely turned the tide.

VACCINATIONS

Health officials caught an early break: An existing two-dose vaccine named Jynneos, developed to fight smallpox, was also approved for use against the monkeypox.

Initially, only a few thousand doses were available in the U.S., and most countries had none at all. Shipping and regulatory delays left local health departments unable to meet demand for shots.

In early August, U.S. health officials decided to stretch the limited supply by giving people just one-fifth the usual dose. The plan called for administering the vaccine with an injection just under the skin, rather than into deeper tissue.

Some in the public health community worried that it was a big decision based on a small amount of research — a single 2015 study. But the Centers for Disease Control and Prevention since then has confirmed there was no difference in vaccine performance between the two methods.

“They got criticized for the revised dosing strategy, but it was the right call,” said Frieden, who is currently president of Resolve to Save Lives, a non-profit organization focused on preventing epidemics.

Cases, however, had already begun falling by the time the government made the switch.

COMMUNITY OUTREACH

The current CDC director, Dr. Rochelle Walensky, cited efforts to educate doctors on how to better diagnose and treat mpox. Other experts said that even more important was outreach to the sexually active gay and bisexual men most at risk.

In the first months of the outbreak, the government was cautious about focusing warnings too intently on gay and bisexual men for fear of stigmatizing the men and — in so doing — undermining efforts to identify infections. (Indeed, in November the WHO changed the name of the disease from monkeypox to mpox in an effort to reduce stigma.)

“They were a little coy about the population principally affected,” Schaffner said.

Many say queer activists and community organizations stepped up to fill the void, quickly offering frank education and assistance. In an online survey conducted in early August, many men who have sex with men reported having fewer sexual encounters and partners because of the outbreak.

“The success was really due to grassroots activities,” said Amira Roess, a George Mason University professor of epidemiology and global health. Leaders in the gay community “took it upon themselves to step in when the government response was really lacking” in a way that recalled what happened during the plodding government response to the HIV/AIDS epidemic in the 1980s, she said.

Among those efforts was called RESPND-MI — Rapid Epidemiologic Study of Prevalence, Networks, and Demographics of Monkeypox Infection. The grant-funded organization put out transmission-prevention messaging, conducted a community-led survey of mpox symptoms, and mapped the social and sexual networks of queer and transgender people in New York City.

Nick Diamond, a leader of the effort, said government response improved only after gay activists pressured officials and did a lot of the outreach and education themselves.

“A lot of HIV activists knew that it would be up to us to start a response to monkeypox,” he said.

But Diamond also noted another possible reason for the declines: Spread of mpox at LGBTQ celebrations in June — coupled with a lack of testing and vaccinations — likely contributed to the July surge. “A lot of people came out of Pride, after being in close contact, symptomatic,” he said. They suffered blisters and scabs, bringing home the message to other at-risk men that the virus was a very real danger.

BIOLOGY VS. BEHAVIOR

There are also possible explanations that have more to do with biology than behavior.

The number of new infections may have been limited by increases in infection-acquired immunity in the men active in the social networks that fueled the outbreak, CDC scientists said in a recent report.

Past research has suggested there may be limits in how many times monkeypox virus will spread from person to person, noted Stephen Morse, a Columbia University virologist.

“The monkeypox virus essentially loses steam after a couple of rounds in humans,” Morse said. “Everyone credits the interventions, but I don’t know what the reason really is.”

___

Maria Cheng in London contributed to this report.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Copyright © The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

AP

Arizona and New York attorneys feud over extraditing suspect...

Associated Press

Why Alvin Bragg and Rachel Mitchell are fighting over extraditing suspect in New York hotel killing

Maricopa County Attorney Rachel Mitchell says she isn't into extraditing a suspect due to her lack of faith in Manhattan’s top prosecutor.

4 days ago

A Gila monster is displayed at the Woodland Park Zoo in Seattle, Dec. 14, 2018. A 34-year-old Color...

Associated Press

Colorado man dies after being bitten by pet Gila monster

A Colorado man has died after being bitten by his pet Gila monster in what would be a rare death by one of the desert lizards if the creature's venom turns out to have been the cause.

5 days ago

Police clear the area following a shooting at the Kansas City Chiefs NFL football Super Bowl celebr...

Associated Press

1 dead, many wounded after shooting at Kansas City Chiefs’ Super Bowl victory parade

One person died after 22 people were hit by gunfire in a shooting at the end of the Kansas Chiefs' Super Bowl victory celebration Wednesday.

12 days ago

This image from House Television shows House Speaker Mike Johnson of La., banging the gavel after h...

Associated Press

GOP-led House impeaches Homeland Security Secretary Mayorkas — by one vote — over border management

Having failed to impeach Homeland Security Secretary Alejandro Mayorkas the first time, House Republicans are determined to try again Tuesday.

13 days ago

Defense Secretary Lloyd Austin, right, and Kenya's Defense Minister Aden Duale, left, listen during...

Associated Press

Defense Secretary Lloyd Austin hospitalized with bladder issue

Defense Secretary Lloyd Austin has been hospitalized following symptoms pointing to an “emergent bladder issue."

15 days ago

Joel Osteen, the pastor of Lakewood Church, stands with his wife, Victoria Osteen, as he conducts a...

Associated Press

Woman firing rifle killed by 2 off-duty officers at Houston’s Lakewood Church run by Joel Osteen

A woman entered the Texas megachurch of Joel Osteen and started shooting with a rifle Sunday and was killed by two off-duty officers.

15 days ago

Sponsored Articles

...

Midwestern University

Midwestern University Clinics: transforming health care in the valley

Midwestern University, long a fixture of comprehensive health care education in the West Valley, is also a recognized leader in community health care.

...

Collins Comfort Masters

Avoid a potential emergency and get your home’s heating and furnace safety checked

With the weather getting colder throughout the Valley, the best time to make sure your heating is all up to date is now. 

...

Canvas Annuity

Interest rates may have peaked. Should you buy a CD, high-yield savings account, or a fixed annuity?

Interest rates are the highest they’ve been in decades, and it looks like the Fed has paused hikes. This may be the best time to lock in rates for long-term, low-risk financial products like fixed annuities.

Mpox has faded in the US. Who deserves the credit?