With new data showing that people at risk for monkeypox who are unvaccinated were 14 times more likely to become infected with the virus, Atlanta public health officials and workers say it’s important to remain cautious and use all mitigation measures.
And nearly six months into the outbreak, scientists haven’t reached consensus around many aspects of the monkeypox virus in the United States, which fuels uncertainty, fear, misinformation and stigma.
“There’s a lot that we actually don’t know about how the virus that’s operating in this particular outbreak functions,” says Justin Smith, director of the Campaign to End AIDS at Positive Impact Health Centers in metro Atlanta, one of the largest HIV service organizations in Georgia. “It’s behaving differently than the ancestral strains of monkeypox that we’ve seen that are endemic to parts of West and Central Africa.”
Monkeypox is a disease that is caused by infection with the monkeypox virus, according to the Centers for Disease Control and Prevention. People with monkeypox get a rash – which can originally look like pimples or blisters and may be itchy or painful – that may be located on or near the genitals and could be on other areas like the hands, feet, chest, face, or mouth.
Other symptoms of monkeypox can include fever, chills, swollen lymph nodes, exhaustion, muscle aches and backache, headache and respiratory issues, such as sore throat, nasal congestion or cough. Before this spring, monkeypox was rarely reported outside of the African continent, with the first case being reported in the United States in May. The disease has since spread to all 50 states, Washington, D.C., and Puerto Rico, with the U.S. having the most confirmed cases in the world.
Georgia ranks fifth in monkeypox infections among all U.S. states behind California, New York, Florida and Texas, according to CDC data. As of Sept. 28, Georgia’s Department of Health reported 1,784 cases. As of that same date, more than 25,000 people have been issued a single dose of the Jynneos vaccine, and more than 14,000 people have received two doses. As with public health generally, the Black community is hardest hit. More than 77% of those infected were Black or African American and just under half of those vaccinated were Black or African American. This disparity is largely driven by lack of access to health care, stigma around sex and sexuality, and shame, according to Smith.
“Sadly, but unsurprisingly, what we have seen with monkeypox is that it has been concentrated primarily within Black communities here in Georgia — specifically among Black, gay, bisexual and other men who have sex with men,” says Smith, who is a member of the White House Working Group on Monkeypox Equity. “So the risk is not distributed equally across the population.”
In Dekalb County, there have been 373 confirmed cases of monkeypox, according to the county’s latest internal report. In Fulton County, infection rates began to decline in August and have since leveled off, says Dr. David Holland, the chief clinical officer for the Fulton County Board of Health. But until those levels reach zero or effectively zero, Holland says the county will try to vaccinate as many people as possible.
“The population of individuals we are trying to vaccinate, fortunately, respond very well to vaccines. There’s the people that demand the vaccine and stand in line to get it and there’s the people that will get it if it’s right in front of them,” says Holland, who is also an associate professor at the Emory University School of Medicine. “We are seeing less of a demand for the vaccine, but it’s not going to zero and we’re still having a lot of success by taking it out to venues.”
One such outreach effort was at Atlanta Black Pride in September, where almost 4,000 monkeypox vaccine doses were administered. With the virus disproportionately affecting African Americans – specifically Black, gay, bisexual and other men who have sex with men – officials say this pivot in strategy is essential to reaching the communities that are most at risk. But that doesn’t mean that others cannot become infected by the virus.
“It is true that monkeypox disproportionately impacts members of the Black LGBTQ community, but you don’t have to be gay to get monkeypox,” Smith says. “That’s really important for people to know.”
Holland says it’s also important to know how people are becoming infected with the monkeypox virus. It is not transmitted by casual contact, such as at the grocery store or on public transportation, he says. Rather, transmission requires prolonged, intimate or skin-to-skin contact. “If you’re not in or in close proximity to one of the risk groups, your risk of getting it is pretty low to zero. That said, the virus is still a virus. It can affect anyone, so we’re working really hard to eliminate the disease before it gets into the general population,” he says.
It’s also important to understand that there are countermeasures: the two-dose Jynneos vaccine, testing and the investigational treatment Tecovirimat, also known as TPOXX, are the major efforts at mitigation that are currently available, although not as readily accessible as they should be, according to Smith.