Monkeypox cases more than double in LA County

The number of cumulative monkeypox cases has more than doubled in Los Angeles County in the past two weeks as authorities race to better track the virus and more widely vaccinate the most vulnerable communities.

There had been 1,036 cumulative cases of monkeypox countywide as of Thursday, according to data from the Department of Public Health. That total now includes the region’s first reported cases at a prison and at a homeless shelter, health officer Dr. Muntu Davis said.

Just under half of LA County cases for which geographic information is available involved residents of a central part of the county that includes West Hollywood, Hollywood, downtown Los Angeles, Eagle Rock, Highland Park and Boyle Heights, while 15% is in an area that includes the San Fernando and Santa Clarita Valleys, county health data shows. The San Gabriel and Antelope Valleys have reported the fewest cases.

The median age of people with confirmed monkeypox cases in LA County is 35.

The disease – characterized by a rash and lesions that may look like pimples, bumps or blisters – is spread primarily through prolonged skin-to-skin contact with these lesions, which may be in hard-to-see places on the body. body or be confused with other skin problems. Lesions may first appear in the genital area and rectum before spreading to other parts of the body.

“Although cases are increasing in Los Angeles County, the risk of infection in the general population continues to remain very low,” Davis said during a Thursday briefing.

But the monkeypox has taken hold.

About 98% of cases for which gender identity information is available are male, according to county figures. And 98% of cases where sexual orientation is known involve people who identify as gay or bisexual, Davis said.

Although the disease can be quite painful, it is rarely fatal. So far, 26 people have been hospitalized in LA County, “most of them due to minor complications from monkeypox infection or pain management,” Davis said.

Globally, however, there have been five deaths in the epidemic in countries that have never reported cases of monkeypox. No deaths have been reported in the United States

Wastewater analysis, which continues to prove useful in estimating the spread of the coronavirus, is also now used to track monkeypox.

Late June — about a month after the first California case has been confirmed – monkeypox DNA has been detected in San Francisco sewage, according to the WastewaterSCAN coalitiona group of scientists who have been testing sewage for coronavirus since 2020.

“It helps to understand how widespread this is,” said Alexandria Boehm, a Stanford professor of civil and environmental engineering, one of the lead researchers on the WastewaterSCAN team.

The monkeypox virus has also been detected in LA County wastewater. Samples from the LA County Joint Water Pollution Control Plant in Carson, which serves approximately 4 million residents and businesses in South and East LA County, showed a small presence on July 31 and for three days during the first week of August, according to WastewaterSCAN The data. The virus has not been detected there since, despite rising case rates in the county.

By comparison, monkeypox DNA has been detected nearly every day since June 27 at two San Francisco sewage treatment plants — and at much higher levels than in LA County.

Still, Boehm said that doesn’t mean there’s no more monkeypox in Los Angeles County; it was just hard to detect among the massive sample size.

Because the Los Angeles sewage treatment facility serves such a large number of people, “you have to think about the sensitivity of detecting monkeypox versus the incident rate in the population,” said Bohm. “Just because you don’t detect monkeypox doesn’t mean there’s no one there. [in that waste watershed] with monkeypox.

LA County Public Health Director Barbara Ferrer also noted that a negative sewage test does not always indicate the absence of the virus.

“It could simply mean that the virus is present at concentrations below the level of detection by available laboratory tests,” she said.

Detection of monkeypox virus in LA County sewage hasn’t come as quickly as in the San Francisco area, “but I think that’s because we have a very large population relative to the number of cases that we have,” Ferrer said. Cumulatively, as of Thursday, LA County had 10 monkeypox cases per 100,000 residents, while San Francisco has 71 cases of monkeypox per 100,000 population.

It’s not immediately clear whether the Los Angeles County Department of Public Health plans to expand sewage testing for monkeypox. The county has been monitoring wastewater for coronavirus for months, including at the joint water pollution plant, as well as the Hyperion water reclamation plant in Playa del Rey and facilities near Lancaster. and Malibu.

“We think it’s a useful strategy,” Ferrer said of the wastewater data analysis. “It will take some time to examine and assess the correlations between concentrations and the number of cases. … [But] we are excited to be part of a larger group looking to make the best use of wastewater data.

As of last week, LA County received more than 43,000 doses of the Jynneos monkeypox vaccine. Almost all — 91% — of these have already been administered, with the county offering second doses of the two-shot series for the first time this week. People are eligible for their second injection 28 days after their first dose, and people are considered fully vaccinated two weeks after their second dose.

An additional 29,000 doses have just been received, Davis said Thursday. The latest vaccines will be used in the new method of delivering doses intradermally – between layers of skin – instead of subcutaneously, in which the vaccine is injected into the fat under the skin. The new strategy now allows each dose to be one-fifth of the volume of the original dosesthus stretching the limited reserves.

People eligible for the monkeypox vaccine in LA County include gay or bisexual men and transgender people who have had multiple or anonymous sexual partners in the past 14 days. Immunocompromised residents, including those with advanced or controlled HIV infection, are prioritized for immunization.

Previous data from Africa suggests that the Jynneos vaccine is at least 85% effective in to prevent monkeypox. Because the vaccine is not 100% effective, health officials still advise taking steps to reduce the risk of infection. But if the infection were to still occur, “hopefully that will make the infection less severe,” Davis said.

People who have ever had monkeypox don’t need the vaccine because they are already immune to the disease, according to the county’s public health department. People who received the first dose of vaccine and then became infected with monkeypox usually do not need the second dose; however, a second dose may be suggested by a health care provider for an infected, partially vaccinated, immunocompromised person on a case-by-case basis.

County officials have already begun making monkeypox vaccines available to high-risk people in the county’s prison system and among the homeless.

Officials have long said the risk of exposure to monkeypox is primarily due to intimate skin-to-skin contact, and transmission of the virus has not been observed in this outbreak through surfaces in gymnasiums or other public surfaces. .

However, in 2018 there was a single documented case of monkeypox transmission in Britain in which a health care worker was infected with monkeypox after changing “presumably contaminated bedding” without wearing a face mask or respirator. According medical journals.

Davis suggested that workers in environments where they clean high-touch surfaces, such as gym equipment or laundering bedding, towels and uniforms, ensure they implement reasonable general prevention practices that protect also against COVID-19 and other diseases.

Workers should wear disposable gloves when cleaning, and workplaces should provide hand-washing facilities and hand sanitizer for employees and customers, Davis said.

“We are also encouraging businesses where workers provide personal care services – such as massage or skincare – to consider posting signs asking customers or customers to delay services if they have symptoms. or if they have new or unexplained rashes, bumps, pustules, blisters. or scabs that started out as blisters,” he said.

It is also recommended “that workers visually inspect the area of ​​skin that will be affected. And, of course, under no circumstances should workers touch a rash. Staff should only work on intact skin that has no cuts, blisters, cuts or scabs,” Davis continued.

Residents can request the monkeypox vaccine through their regular healthcare provider or register online with the county public health department to request one. vaccination. They can also call the health agency at (833) 540-0473, seven days a week between 8 a.m. and 8:30 p.m.

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