The Oregon Health Authority briefed reporters on monkeypox, or hMPXV, and unveiled a new website with data about case numbers and vaccine access. Here’s what you need to know:
1. Gay and bisexual men are at the greatest risk in the current outbreak.
To date, Oregon has 95 known cases of monkeypox, including 92 men and 3 women. Locally and globally, the overwhelming majority — greater than 90 percent — of cases are in gay and bisexual men.
While the virus can transmit in a variety of ways, skin-to-skin contact is the most important, and most people in the current outbreak appear to have gotten it from having sex, according to OHA.
“What we’re seeing is it requires this close intimate or sexual contact,” said state epidemiologist Dean Sidelinger. “We’re not even seeing significant transmission amongst household members.”
The majority of cases so far are in the tri-county Portland metro area, but Columbia, Coos, Lane, and Marion counties have also reported cases.
2. It’s behavior, not identity, that is driving community transmission.
Not everyone in the LGBTQ community is at risk and some straight people may be. While most cases in Oregon have been in gay men, a few infections have occurred in people who identify as straight and have sex with women.
Public health educators say it’s inadequate to use sexual orientation alone as a proxy for a person’s risk of exposure to monkeypox. That’s because the virus is being spread by particular behaviors, including anonymous sex, sex with multiple partners, and sex at clubs.
“There are many gay, bisexual, queer men and trans people who don’t engage in this type of sex at all,” said Katie Cox, executive director of The Equi Institute, a community health organization that works with the LGBTQ community and with people who are homeless.
Sex workers, people who engage in polyamory, swingers, the kink community, people attending raves, and people who are having sex with multiple people via dating apps are all engaging in higher-risk behavior, regardless of whether they identify as gay or straight, Cox said.
“I’m hearing straight people say they don’t have to worry about it because it doesn’t affect them,” Cox said. “It is not an if but a when. It will start affecting other communities.”
3. Ethnicity is also a risk factor.
About 28% of the 94 cases in Oregon so far are in people who identified as Hispanic. That’s roughly double what you’d expect if cases were evenly distributed across all ethnic groups; Hispanic people make up 14% of Oregon’s population.
Sidelinger said OHA is providing information about the virus online in Spanish as well as English and is trying to get more information out to community groups and medical providers that serve the Hispanic community.
4. The OHA’s messaging on how to prevent monkeypox is evolving after criticism at the national level.
Some prominent scientists and LGBTQ advocates have criticized public health officials for failing to talk about how important sex is in the transmission of monkeypox.
Others, including Pacific Northwest icon and sex writer Dan Savage, have said public health officials should be urging gay men to curb their number of partners until the vaccine is more widely available.
OHA has come under particular fire for muddling these messages in an interview with OPB last week.
Sidelinger was clear on Thursday about the elevated risk to gay and bisexual men, and the role sex plays in transmission. He also gave an extended description of monkeypox symptoms and was frank that people should be checking their genitals for lesions.
“Talk to potential partners about any symptoms or rashes they may have, and postpone activity if either of you is sick. Limiting the number of partners you have contact with, particularly partners you don’t know, during this time that monkeypox is spreading, can limit the spread,” he said.
In messaging available online, OHA recommends people ask potential partners about illnesses or rashes, and consider limiting partners you engage in intimate contact or sex with until you’ve received two vaccinations against monkeypox.
5. Vaccines remain in short supply, and Oregon will start dividing doses.
Vaccines are currently not available to the general public. They are being given to people with known exposures to monkeypox and to people at high risk.
Oregon public health officials are shifting their strategy to stretch the doses they have — roughly 6,800 as far as possible.
Starting next week, OHA will allow a smaller dose of the vaccine to be injected into the outer layer of the skin, as opposed to the fat underneath. The technique, called intradermal vaccination, uses a smaller dose per person. Experts at the FDA believe it could allow a single dose to be split into up to five doses.
Earlier this week, the FDA issued an emergency use authorization approving the technique.
It’s still unknown if the smaller dose will offer the same degree of protection against monkeypox infection, but experts think it’s a promising strategy. Sidelinger says there’s good reason to believe it will work because of special immune cells present in the skin.
“It’s thought that by injecting them not so deeply into the skin, allows those cells to perform their duty better and provide a similar response,” he said.
Another potential challenge is that administering vaccines this way takes some skill and not all vaccinators may be comfortable doing it.
The demand for vaccines continues to far outstrip the supply, with more than 2,000 people on a waitlist for the vaccine run by Multnomah County.
6. This outbreak is not going away anytime soon.
“We will be facing this for months, if not if not years,” Sidelinger said. At the same time, he urged people not to conflate the risks of monkeypox with COVID-19.
School, for example, is a very low-risk setting for monkeypox transmission, Sidelinger said. To date, there have been no cases in children in Oregon.
Individual children could be at risk if they share a household with an infected person, and adolescents who are having sex could be at risk through that behavior.
“Although monkeypox is a serious public health concern and it is highly infectious in certain situations, it’s not another COVID-19,” Sidelinger said.
