Q&A: How prepared is San Diego for monkeypox?

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According to the Center for Disease Control and Prevention, there have been more than 750 confirmed cases of monkeypox in the United States, including more than 130 in California. While only a very small number of cases have been reported in San Diego, the number of cases is increasing in other parts of the United States as well as in Europe. So how prepared is San Diego for monkeypox?

Dr. Robert Schooley, an infectious disease specialist with UC San Diego and UC San Diego Health, joined Monday’s noon edition to talk about what the monkeypox virus is and how local authorities are preparing for the possibility of new cases in San Diego. The conversation transcribed below has been lightly edited for clarity.

To date, the majority of monkeypox cases in California have not occurred in San Diego County, and there is currently no local community spread of the virus that we are aware of. So how much of a concern is this for local health officials today?

Dr. Schooley: I think the local health authorities are watching what’s going on very carefully. The county health department has a case finding unit and has been in contact with us to be ready to provide care to those in need. So I think the preparations are well advanced.

It should be noted that monkeypox is very different from COVID-19. Can you say more about monkey pox? How does it work and how is it transmitted?

Dr. Schooley: Monkeypox is a virus that does not belong to the same general family as smallpox. It’s nowhere near as bad as smallpox. It is a virus of the so-called Orthopoxvirus family. These are viruses that particularly affect the skin and are spread mainly through close skin-to-skin contact, but can only be spread through close contact with the breath. Although again, not even close to the transmission efficiency of, say, coronaviruses. Viruses are a bit more hearty than some of the other viruses we’ve come across, like coronaviruses. This in the sense that they can remain on clothes and bedding after people who have been infected with monkeypox there have left. We must therefore ensure that you do not come into contact with clothing and other surfaces on which people with monkeypox may have spread the virus.

As a rule, this is not fatal, is it?

Dr. Schooley: It is rarely fatal. The mortality rate is less than 1%. This is more of a problem for people with damaged cellular immunity. Those would be pregnant people, for example, people with severe T-cell immune defects. You wouldn’t want a transplant recipient to get it, or someone with advanced HIV disease, you wouldn’t want someone with lymphoma going through chemotherapy to get it. It can also cause scarring and has caused blindness when it involves the eyes. It is therefore not an ordinary virus, although mortality is rare.

What are local health officials doing to prepare in case we see a spike here?

Dr. Schooley: Local health officials have set up an active surveillance system to collect samples to make the diagnosis. They have been in contact with UCSD Health for us to provide care and assess people who need to be seen medically.

In the current 2022 outbreak of the monkeypox virus has disproportionately affected gay and bisexual men. Can you explain why?

Dr. Schooley: It can affect anyone who comes into contact with someone with broken skin. It has just made its way into that population and if there are gatherings of large numbers of people who are in close contact of any kind, the virus can take advantage of that. And so it began to spread first in Europe and then in the United States. But the epidemic was by no means limited to homosexuals.

What treatments are available for monkeypox?

Dr. Schooley: Two drugs are active. One of them is called TPOXX and it is being made available by the county health department and UCSD. There is another drug called Brincidofovir which is not yet available for this virus but which is active against smallpox, and we assume it would be active against monkeypox. This drug was developed here by Dr. Karl Hostetler at UC San Diego.

Vaccine shortages have been reported in Los Angeles and elsewhere. Does San Diego have an adequate supply of monkeypox vaccines?

Dr. Schooley: Well, there are two different vaccines that are effective against monkeypox. One of them is called ACAM2000. There’s a lot of this vaccine around. It’s a vaccine closer to the smallpox vaccine and a bit more likely to cause side effects if people use it. The other vaccine, called the JYNNEOS vaccine, is a vaccine less likely to cause side effects. It’s safest to give to people with blemishes and immunity and there’s a bit of a shortage, although new supplies are coming in relatively quickly.

What lessons have health officials learned from the coronavirus pandemic that you see being used to prepare for monkeypox?

Dr. Schooley: I think it’s important – as Wayne Gretzky used to say – to try to skate where the puck is going to be rather than where it is, and to keep an eye on how the virus spreads . We have to be careful to realize that this virus can spread to anyone who comes in close contact with someone with monkeypox. So we have to be careful not to limit case funding only to people who are presumed to be at risk, at primary risk. In other words, we know that the virus disproportionately affects people in MSM community. But we have to be very careful not to assume that someone who arrives with fever and skin lesions does not have monkeypox because they are not part of that community. We made that mistake with the coronavirus when initially the CDC didn’t want to investigate cases of people who hadn’t recently come from China. And once the virus starts spreading in the community, you need to have a wide net to be sure to catch all the cases. I think we learned that from the coronavirus and I think that’s one of the mistakes we won’t make with this one.

You mentioned MSM. Can you explain what it is?

Dr. Schooley: MSM are men who have sex with men. This is a terminology that we now use to refer to the homosexual and bisexual male population.

Do you think community awareness of the virus is where it needs to be right now?

Dr. Schooley: I think a lot of work is being done across the community. It is especially in the community that the greatest risk is to have people aware of what is happening and to look for cases. So I don’t think we’re missing a lot of cases here in San Diego right now. And I think if the cases started to show up, especially in higher-risk communities elsewhere, we would pick them up pretty quickly.

So ultimately you think San Diego is ready if there’s an upside?

Dr. Schooley: I think we are right now. We’re a bit behind the curve right now, which is great. This allows us to learn from what is happening elsewhere. And we have a very knowledgeable health service and a very tight-knit community looking for these cases.

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