Monkeypox cases more than double in L.A. County

The number of cumulative cases of monkeypox has more than doubled in Los Angeles County in the past two weeks as officials scramble to better track the virus and get more widespread immunizations in more vulnerable communities.

There were 1,036 cumulative monkeypox cases nationwide as of Thursday, according to the Health Department. That total now includes the region’s first reported cases in a prison and at a homeless shelter, health commissioner Dr. Muntu Davis.

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

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

The disease — characterized by a rash and lesions that can look like pimples, bumps, or blisters — spreads primarily through prolonged skin contact with these lesions, which are in hard-to-see areas on the body or can be confused with other skin problems. The 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 remains very low,” Davis said during a Thursday briefing.

But monkeypox has taken hold.

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

Although the disease can be very painful, it is rarely fatal. To date, 26 people have been hospitalized in LA County, “most of whom arose from minor complications from monkeypox infection or for pain management,” Davis said.

However, there have been five deaths worldwide from the outbreak in countries that have not reported any cases of monkeypox in the past. No deaths have been reported in the US

Sewage tests, which continue to prove useful in estimating the spread of the coronavirus, are now being used to track monkeypox as well.

In late June — about a month after the first California case was confirmed — monkeypox DNA was detected in San Francisco sewage, according to the WastewaterSCAN coalition, a group of scientists who have been testing wastewater for the coronavirus since 2020.

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

The monkeypox virus has also been detected in LA County sewage. Samples from LA County’s Joint Water Pollution Plant in Carson, which serves approximately 4 million residents and businesses in southern and eastern LA County, showed low presence on July 31 and three days in the first week of August, according to WastewaterSCAN data. The virus has not been detected there since then, despite the increasing number of cases in the district.

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

However, Boehm said that doesn’t mean that monkeypox is gone in Los Angeles County; It was just difficult to tell from the massive sample size.

Because LA’s sewage facility serves such a large number of people, “you have to think about the sensitivity of detecting monkeypox relative to the incident rate in the population,” Boehm said. “Just because you don’t find monkeypox doesn’t mean there isn’t anyone [in that waste watershed] with monkey pox.”

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

“It could just mean that the virus is present at levels below the detection limit of available laboratory tests,” she said.

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

It’s not immediately clear if the LA County Department of Public Health plans to expand monkeypox testing in sewage. The county has been monitoring wastewater for the coronavirus for months, including at the Joint Water Pollution Plant and Hyperion Water Reclamation Plant in Playa del Rey and facilities near Lancaster and Malibu.

“We think this is a useful strategy,” Ferrer said of analyzing the wastewater data. “It will take some time to examine and evaluate the correlations between the concentrations and the number of cases. … [But] We are excited to be part of a larger group exploring how best to use the wastewater data.”

As of last week, LA County had 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. Individuals are eligible for their second vaccination 28 days after their first dose, and individuals are considered fully vaccinated two weeks after their second dose.

Another 29,000 cans have just been received, Davis said Thursday. The latest vaccines use the new method of administering doses intradermally – between layers of skin – instead of subcutaneously, where the injection is given into the fat under the skin. The new strategy allows each dose to now be one-fifth the volume of the doses originally metered, stretching limited supplies.

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

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

People who have already had monkeypox don’t need the vaccine because they already have immunity to the disease, according to the county health department. People who received the first dose of the vaccine and later became infected with monkeypox generally do not need a second dose; However, a second dose may be suggested by a healthcare provider on a case-by-case basis for an infected, partially vaccinated, immunocompromised individual.

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

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

However, in 2018 there was a single documented case of monkeypox transmission in the UK, in which a caregiver contracted monkeypox after changing “suspected contaminated bedding” without wearing a face mask or ventilator. The worker was in contact with the sheets at a time when the patient had skin lesions but had not yet been diagnosed and isolated with monkeypox, according to medical journals.

Davis suggested that workers in environments where they clean surfaces that are frequently touched, such as B. fitness equipment, or washing bedding, towels and uniforms, be careful to implement appropriate general prevention practices that also protect against COVID-19 and other diseases.

Workers should wear disposable gloves when cleaning, and workplaces should make hand washing facilities and hand sanitizer available to employees and customers, Davis said.

“We also encourage businesses where employees provide personal care services — like massages or skin treatments — to also consider posting signs asking customers or clients to postpone services if they have symptoms or if they have new or unexplained skin rashes , bumps, pustules, or blisters, or scabs that started as blisters,” he said.

It is also recommended that “workers visually inspect the area of ​​skin that is being touched. And, of course, workers should definitely not touch a rash. Personnel should only work on intact skin that has no breaks, blisters, cuts or scabs,” Davis continued.

Residents can request the monkeypox vaccine through their regular healthcare provider or by registering online with the County Department of Public Health to request a vaccination. You can also call the health department at (833) 540-0473, seven days a week between 8 a.m. and 8:30 p.m Monkeypox cases more than double in L.A. County

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