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Nov. 26, 2022

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Monkeypox cases declining in Washington, but outbreak trajectory still unclear

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After weeks of surging cases, monkeypox is on the decline in Washington state though vaccination levels in King County, the state’s primary hot spot, are still well below the level estimated to adequately combat the virus.

The drop in infections statewide is directly linked to the drop in cases in King County. Since a peak in late July, the weekly case rate in King County fell 66% to 22 cases in the week of Aug. 28. Early counts for the week of Sept. 4 show 10 cases have been detected so far.

King County Health Officer Dr. Jeff Duchin says the decline in cases is likely due to a combination of factors including behavioral change and the vaccination of high-risk communities.

The health department also said more people may have some immunity from infection as more susceptible people have been exposed to the virus.

Health officials are hesitant to claim the outbreak is under control.

“It can be a painful and difficult illness, so ideally, we wouldn’t want to see any cases of the illness. But it will take some time to see what type of trajectory the outbreak takes,” said spokesperson Sharon Bogan.

Vaccine distribution

So far, 10,444 residents across Washington have received at least one shot of the Jynneos vaccine as of Sept. 7, according to state health department data. About 6% of these people got a second dose after 28 days. The Jynneos vaccine is a two-dose vaccine series, with two doses administered four weeks apart.

In King County alone, over 9,800 residents have received at least one dose of the vaccine — about a quarter of the 40,000 King County residents the county health department estimates are either at the “highest” or at an “elevated” risk for exposure.

The health department estimates 80,000 doses are needed to adequately address the outbreak.

Monkeypox can affect anyone — regardless of gender or sexual orientation — who has close contact with an infected person. So far, the virus has disproportionately affected the LGBTQ+ community, particularly men who report intimate contact with other men.

Many of these King County cases have been identified in the Hispanic community, with the majority between the ages 18 to 49.

Distribution inequities

Within King County, more than half of all cases were reported in Central Seattle. So far, the county’s vaccination drives have been concentrated in this region.

Community workers say current vaccination efforts are inequitable and don’t address the socio-economic and geographical barriers people of color, especially queer people of color, may face in accessing the vaccine.

“The most affected and vulnerable group, which is LGBTQ+ people of color, mostly congregates and resides in South King County,” said Sasha Samuelu, a community care program coordinator at UTOPIA, a community organization focused on helping trans people of color.

So far, UTOPIA has organized two monkeypox vaccination events in Kent, giving 100 people their first doses.

Agencies should provide vaccine clinics in areas like Kent, Auburn and Federal Way, where the most vulnerable populations live, Samuelu said.

“I’m really appalled that both health agencies and folks are quick to say this is a disease that is affecting gay people but when it comes to vaccine distribution, they find it difficult to prioritize vaccine distribution among these same vulnerable groups,” said Diana Krishna, wellness navigator at UTOPIA.

Public Health — Seattle & King County said it has facilitated partnerships between health care organizations and community-based organizations, including UTOPIA and HealthPoint, to host vaccination events. Some of these were focused outreach events and were not broadly publicized.

Since the outbreak, the health department said it has worked closely with organizations on messaging, resources and vaccine distribution coordination.

Bogan said it’s important to have a range of approaches to reach communities, because first-come, first-served strategies may not always reach those at higher risk. Some people, she added, may be more likely to get a vaccine at a clinic they have already been to, while others may be interested in a community-based health care site, where their family and others can get vaccinated at the same time.

A look at vaccine distribution at the state level shows 81 doses were given to Thurston County residents, though no monkeypox cases have been recorded there.

In fact, Thurston County has administered more doses than Snohomish County, which has become a virus hot spot. There are six other counties recording monkeypox cases where fewer than 10 doses have been administered so far.

Chris Porter, an LGBTQ+ activist in Seattle, said a “pandemic-epidemic” is weighing on the queer community, especially men of color. Be it the HIV/AIDS epidemic, the COVID-19 pandemic or now monkeypox, queer men of color continue to be disproportionately affected, he said.

“As Black gay men, how do you navigate all of that?”

Enduring stigma

DOH recently expanded its vaccine eligibility requirements to include gay, bisexual and other men who have had sex with men with multiple sexual partners in the last three months. Previously it specified only those with more than 10 sexual partners or those who had group sex in bath houses.

The expanded criteria now also includes sex workers and people who experienced homelessness, unstable housing or were incarcerated in the last three months.

Community organizers in the LGBTQ+ community criticized health officials’ past communications about the disease. They say the language, especially the vaccine eligibility questionnaire’s focus on number of sexual partners, felt invasive and contributed to the stigma that has already deterred many from getting the vaccine.

The messaging should have emphasized the fact that the virus spreads through skin-to-skin contact, said Krishna.

“So much emphasis has been on the sexual part,” she said. “It causes people to isolate themselves from accessing these resources or vaccines, and leaves them further marginalized.”

She added that after this was pointed out, the county health department worked quickly to improve the language.

But Porter said messaging, alone, is not enough.

“It’s one thing if you’re coming to me and you’re providing this information,” Porter said. “And then my question is, ‘Where can I get the vaccine’ and then you tell me, ‘Well, it’s only available in certain situations and in certain locations, but not necessarily where you live.’

“You have to wonder what is the weight and wealth of that information?”

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