Mpox Updates

December 21, 2023

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East Bay Mpox updates
How Mpox is spread and how to prevent it
Mpox vaccine: how to get it in Alameda County and Contra Costa County
Mpox Treatment
East Bay Mpox epidemiology and links
Community resources: fact sheets, videos, references

East Bay Mpox Updates

Getting Vaccinated:
- Free mpox vaccines are available in Alameda County, Contra Costa County and throughout California, with additional vaccine events added for Pride and summer events. Walk-ins are welcome at some locations.
- Two doses of the mpox vaccine still offers the best protection.
- Anyone who requests the mpox vaccine should receive it, including women and especially people of color.
Getting Treated:
- The STOMP study for Tpoxx mpox treatment is still enrolling, both in-person at UCSF as well as online with a remote only option if people aren’t able to go in. This is a great opportunity for folks with mpox who don’t have easy access to treatment and/or want to participate in a study.
Don’t forget other STIs:
- Get screened right away for mpox along with HIV and other STIs if you have symptoms, especially when a rash or other symptoms are not getting better, and even if you’ve received the mpox vaccine.
- A study found that 38% of people with mpox had HIV, and 41% had an STI in the preceding year.
Local Mpox data:
- Local public health department updates can be found here: Alameda County, Contra Costa County, California.
- Mpox Wastewater Monitoring Dashboard from the national Biobot network. Data from April 2023 shows that 0% of the Western region wastewater sites (including California) had positive mpox detection.
Recent updates:
- Starting January 2024, California Department of Public Health launched a new incentive program for Mpox vaccines prioritizing people with HIV. Please click here for more info (PDF).
- California Department of Public Health released an updated Mpox Health Advisory on Oct 30, 2023. Key messages are as follows:
  - The California Department of Public Health has noticed recent increases in mpox cases and encourages providers to consider mpox in their differential diagnoses, test persons with suspected mpox, treat mpox, and offer vaccine to populations at increased risk to prevent severe mpox disease and reduce the number of new infections.
  - Providers are encouraged to consider mpox in the differential diagnosis of people with any diffuse or localized (e.g., genital) rash; along with syphilis, herpes, varicella, and molluscum contagiosum.  
  - Since the beginning of September 2023, 44% of persons with mpox have reported having at least one dose of vaccine with 31% reporting having two doses.
    - While the mpox vaccine is effective at preventing illness and reducing disease severity, infections after vaccination are possible and testing is warranted among vaccinated persons who have compatible signs and symptoms. Vaccinated persons may have milder symptoms compared with unvaccinated persons, necessitating a low threshold for testing.
  - Because mpox continues to circulate in California, now is the time to promote vaccination in high-risk groups, however the vaccine is available to anyone who requests it.
    - People with HIV are at risk for severe manifestations of mpox, thus vaccination should be especially prioritized in people with HIV in these risk groups. 
    - As mpox continues to circulate in California, vaccination of persons at risk continues to be important, especially with upcoming holiday gatherings.
  - The risk of severe disease is greater in persons with HIV and less than 30% of people with HIV have received at least one dose of JYNNEOS in California. Persons with HIV infection and risk factors for mpox exposure should be prioritized for education about mpox, vaccination, testing, and treatment.
- August-November 2023 rise in Alameda County and SF Mpox cases: Alameda County has had several Mpox cases since July 2023. SFDPH reported 19, 23 and 12 cases of Mpox during each of the months of September, October and November 2023. This is a substantial increase over the 6 cases reported in August 2023, when SFDPH sent out a health alert. Prior to July 2023, there was an average of ~1 case per month in SF. This is an important reminder that mpox is still around, that we should continue to make sure folks complete 2-doses of the mpox vaccine, be on the lookout for mpox symptoms, and provide rapid access to treatment.
- Alameda County released an mpox health alert on May 23, 2023: “Healthcare providers should suspect and test for mpox in patients with a new rash, even if a person has received mpox vaccination. Prompt testing and isolation until results of testing return can limit spread of the infection. Any suspect, probable, or confirmed mpox case should be reported within 24 hrs to ACPHD by email at AcuteCD@acgov.org.”
- New mpox clusters were seen elsewhere in the US March-May 2023, so please encourage people at risk to complete 2 doses of the vaccine. Dr. Eileen Dunne, ACPHD STD/HIV Controller, presented mpox updates on May 18 describing a cluster of cases seen in the Chicago area March-May 2023, including cases among people who received the mpox vaccine. None were hospitalized. Providers should have high suspicion for mpox among people presenting with symptoms even if they’ve gotten 2 doses of the vaccine.

Updates for Clinical Teams:

Alameda County Health Care Provider Clinical Guidance and Resources
Mpox Learning Opportunities:
- The National STD Curriculum (University of Washington) now includes a detailed Mpox Clinical Guide that includes clinical presentations, photos of lesions, and guidelines for infection control, obtaining a sample for testing, providing treatment, and vaccination.
- California Prevention Training Center’s STI Clinical Update Webinar: California Mpox Update for Healthcare Providers – October 2023: recording is available here.
Mpox in people living with HIV (PLWH):
- Mpox in PLWH with advanced immunosuppression can be life-threatening. A global mpox study found that mpox can be a disfiguring and life-threatening opportunistic infection, with a mortality rate of 27% among PLWH with CD4 <100. These data presented at CROI 2023 show how important it is to test and treat HIV early, vaccinate people against mpox, and treat mpox early in PLWH with immunosuppression. This study confirms earlier studies that found PLWH are at higher risk for infection and severe disease, especially PLWH of color and those with low CD4 counts or not on treatment. In addition, presymptomic mpox transmission has been found to be very common (53%), so ensuring vaccine coverage and rapid access to diagnosis and TPOXX treatment continues to be crucial.
Mpox vaccine efficacy:
- Vaccine efficacy has been found to be 36-75% for one dose and 66-86% for two doses. Please see table below for updated US vaccine efficacy data. A study presented at CROI 2023 found that a 2-dose mpox vaccination campaign reduced mpox incidence by 99%. Data from the UK found that a single dose of the MVA-BN (JYNNEOS) vaccine provided 78% protection against mpox 14 days after vaccination. A second dose offers greater and longer protection. All people in the East Bay getting the mpox vaccine are strongly encouraged to receive both doses of the vaccine.
TPOXX (tecovirimat) treatment for severe and/or high-risk mpox illness is available.
- People at high risk include those with weakened immune systems (such as HIV not virally suppressed and/or CD4 <200) and skin conditions (such as eczema).
- Severe disease includes a large number of lesions, involvement of body parts which might result in scarring or strictures, and serious systemic illness such as sepsis, encephalitis and bleeding.
- A CDC study found that in a group of people with mpox, most of the people hospitalized for severe mpox were Black/African American cismen living with HIV and had CD4<200. They experienced had delays in diagnosis and treatment. 12 of the 57 in this group died. This study underscores the importance of mpox vaccination, rapid diagnosis and treatment with TPOXX ASAP for all people with severe mpox symptoms and all people living with HIV with CD4<200.
- In Alameda County, TPOXX may be available at your clinic’s pharmacy, the EBAC pharmacy and through the Summit Emergency Department.
- In Contra Costa County, TPOXX is available through the county for people with Medi-Cal and no insurance (call 887-661-6230) or through the BASS ID group for people with Medicare and private insurance (call 925-947-2334).

How mpox spreads and how to prevent it

The mpox virus spreads mostly through close, intimate contact with someone who has mpox.
A large study in the UK found that 53% of mpox transmissions occurred before symptoms started.
You can take steps to prevent getting mpox, such as through vaccination, and lower your risk during sex.
CDC recommends vaccination for people who have been exposed to mpox and people who are at higher risk of being exposed to mpox.
If you’ve been exposed to someone with mpox, get the vaccine, talk to your healthcare provider and try to avoid close, intimate contact for 16-23 days.
If you have any symptoms of mpox, talk to your healthcare provider, even if you don’t think you had contact with someone who has mpox.
Providers: be alert for patients who have rashes consistent with mpox and evaluate for mpox along with HIV and other STIs.

Click here for photos of mpox skin rashes (goes to CDC website).

Mpox Vaccine

The JYNNEOS vaccine is a live attenuated virus that is considered safe and effective at preventing the onset of disease and severity of illness due to the mpox virus. It is most effective as prevention and within 4 days of exposure but can be given 4-14 days after exposure to help decrease disease severity. Full vaccination requires 2 doses at least 28 days apart and a person is not considered fully vaccinated until 2 weeks after their second dose. Although a 28-day interval is optimal, there is no need to restart or add doses to the vaccine series if the second dose is given after 28 days. As of September 2022, there is adequate supply of the vaccine in the East Bay to give second doses.

Where to get the vaccine in Alameda County:

Free mpox vaccines in Alameda County can be found here.

Oakland LGBTQ Center: Please click for more information and click here for vax registration.

Schedule: Walk-ins and appointments for mpox vaccinations will be held weekly on Tuesdays 11-4 pm. Please call 510-781-2639 for more info.
Location: Directly across from the Oakland LGBTQ Center and the T-Mobile store, at the corner of Lakeshore and Lakeside, beneath the 580 overpass at 533 Lake Park Ave.

Kaiser: Kaiser members who are Alameda County residents who get their care at the Oakland Medical Center can call 510-225-8233. Kaiser members who get their care at Kaiser Fremont and San Leandro can call 510-454-2780.

Other potential vaccine options: please contact your healthcare provider or occupational health department if they can provide mpox vaccine. Click for more options throughout California. If you do not have a healthcare provider, please contact monkeypox@acgov.org.

Who is eligible in Alameda County:

ACPHD recommends that “Mpox vaccine providers should offer JYNNEOS vaccine to ANY person who may be at risk or believes they may be at risk, and ANY person who requests vaccination should receive it. Providers should not require that a person share a reason for wanting vaccination.” This includes women and especially people of color, who have faced the biggest gaps in vaccination rates.

In Alameda County during the summer of 2022, although 40% of persons with mpox were Latinx and 25% are Black/African American, only 19% of vaccine recipients were Latinx and 12% Black/African American. It is crucial that we ensure outreach and access for communities of color.

ACPHD recommends intradermal administration as the preferred route of administration of JYNNEOS vaccine. This allows more vaccine doses to be given per vial. Vaccination sites run by Alameda County staff and contractors will allow all minors 12 to 17 years of age to receive the JYNNEOS vaccine without parent/guardian consent.

Second Doses of JYNNEOS

Second doses of JYNNEOS vaccine should be administered to anyone who received a first dose at least 28 days prior. Although a 28-day interval is optimal, there is no need to restart or add doses to the vaccine series if the second dose is given after 28 days.
Persons with moderate to severe immunosuppression should receive their second dose no later than 35 days after their first dose.
Persons 18 and older who received their first dose subcutaneously may receive a second dose intradermally.
Persons diagnosed with mpox after their first dose are not recommended to receive the second dose (unless they are immunocompromised), because mpox infection likely confers additional immune protection.

Where to get the vaccine in Contra Costa County:

In Contra Costa County, walk-in or schedule your mpox vaccine appointment at locations listed here or call 1-833-829-2626. Click for more options throughout California.

Second doses of the mpox vaccine are available to individuals if it has at least been 28 days since someone got the first dose.

Who is eligible in Contra Costa County

Contra Costa Health (CCH): “recommends vaccination for anyone who thinks they are at risk for an MPX infection (see risk factors below).

For the best protection, people should get two doses of Jynneos vaccine for MPX at least 28 days apart. There are two methods for vaccine injection, intradermal (similar to a TB test) or subcutaneous (a regular shot like you’d get for chickenpox or measles). At county-run vaccination sites, you can choose which injection method you prefer.

Risk Factors

Sex with multiple partners
Sex at a commercial sex venue (like a sex club or bathhouse) or at an event
People who have had close contact with someone with suspected for confirmed MPX
People taking or prescribed HIV Pre-Exposure Prophylaxis (PrEP)
People with HIV
People who have been diagnosed with syphilis or gonorrhea infection in the past 12 months
People whose sexual partner identifies with any of the above scenarios”

Mpox Treatment

Most mpox infections are mild and will heal without treatment.

TPOXX (tecovirimat) treatment is available and should be given without delay to people with severe mpox illness and/or at high-risk.

People at high risk include those with HIV not virally suppressed and/or CD4<200, other immunocompromising conditions, skin conditions (such as eczema), children under 8 years of age, and people who are pregnant or breastfeeding.
Severe disease includes a large number of lesions, involvement of anatomic areas (such as eyes or genitals) which might result in serious sequelae that includes scarring or strictures, and serious systemic illness such as sepsis, encephalitis and bleeding.
If you have mpox and want treatment but don’t have a medical provider and/or want to participate in a research study, please consider enrolling in the STOMP study at UCSF (call 415-535-9495).
Clinicians: please see the CDC TPOXX treatment guide and TPOXX investigational new drug (IND) protocol here.

In Alameda County, TPOXX may be available at your clinic’s pharmacy, the EBAC pharmacy and through the Summit Emergency Department.
In Contra Costa County, TPOXX is available through the county for people with Medi-Cal and no insurance (call 887-661-6230) or through the BASS ID group for people with Medicare and private insurance (call 925-947-2334).

East Bay Mpox Epidemiology & Data

Mpox in Alameda County

Click here for the latest Alameda County mpox and other health advisories.

Mpox in Contra Costa County

Visit the Contra Costa Health Services Mpox dashboard for the latest updates on local mpox cases. Visit the CDPH mpox page and data dashboard for the latest information about confirmed or suspected cases of monkeypox in the county.

Mpox data dashboards: Alameda County | Contra Costa County | California | United States