Mpox is down, but US cities could be at risk of summer outbreaks

New Orleans, LA – The mpox public health emergency is over, but U.S. health officials are working to prevent a repeat of last year’s outbreak.

In the early summer of 2022, Mpox infection broke out after the Pride parades. Last year, more than 30,000 cases of the disease were reported in the United States, most of which were spread during sexual contact between gay and bisexual people. About 40 people died.

With Pride events planned across the country in the coming weeks, health officials and event organizers say they are optimistic that infections will be fewer and less serious this year. More vaccines, more people with immunity, and easier access to drugs to treat smallpox are among the reasons.

But they also worry that people may think of smallpox as last year’s problem.

“Out of sight, out of mind,” said Dr. Demetri Daskalakis, who advises the White House on the smallpox response. “But we beat the drum.”

Last week, the Centers for Disease Control and Prevention issued a warning to American doctors about new cases. On Thursday, the agency released a modeling study that estimated the likelihood of smallpox resurgence in 50 countries that have been the focus of the government’s campaign to combat the sexually transmitted disease.

The study concluded that 10 counties had a 50% or higher chance of smallpox outbreaks this year. The calculation was mainly based on how many people were considered to be at high risk of infection and what proportion of them had some immunity through vaccination or previous infection.

At the top of the list are Jacksonville, Florida; Memphis, Tennessee; and Cincinnati are cities where 10% or fewer of those at highest risk are estimated to be immune. In another 25 counties, low or moderate levels of immunity put them at greater risk of outbreaks.

The study had a number of limitations, including that scientists do not know how long immunity lasts from vaccination or previous infections.

So why do the research? To warn people, said Dr. Chris Braden, who leads the CDC’s smallpox response.

“This is something that is important for jurisdictions that promote smallpox prevention and for the public to take note — and take care of themselves. That’s why we’re doing it,” he said.

Officials are trying to inject a sense of urgency into the health threat, which was seen as a growing crisis last summer but faded by the end of the year.

Formerly known as monkeypox, smallpox is caused by a virus in the same family as the one that causes smallpox. It is endemic in parts of Africa where humans have been infected through rodent or small animal bites, but it has not been known to spread easily among humans.

Cases began to appear in Europe and the United States about a year ago, mostly among men who have sex with men, and escalated in dozens of countries in June and July. Infections were rarely fatal, but many people suffered from painful skin lesions for weeks.

Countries scrambled to find a vaccine or other countermeasures. At the end of July, the World Health Organization declared a public health emergency. The US followed suit in early August.

But then cases began to decline, from an average of nearly 500 a day in August to fewer than 10 by the end of December. Experts attribute the decline to several factors, including government measures to overcome vaccine shortages and efforts by gay and bisexual men to spread warnings and limit sexual contact.

The US state of emergency ended in late January, and the WHO ended its declaration earlier this month.

Indeed, the sense of urgency about mpox is less than last year, said Dan Dimant, a spokesman for NYC Pride. The organization anticipates there will be fewer threat reports at events next month, although plans may change if the situation worsens.

At the height of the crisis last year, there were long lines to get the shots, but demand has died down as the number of cases has fallen. The government estimates that 1.7 million people – mostly men who have sex with men – are at high risk of contracting smallpox, but only about 400,000 have received the recommended two doses of the vaccine.

“We’re definitely not where we need to be,” Daskalakis said during an interview last week at the STD conference in New Orleans.

Some see possible storm clouds on the horizon.

This year, cases of infection have been recorded in some European countries and South Korea. British officials said Thursday that a surge in smallpox cases in London over the past month showed the virus was not going away.

Nearly 30 people, many of them fully vaccinated, were infected in a recent outbreak in Chicago. (As with COVID-19 and the flu shot, vaccinated people can still get smallpox, but they’re likely to have milder symptoms, officials say.)

Dr. Joseph Cherabi, associate medical director of the Sexual Health Clinic of St. Louis County, said people from the area travel to Chicago for events, so outbreaks could cause ripples elsewhere.

“We’re a few weeks behind Chicago. “Chicago is usually our leader,” Cherabi said.

Chicago health officials are taking steps to prevent further spread at this weekend’s Mr. Skin international gathering.

Event organizers strongly advise attendees to get vaccinated. Chicago health officials collected the social media posts, including one showing three candles and a leather paddle with the caption: “Before you play with leather or wax, buy yourself a chicken pox.”