A new cluster of mpox cases in the United States after nearly seven months of steady decline leads health officials to warn of a possible rebound outbreak this summer.

Chicago health officials recently reported this

20 new

cases and urge people there to get vaccinated.

Major cities such as Los Angeles, San Francisco and New York are stepping up awareness campaigns and vaccination programs, especially targeting men who have sex with men and transgender people.

They warn that cases of mpox, formerly called monkeypox, can spread easily as LGBTQ pride parades get underway in the summer.

The spring and summer season in 2023 could lead to a resurgence of mpox as people gather for festivals and other events, the Centers for Disease Control and Prevention said in a health alert Monday.

The CDC warned that without additional vaccination and other virus containment measures, a rebound outbreak could be as large or larger than in 2022.

While anyone can get mpox, the virus has largely affected gay and bisexual men in the US so far. It is not a sexually transmitted virus, but close physical contact is the main mode of infection.

On May 11, the World Health Organization declared a global state of emergency mpox over, a year after the virus spread beyond endemic regions.

The drop in cases over the past year has led to a sharp drop in vaccinations. In Los Angeles County, for example, weekly vaccinations fell from 8,000 last year to about 100-150 in recent months, officials said.

But officials in the Biden administration said on Tuesday they weren’t wary, especially amid the recent uptick in cases in some places.

“What we are seeing in Chicago certainly reminds us that… we are not out of the woods. We have a vaccine mission not yet completed,

said Dr. Demetre Daskalakis,

deputy coordinator for the National Mpox Response at the White House.

Among other things, his office is moving quickly to ensure local health departments have the resources to deal with the new cases. “

We are in that place where we expect clusters, but we have our mission, which is to vaccinate people so we can make sure we prevent them,” he told The Times.

The current outbreak of mpox is the largest and most widespread since the virus was discovered in 1958.

More than 87,000 cases in 111 countries with 140 deaths worldwide have been reported to WHO in the past year.

The United States has recorded nearly 31,000 cases and 42 deaths in the past year. The current outbreak in the US was first recorded in Boston. California leads with 5,759 cases, according to the latest available data from the CDC.

Despite concerns about a recovery, the dramatic drop in cases has fallen from 600

rural

on Aug.

VAT

January 1, 2022,

rural

to a weekly average of one in April

2023

represents a bit of a success story in suppressing the virus, at least for now.

It also provides lessons for future outbreaks.

Some health experts praise President Biden for his aggressive handling of the mpox health crisis.

Days after the Boston case was confirmed, Biden said the virus was “something everyone should be concerned about”.

His Ministry of Health and Human Services signed a contract with a Danish vaccine maker the same day. He assembled a widely respected coordination team to lead the response and had previously reversed President Trump’s decision to withdraw the United States from the WHO.

Yet the current mpox outbreak became much larger and more widespread than previous ones. Previous outbreaks were limited to a handful of cases traceable to recent travelers to mpox-endemic regions of Africa, and were quickly brought under control.

The current outbreak has seen widespread community transmission and has been detected in all 50 states, the District of Columbia and Puerto Rico.

Stretched by the ongoing COVID-19 pandemic, health systems struggled to get to grips with mpox at first.

Initially, testing for mpox was limited to select labs and medical professionals, who had to weave through a network of red tape to order and prescribe Tpoxx, an investigational drug used to treat the virus.

“There was a lot of paperwork you had to fill out with an outdated public health system, where you had to go through the local health department, the CDC, to get clearance,” said Dr. Peter Chin-Hong, professor of medicine and infectious disease specialist at

University of California UC

san francisco

The standard time to complete the form for Tpoxx took doctors two hours,

Daskalakis said, before any attempts were made to shorten it to 15 minutes

.

Then a quarrel arose with the Danish vaccine maker. When some vaccines were in stock, local health officials struggled to manage distribution with websites often crashing as concerned men and transgender people sought appointments.

There was some delay as officials discussed how best to communicate with the LGBTQ community and what advice to give regarding sexual behavior.

“That was very challenging given that people wanted to be as sex-positive as possible,” Chin-Hong said. “There was a lot of hesitation because you didn’t want to shame people.”

These early challenges may have helped the virus gain a foothold across the country.

“The concern is the delay that allowed the virus to become more established in the United States,”

Dr. Bruce Y. Lee, professor of health policy management at the School of Public Health, City University of New York Lee, said

. “And if that is the case, then we will continue to pay the cost of not responding faster and more effectively for many years to come.”

One thing that helped in the fight against mpox was the LGBTQ community itself.

That community has already experienced an HIV/AIDS epidemic that has claimed the lives of many. It has also seen how public health interventions and scientific breakthroughs, especially with pharmaceutical developments, can not only enable people living with HIV to live long and fulfilling lives, but also prevent new infections with PrEP and PEP.

So when a new virus threatened that community, compliance with public health messages was strong, and in stark contrast to COVID-19, there was little resistance to vaccinations.

“I can’t think of anyone who didn’t want it. In fact, it was the opposite; it became a very popular item,” Chin-Hong said, referring to the vaccine. “The legacy of HIV, I think, has given a lot of information about how the community rallied, not just for acceptance of interventions like vaccines or seeking help, but also for activism,” he added.

A study by Emory University researchers found that many gay men not only embraced the vaccine but also modified their sexual behavior in response to the mpox outbreak. It found that 48% of respondents reduced their sexual partners and 50% of respondents reduced sex with partners found on dating apps like Grindr and at sex parties.

That change in behavior, “I think, surprised even people who know the community well like me,” Chin-Hong said, and contributed to the decline.

However, there is still much work to be done. The CDC estimates that only 23% of people in the high-risk groups have received the vaccine. This is perhaps a symptom of pandemic fatigue after many failed attempts to get the vaccine, combined with a perceived reduction in risk as cases declined.

The administration hopes trusted community voices like it

Daskalakis, who is openly gay, would get the message from

mpox vaccination in addition to other sexual health practices

. “

I’d like to tell people it’s really good to be proactive about your summer planning… check your oil and kick the tires as you approach pride season.

One final lesson, experts say, is how important it is to work globally to identify and combat deadly viruses.

Unlike COVID-19, mpox was not new. For decades, countries in West and Central Africa battled smaller outbreaks.

If wealthier countries like the US had done more to share existing treatments and vaccines with these African countries, they might have been able to prevent the mpox pandemic from spreading worldwide, experts say.

“As long as something poses a threat in one part of the world, it can very easily spread to other parts,” Lee said. “Increasing efforts to fight infectious diseases in countries with fewer resources will ultimately protect the US”