A case of monkeypox reported in the Bay Area adds to growing evidence that people can contract the virus in multiple ways – and raises questions about how easily it is possible to become infected from casual encounters with others .
A case investigation published tuesday by the Centers for Disease Control reveals that a man in his twenties who sought treatment at Stanford Hospital tested positive for monkeypox even though he had not recently had sexual activity. Epidemiologists have long believed that the virus is transmitted primarily through close skin-to-skin contact.
The case also highlights the trajectory of the virus and whether it could leap from the LGBTQ community – which has been disproportionately affected by the virus – to the wider population via public spaces. While this isn’t the first time a case not involving sexual contact has been reported — two toddlers in the state have tested positive — the CDC report offers an in-depth look at the kind of activities that the Stanford man did before he contracted monkey pox.
“There have been concerns from the very beginning: Do we really know of any means of transmission other than intimate contact?” asked John Swartzberg, a UC Berkeley epidemiologist. “This case reinforces that this virus can be transmitted in other ways.”
According to the CDC report, the man began developing monkeypox lesions on his body about two weeks after attending four crowded outdoor gatherings in the UK. The man told investigators the events involved dancing, many people were wearing sleeveless t-shirts and shorts, and the gathering was not exclusively for the LGBTQ community.
No one had any injuries at the event, the man said, and no one appeared to be ill. The man also traveled on crowded trains and took two flights back to the United States. Lesions appeared on the man’s hands, lips, chest and back, but none were reported on or near his penis. The symptoms disappeared almost a month after the lesions appeared.
The report says fomites — inanimate objects that can transmit a virus, like bed sheets or doorknobs — may be a vector in which monkeypox can spread, but needs further investigation.
For his part, Swartzberg said there simply isn’t enough data to have a conclusive idea of whether the virus is transmitted by fomites or even other means, such as respiratory droplets, which tend to spread about six feet before landing on the ground. Researchers are also studying whether monkeypox is spread through semen.
Although the case is an anomaly at the moment in terms of transmission, Swartzberg said it should not raise alarm bells for the general public.
“I wouldn’t worry about getting into a grocery store story and someone next to me getting monkeypox,” he said. “This one case, I don’t think changes the way we go about our daily lives.”
Art Reingold, another UC Berkeley epidemiologist, said he was not surprised by the report.
“I think one could have predicted that we would see cases like this,” he said. “We knew there would be cases of non-sexual transmission.”
In a statement, the Santa Clara County Health Department said it would not comment on specific patients, but said, “It is possible, but much rarer, to contract monkeypox through contact. with respiratory secretions and shared surfaces such as clothing, towels, or bedding. .”
The Stanford incident comes as cases in the Bay Area continue to rise. The Bay Area is currently reporting 921 cases, with San Francisco seeing the highest number at 600. Santa Clara County has 106 cases, Alameda 132, San Mateo 31, Contra Costa 41 and Marin 11.
On Wednesday, Santa Clara County announced it was following new federal guidelines last week that help stretch the limited supply of the monkeypox vaccine, known as JYNNEOS. Previously, health officials used one vaccine for each person; the recent recommendation now allows a single dose to be shared among five people.
Other Bay Area counties have yet to announce whether they will follow the new guidelines.
Contra Costa County said Wednesday that its vaccine supply has increased and residents can now book appointments online instead of having to send in a request.
In San Francisco, where the monkeypox outbreak remains highest, vaccine supplies also appear to be increasing. According to the city’s health department, Zuckerberg SF General Hospital has been able to respond to hundreds of walk-in requests since Aug. 9 and not turn anyone away after receiving 10,000 doses earlier this month.