Spread of monkeypox appears to be slowing in major US cities: Gunshots

Physician Assistant Susan Eng-Na, right, administers a monkeypox vaccine during a vaccination clinic in New York City. New cases are starting to decline in New York and some other US cities.

Marie Altaffer/AP

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Marie Altaffer/AP

Physician Assistant Susan Eng-Na, right, administers a monkeypox vaccine during a vaccination clinic in New York City. New cases are starting to decline in New York and some other US cities.

Marie Altaffer/AP

More than three months into the outbreak of monkeypox in the United States, a new — and welcome — phrase is coming from the lips of health officials leading the nation’s response: cautious optimism.

The change in tone reflects early signs that rates of new infections are slowing in some of the major cities where the virus arrived early and spread quickly, particularly New York, Chicago and San Francisco.

Federal officials warn it’s too early to tell if the country is turning a corner. Still, the slowdown in parts of the United States — coupled with data on how those most at risk are protecting themselves and getting vaccinated — are promising signs.

“Our numbers keep growing, [but] the rate of increase is lower,” Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, told reporters on Friday. will work.”

The number of reported cases has been trending downward since mid-August, based on an NPR analysis of the data The CDC released on Wednesday. Overall, there has been a drop of around 25% in the 7-day average of new cases over the past two weeks.

However, health officials warn that delays in reporting data may offer an incomplete picture of the outbreak over the past few weeks, making it difficult to know if cases have truly peaked.

The decline in parts of the United States mirrors what is already being seen in some European countries, where the virus was detected a few weeks earlier. In the UK and Germany, the number of daily cases has steadily declined since late July. In several other countries, including the Netherlands and Italy, the number of new cases has plateaued.

Cases slow in major cities

In New York – one of the epicenters of the outbreak – the number of newly infected people has fallen by 40% in the past month. San Francisco health officials are also seeing a drop in the rate of new cases.

“I’m cautiously optimistic,” says Dr. Susan Philip, health officer for the city and county of San Francisco. “We know, however, that it will take a lot of work and effort to maintain this downward curve and ensure that cases continue to drop.”

The situation is also improving in other cities such as Angels, Houston and Chicago, where local health officials say there are indications infections are stabilizing.

Key indicators — such as the average number of cases and the time it takes for cases to double — have declined over the past two weeks, says Janna Kerins, chief medical officer at the Chicago Department of Public Health. “I’m not sure we’re ready to say this outbreak is really over,” Kerins says, “but all of these things are encouraging.”

Changes also follow with modeling released this week this suggests that the national epidemic is in decline.

“We are seeing signs of a substantial slowdown and forecasts suggest it will be headed in the right direction,” at least over the next four weeks, says Gerardo Chowell-Puenteprofessor of epidemiology and biostatistics at Georgia State University, who models the monkeypox outbreak

Behavioral changes lead to decline

Given the size and diversity of the United States, there is still considerable uncertainty about how the outbreak will unfold in different parts of the country, but infectious disease experts attribute the slowdown largely to efforts aimed at changing the behavior of homosexuals, bisexuals and other men who have sex. with men – a group that accounts for the vast majority of cases.

“Most of us in public health working on this disease are quite confident that the majority of the reduction is due to behavior change,” says Dr. Jay Varma, director of the Cornell Center for Pandemic Prevention and Response at Weill Cornell Medicine.

More than 94% of monkeypox cases in the United States are associated with sexual activity. And on Friday, CDC officials highlighted new data showing that gay and queer communities are changing their sexual behaviors in response to messaging around monkeypox.

In an online surveyabout 50% of respondents said they had reduced “their number of sexual partners, occasional sexual encounters [or] the use of dating apps due to the monkeypox epidemic.” An accompaniment modeling study published by the CDC showed that a “40% reduction in occasional sex could delay the spread of monkeypox and reduce the percentage of people infected” by up to about 30%.

“It means that LGBTQIA+ people are doing things that actually reduce their risk, and it’s working,” Dr. Demetre Daskalakis, deputy White House monkeypox response coordinator, said in a Friday press briefing.

It’s not entirely surprising that the virus appears to be slowing down in the United States as it has in Europe, says Dr. Jeffrey Klausnerprofessor of medicine and infectious disease, population science, and public health at the Keck School of Medicine at the University of Southern California.

Most cities will see a drop in the number of cases – this drop may not be as rapid or as steep as the rise,” says Klausner.

Klausner notes that monkeypox has remained mostly in certain relatively small sexual networks – making it harder for the virus to maintain momentum as vaccination increases, people develop immunity to infection and those most at risk change in behavior.

“People who have raised concerns about the spread of infection on college campuses and daycares and other types of settings where there is close personal contact, at this stage, that has not happened” , he said.

Uncertainty remains

But other experts aren’t as optimistic about the outbreak’s trajectory — at least not yet.

“It’s great to see declines,” says Anne Rimon, an epidemiologist at UCLA who has studied monkeypox for years. “But if the downward trend is due to behavioral changes and vaccinations, it’s unclear how long behavioral changes can be sustained and how well vaccinations actually work to prevent infections.”

Health officials are urging members of affected communities to continue taking precautions to slow the spread of monkeypox.

“Let’s be clear,” Daskalakis said on Friday. “The tips to reduce risk because exposure to monkeypox is for now, not forever, and an important part of our public health and community response as we urgently increase vaccinations to control this outbreak.

Yet there are no hard real data on how well the monkeypox vaccine – approved by the Food and Drug Administration in 2019 – protects against infection and transmission. To further complicate the picture, a shortage of vaccines led the Biden administration to pursue a new strategy of offering the injections intradermally in order to stretch the supply.

“The laboratory data we have on the vaccine suggests that it will be very effective in humans,” says Varma. “But what we know in medicine is that until we see what’s going on in the real world, we never know for sure..”

NPR’s Michaeleen Doucleff contributed to this report.

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