Jun 7, 2022 - Health

Monkeypox offers new cause for contact tracing

Illustration of a gloved hand holding a petri dish with a question mark.
Illustration: Shoshana Gordon/Axios

With 31 monkeypox cases confirmed in 12 states and the District of Columbia and growing concern about community spread, federal and state public health officials are turning to a frayed page in the pandemic playbook: Using contact tracing to track exposure risk.

Why it matters: Contact tracing proved an ineffective tool for an airborne virus like COVID-19 with a short incubation period, but monkeypox is different.

Driving the news: Officials are turning to contact tracing in the hopes that identifying close, high-risk contacts of infected people will prevent further spread of the virus.

  • "Health departments should be capable of doing contact tracing — the only thing that concerns me is the public reaction to it," Richard Garfein, an epidemiologist at the University of California San Diego School of Public Health, told Axios.
  • If close contacts of people who test positive are too crisis-fatigued or suspicious to pick up the phone when a public health worker calls, contact tracing will become less effective, Garfein added.

But, but, but: If public health workers can reach the hundreds of high-to-intermediate-risk contacts of people with confirmed cases, they can offer them necessary vaccines.

  • In at least one confirmed U.S. case, the person had no prior travel history or known contact with a person who tested positive, indicating that community transmission of the virus is occurring in some parts of the country.

Flashback: Contact tracing couldn't keep up with the sheer number of COVID cases, as efforts were hampered by data gaps, a shortage of health care workers and public skepticism of how the information would be used.

By the numbers: Worldwide, there are more than 1,000 monkeypox cases reported in 29 countries where the virus is not endemic, per the CDC.

  • As of Friday, the U.S. has delivered 1,200 vaccines and 100 treatment courses to eight jurisdictions, Raj Panjabi, the White House senior director for global health security, told reporters.
  • Since the outbreak began in May, more than 120 PCR orthopoxvirus tests have been performed across the country, Panjabi said on Friday.
  • The U.S. has millions of vaccine doses in its stockpile, including 36,000 doses of the Jynneos vaccine in its immediate inventory, an HHS spokesperson told Axios.

"Our strategy is focused on identifying cases and contacts and that cases are being isolated to prevent onward spread," Jennifer McQuiston, CDC incident manager for the outbreak, said last week.

Between the lines: Monkeypox is spread through various types of close, intimate contact with an infected person's rash, respiratory droplets or mucous and can be transmitted by sharing sheets or towels, kissing, touching, hugging or sex.

Threat level: The vast majority of cases in the U.S. are connected to the clade from West Africa, which is associated with less severe disease and death, federal health officials say.

  • So far, no deaths have been reported by WHO as of June 2 in countries with current outbreaks where the disease is not endemic.
  • Despite community transmission, CDC officials maintain the overall risk level remains low.

State of play: At least two genetic sequences have been detected in the U.S. already, meaning the virus may have been spreading longer and further than previously thought, STAT News reported.

  • State and local health departments are interviewing each person with a confirmed case of monkeypox to identify close contacts.
  • States such as Washington and California are coordinating efforts and offering treatments to those who test positive and vaccines to high-risk contacts.
  • Health workers who've been within six feet of a patient during procedures that might create exposures without wearing an N95 and eye protection are also considered high-risk and offered vaccines.
  • Chicago health officials linked two cases in the state through contact tracing.
  • California received 200 doses of the Jynneos vaccine from the federal government to offer those who have high-risk exposures.
  • Salt Lake County, Utah, health officials determined that the two people who tested positive for monkeypox had very few "low risk" contacts, and no additional cases have been confirmed since then.

Of note: The majority of cases have been confirmed in patients who identify as men who have sex with men, but that doesn't mean the risk is confined to that community, experts say.

  • "People have to be aware of how it's transmitted, and somebody who is not gay can get it just as easily as someone who is gay," Garfein said.
  • Anyone with close contact or recent travel history can test positive, and federal health officials encourage physicians to test any person with a suspect rash.
  • A person can test positive for another STI while also having monkeypox, health officials said last week.

The bottom line: The limited number of cases and longer incubation period may prove the utility of contact tracing after COVID rendered many state and federal efforts ineffective.

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