By Mikkel Hyldebrandt
Atlanta Pride is here, and the community is bursting at the seams to get out there and celebrate in person. But with the current outbreak of the MPX virus, it’s crucial to stay on top of the latest updates, so you can stay safe and celebrate Pride at the same time. So, we went directly to the source and spoke to Dr. Demetre Daskalakis, the current Director of the CDC Division of HIV Prevention, who was appointed National Monkeypox Response Deputy Coordinator to the White House at the beginning of August.
As a leading public health expert on issues affecting the LGBTQ+ communities and now White House-appointed authority on MPX, can you tell us a little bit about the current status of the outbreak?
Cases are down 50% from early August. That’s really good news and a cause for cautious optimism. Georgia appears to be on the downslope of cases. That’s due to the amazing work of letting people know how to reduce their risk, get vaccinated, and get tested. Atlanta has been a shining example of how to respond to monkeypox from the significant work the community and government have done to make vaccine distribution equitable and by putting vaccines and education right where people live, work, and play. At the same time, we have more work to be done to ensure we’re reaching every community equitably with resources to fight this outbreak. Georgia has been at the forefront of this equity work and is a model for many other states.
It may seem like we have heard it repeatedly, but how is MPX spread? And what are the symptoms?
The most common way monkeypox is spread in this outbreak is through the close physical contact that happens during sex. Other skin-to-skin contact may also spread the infection, but it’s a lot less prominent. Less commonly, monkeypox can be transmitted by touching objects that have touched monkeypox lesions, or from prolonged face-to-face contact, like kissing. The bottom line is well over 90% of cases reported sex, and the lion share of the cases are in gay, bisexual, and other men who have sex with men. We need to be aware of monkeypox, make changes to some behaviors to reduce risk of exposure, and get vaccinated if at risk!
Monkeypox can start with a flu-like illness with fever, muscle aches, and fatigue. Soon after, people develop a rash. Many people during this outbreak skip the flu-like symptoms and go right to the rash. The rash looks like pimples or bumps. Classic monkeypox rashes are usually on the face and body, but in this outbreak, we are seeing a different pattern with lesions around the anus and genitals as well as in the anus and mouth. If you have a rash, it’s a good idea to see a medical provider to see if you need testing for monkeypox.
How serious is MPX?
Monkeypox can be a very serious infection. Although deaths related to this infection in this outbreak have been uncommon, people can still have very severe manifestations of the infection, including rashes that scar, painful lesions in the mouth, anus, and genitals, and rarely lesions that affect the eye. Monkeypox can be more severe in people with medical problems that weaken the immune system, including HIV. People with HIV who qualify for the vaccine should get it and should seek early care if they have a rash.
People living with HIV on medications do better in this and many other infections, so this is an important chance for me to remind people to get tested for HIV, go on PrEP if needed, or connect to HIV care and get treatment if your test is positive!
It is critical that individuals in this highest risk category understand the risk behaviors that may leave you vulnerable to monkeypox and get vaccinated if you have not already.
A lot of people are looking forward to finally being able to celebrate Pride in person after the festival and parade were canceled two years in a row. How do you protect yourself from MPX when you’re out and about?
We are all excited for Atlanta Pride! The CDC has really clear, plain language guidance on how people can prevent monkeypox.
The best strategy is to get vaccinated with a two-dose regimen if you are at risk and temporarily make some changes to your sex life, like reducing multiple, anonymous, or new partners. Although no vaccine provides perfect protection, two weeks after the second dose, lab tests indicate that protection is adequate. Check out the CDC guidance at: www.cdc.gov/poxvirus/monkeypox/prevention/sexual-health.html.
How important is getting an MPX vaccine to protect yourself against infection?
The vaccine is really important but not the only way we can prevent monkeypox. I strongly encourage people who qualify to get the vaccine, both doses! Supply is much better than a few weeks ago, and there is good lab-based evidence that the vaccine works! You can also protect yourself by avoiding some of the exposures that lead to monkeypox. Use all the tools in the toolkit to prevent the infection!
The next phase of the vaccine rollout is to target ‘hotspots’ – like the Atlanta Pride festival – and send out extra vaccine doses to where people will gather in large numbers. Will there be additional vaccine events during Atlanta Pride?
Yes! We worked with the Georgia Department of Public Health and local counties to vaccinate almost 4000 people for monkeypox during Black Pride. More to come!!
So you celebrated Pride, took a few risks, and now you think you have symptoms of MPX, or you know you were exposed to someone who currently has MPX. What should you do?
Seek care! If you have been exposed to someone with monkeypox and you have not been vaccinated, you may need a vaccine as post-exposure protection or prophylaxis (PEP). The sooner, the better to prevent infection. If you have symptoms of monkeypox, get tested and keep to yourself as you wait for test results. Assume you have it until testing comes back.
If you get sick, are there any treatments besides getting the vaccine?
The vaccine does not treat monkeypox. It is a preventive measure that helps before you have symptoms. If you have monkeypox, talk to your medical provider. They can help you treat the symptoms, including pain that may happen because of oral, rectal, and genital lesions. You may also qualify for treatment with tecovirimat or TPOXX, an experimental drug used to treat the infection. We don’t know how well it works, but we know it’s safe. You could potentially even enroll in a trial to help everyone learn about TPOXX. You can learn more about the TPOXX STOMP trail at STOMP (stomptpoxx.org)
With you and other experts at the helm to combat this outbreak, do you think it will disappear at some point? Or will we get unending variants like with Covid-19?
I think we will see that we are able to get good control of this outbreak. We don’t expect variants like we see with COVID-19 because the virus is a lot different. We are at a really important time of the outbreak where we have all the right tools at hand to control monkeypox; we just need to make sure those tools get to people who need them, especially people of color who are over-represented in the outbreak but under-represented in the vaccine administrations.
Where can we read the latest MPX news from you and the White House task force?
I recommend visiting the following website to stay up to date:
www.hhs.gov/monkeypox/index.html. It links to information from multiple agencies, including the CDC!
Anything you’d like to add?
Happy Pride! I just want to thank my Atlanta community! Atlanta is my home, and I am proud to see the work you all have done to help control monkeypox. I am truly honored to represent us at the White House and in my work on HIV at the CDC.