WASHINGTON — New cases of monkeypox have been trending down nationwide for more than two months, raising hopes that the decades-old virus that saw its first major outbreak in the United States this year is nearly under control, even endangered.

However, experts warn that data from the Centers for Disease Control and Prevention broken down by race and ethnicity shows that the percentage of cases affecting black people is increasing, while there has been a decrease in Hispanics and Latinos and a flattening among whites. These data, however, are not complete, leaving out more than 30% of cases.

Overall, monkeypox cases in the United States appear to have peaked in early August, about two and a half months after the first case of this outbreak was diagnosed in mid-May, triggering a nationwide vaccination campaign that has been criticized by public health experts and members of Congress.

But these vaccination efforts, combined with a massive education campaign about the virus and behavioral changes for those most at risk, appear to have largely had the desired effect.

The seven-day daily average of new cases peaked at 443 on Aug. 6 before steadily dropping to 265 on Sept. 6 and then to 79 on Oct. 6, according to CDC data.

During the six-month outbreak, 27,500 Americans were diagnosed with monkeypox, which often manifests as a rash along with fever, fatigue, chills, itching, headache, swollen lymph nodes and muscle pain in the majority of cases reported to the CDC. As of October 18, Virginia had recorded 515 total cases.

Zero cases possible?

Despite the stumbles over the past five months, public health experts interviewed by States Newsroom said monkeypox cases could continue to decline in the coming months, although they warned there was a lot of work to be done. to do before this happens.

“I think it’s very possible that we’ll get to zero, and I think, you know, it’s potentially even possible that we’ll get to zero before the end of this year,” LGBTQ President Aaron Guest said. Health Caucus at American Public Health. Association.

A drop in social activities, an increase in vaccinations and a broader understanding of the spread of monkeypox have all helped reduce the number of new cases, although Guest said it will be some time before public health experts can look back on how successful some of the interventions and education campaigns were.

Guest said the best-case scenario for him, if cases hit zero for an extended period, would be for public health officials to keep talking about monkeypox. He would also like doctors to include education about the virus in regular exams and STI tests, so that vaccinations continue and the only approved vaccine is stockpiled for a possible future outbreak.

He warned, however, that certain pockets of the country or major cities could continue to see periodic increases in positive test results, even if the virus remains dormant for long periods.

Researchers and public health officials, he said, will also need to make sure that lower case numbers don’t coincide with apathy.

“What I think I know unfortunately is that we often have very short attention spans,” Guest said. “And once it looks like we’ve dealt with something, we kind of move on to the next thing or now that the emergency is over… we’re not going to dedicate funds and resources to addressing those challenges.”

Data on race, ethnicity

Jessica Justman, an associate professor of medicine at the Columbia Mailman School of Public Health, said the CDC data on race and ethnicity is concerning.

“This steady increase in the black and African American population really makes me say, you know, we can’t completely sit here,” Justman said. “We’ve just seen the same kind of story over and over again with other epidemics, with HIV, with COVID, that these infections tend to be concentrated in certain parts of the population that probably have less access to vaccines, have less access to health information.”

After the first month of this epidemic, whites accounted for about half of all cases in the United States, with Hispanics or Latinos representing about 31% and blacks or African Americans representing less than 12%, according to partial data from the CDC. . for the week of June 19.

From early July, the percentage of Hispanic or Latino individuals diagnosed with monkeypox remained at around 30% of the total number of cases until mid-September, when it fell into the 20 category. %. The share of white people with the virus fell from 37% to 29% of cases. During the same period, the percentage of black or African Americans rose from 22% to 42% of all cases in the United States, according to CDC data.

CDC Director Rochelle Walensky said in a Sept. 15 briefing that public health officials have begun to see “the racial and ethnic makeup of this outbreak shifting.”

Higher share of cases

The Kaiser Family Foundation’s breakdown of CDC data on race and ethnicity, which includes only 68% of reported cases as of September 23, notes that “Blacks and Hispanics account for a larger share of cases compared to their share of the population.

For example, while people of color make up about 40% of the US population, they accounted for about 70% of monkeypox cases at that time.

Vaccination data is also skewed when disaggregated by race and ethnicity.

Walensky said at the mid-September briefing that whites made up 47% of people who received their first dose of the Jynneos vaccine, while Hispanics made up about 21% and blacks about 12%.

CDC data, however, is not comprehensive, coming from 39 jurisdictions and accounting for about 91% of first-dose injections.

Public health officials, Justman said, should continue to vaccinate at-risk populations regardless of low case numbers.

“Really, for me, the marker for saying we’ve done enough is when you’ve covered a very high percentage of the at-risk population,” she said.

Justman said the decline in monkeypox cases in the United States was due to the vaccination campaign as well as behavioral changes, although she cautioned there was not much data on the exact number of people who have adopted changes in their physical contact.

The largest outbreak in US history

Monkeypox, first discovered in 1958 in research monkeys, is spread by direct physical contact, by touching fabrics such as bedding or towels used by someone with the virus, or by contact with respiratory secretions, according to the CDC.

Since the first human case was diagnosed in 1970, the vast majority of cases have occurred in central and western Africa, while cases outside this region have been linked to travel within the region or imported animals.

This year’s outbreak, the largest in US history, began in mid-May when doctors diagnosed a Massachusetts man with the disease. Europe and other parts of the world where monkeypox is not traditionally diagnosed have also seen a significant outbreak this year.

In total, there have been more than 72,000 diagnoses of monkeypox in countries with no history of the virus. There have been 28 deaths, including two in the United States, according to the CDC.

Understanding the vaccine

Elizabeth Finley, director of communications at the National Coalition of STD Directors, said while she expects new monkeypox diagnoses to continue to decline, she doesn’t expect the virus to go away.

“I think we will continue to see low numbers of monkeypox cases,” she said. “I don’t think it’s going to go away.”

A key aspect of the ongoing response, she said, is to develop a better understanding of the performance of the Jynneos vaccine after one dose as well as after the full two-dose series, and the duration of protection.

“This is a vaccine that was designed to help the nation or other nations deal with an outbreak of smallpox. It wasn’t necessarily designed to be a long-term plan for something like monkeypox,” Finley said.

Although anyone can get monkeypox, this outbreak primarily affected gay, bisexual and other men who have sex with men, leading public health officials to urge members of the community to limit physical contact.

But, Finley said, experts have been unclear about how long and to what extent people should abstain or severely limit physical contact.

“I don’t know if it’s sustainable. And frankly, I don’t know if it’s fair to ask people to support this kind of change,” Finley said.

As cases of monkeypox continue to decline, Finley said she hopes public health officials will target their outreach to people who have little or no access to health care and who may not be vaccinated.

Amesh Adalja, a senior fellow at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, said he thinks it will take some time before the United States reaches zero cases, although he thinks that it is possible with sustained education, vaccination and treatment. .

He cautioned, however, that this would not mean doctors would never diagnose monkeypox again.

“The United States can reach a certain level of resilience, but there will always be a chance of importation from all these other European countries, for example, where the disease is also spreading,” Adalja said. “So there may still be sporadic outbreaks until enough of the population is immunized here or vaccinated. And if the vaccine is considered robust enough to keep it at bay. »