An increase in Oregon cases of mpox – formerly known as monkeypox or hMPXV – over the last two weeks is a reminder that the virus has not gone away and that people should remain vigilant in protecting themselves from infection.

Health care providers are urged to keep mpox in mind when seeing patients with consistent symptoms regardless of reported risk, an Oregon Health Authority (OHA) physician says.

Tim Menza, M.D., Ph.D., senior health adviser for OHA’s mpox response, says the state’s number of mpox cases peaked in early August and has since dropped from 10 to 15 cases diagnosed per week at the height of the outbreak to just two to three cases per week in the last month. However, 19 cases of mpox have been reported to local public health departments since Nov. 9.

Oregon now has 259 mpox cases, including two pediatric cases. Infection rates are highest among people living in Multnomah County, those ages 30 to 39 and members of the Latinx and Black/African communities. Most cases identify as gay or bisexual men.

The initial large decrease in cases in Oregon and nationwide were the result of changes in behavior driven by a strong community-based response. Vaccination, in turn, has helped sustain that decrease in cases, Menza said.

So far, 17,358 doses of Jynneos have been administered in Oregon, including more than 11,000 first doses and almost 6,000 second doses. Menza believes that there are many more people who could benefit from vaccination who have not yet received their first dose and that there are about 6,000 people who remain eligible for a second dose but have not yet received it. Second doses may lengthen the duration of protection and prevent future outbreaks in our communities.

Through case interviews with unvaccinated people who have been recently diagnosed with mpox, we have learned about some of the barriers to getting vaccinated.

“Some people reported that their healthcare providers have not offered them vaccination, that they did not know that vaccine was available and that they didn’t know how to get vaccinated,” Menza said. “Some told us that they had planned to get vaccinated but had put it off, or they assumed they had protection due to prior smallpox vaccination as a child.”

Others, he suggests, thought they weren’t at risk for mpox, or that it wasn’t a serious virus.

“While the number of new mpox cases in Oregon has been on a steady decline, this latest increase in cases tells us that mpox is still here,” Menza said. “We must continue our work with community partners on outreach efforts that encourage people to watch for symptoms, get tested and get vaccinated. Furthermore, we must continue to encourage healthcare providers to keep mpox top of mind when evaluating patients with consistent symptoms and to vaccinate patients who may be at greater risk of mpox infection.”

One of OHA’s more recent outreach efforts has involved Oregon public health officials calling or texting people who received the first dose of the Jynneos mpox vaccine to encourage and help them get a second dose. Those who received a first dose are eligible to get a second dose at least 28 days later.

Local and state public health officials have also been in contact with the Oregon Board of Pharmacy to get Jynneos into pharmacies and have emphasized it as part of sexual healthcare by advertising the vaccine’s availability at federally qualified health centers (FQHCs) across the state. To reduce stigma, health officials have encouraged people to get the mpox vaccine alongside COVID-19 boosters and flu shots and when they access HIV/STI testing, condom distribution, harm reduction supplies and education. Much of the outreach effort has focused on improving vaccine access in communities of color, including community-based vaccination opportunities

Mpox spreads primarily through close, skin-to-skin contact. Most often, it has occurred through intimate or sexual contact. It can also spread during contact with the lesions of an infected individual through a caregiving relationship, such as a parent caring for a child or an adult caretaker of another person.

People who suspect they have mpox should contact their health care provider to let them know before going in to be seen. The provider may recommend testing for mpox. Those who don’t have a health care provider can call 2-1-1 or their local public health authority to get help finding a clinic or health care provider.

For more information about mpox and Oregon’s response to the outbreak, visit OHA’s mpox (hMPXV) website. Vaccine clinics can also be searched by ZIP code with an mpox vaccine locator tool available at https://mpoxvaxmap.org/. In addition, https://covidvaccine.oregon.gov now lists vaccine events or locations that have mpox vaccine under the “ADDITIONAL INFORMATION” section of the event or location description.

Source: Oregon Health Authority

Brad Ford