“The tip of the iceberg”: Health leaders discuss monkeypox in Santa Barbara County
So far, the Central Coast has only seen a handful of confirmed monkeypox cases. But experts say that’s likely just the tip of the iceberg.
"Remembering that there is a lot more of this disease likely circulating than we've been able to confirm is a great starting point," said infectious disease specialist Dr. Lynn Fitzgibbons.
“What we want to think about is really who is potentially infectious and how can we make sure that each of us, each of our loved ones, each of our friends are as protected as possible and armed with good knowledge about this,” Fitzgibbon said at a virtual panel earlier this month.
The Pacific Pride Foundation is a nonprofit that provides services to the HIV/AIDS and LGBTQ+ communities of Santa Barbara. Speakers included representatives from Santa Barbara Public Health, Santa Barbara Neighborhood Clinic, UC Santa Barbara Student Health, and Planned Parenthood.
Monkeypox, or Mpox, is a viral disease that causes flu-like symptoms: fevers, muscle aches, and swollen glands. Patients will often see a rash of the skin within one to four days.
“These are lesions that are often very, very painful, sometimes itchy, and they can be in a variety of parts of the body,” Dr. Fitzgibbons said.
Mpox and smallpox belong to the same family of viruses, but the severity of the two conditions are much different. Unlike smallpox, Mpox has caused very few deaths worldwide relative to the fairly large number of cases.
However, those who have been vaccinated against the smallpox virus may have some immunity.
“The vaccine was given to everybody until 1972 in the United States. So if you were born before 1970, you likely received the smallpox vaccine,” said Santa Barbara Public Health Officer Dr. Henning Ansorg.
There’s two smallpox vaccines: JYNNEOS and ACAM2000. But because ACAM2000 uses a live virus, it’s not preferred.
“Because of the nature of it being a live vaccine, it is really not our first choice as doctors because the side effects are quite significant,” Dr. Ansorg said.
The vaccine is currently in short supply, and is being prioritized to those who have been in contact with the Mpox virus. Unlike the COVID vaccine, this post-exposure vaccine technique works well to curb symptoms and even decrease infection risk.
Santa Barbara County has 220 vials available, according to Dr. Ansorg. Last week, the FDA authorized doses being “stretched” – meaning each of those vials will serve five individuals.
“Now they have found that if you give only a fifth of the full dose into the skin, it is as effective as the full vial in one person. So that means with one vial, we can now vaccinate five individuals, and that of course will stretch our 200 vials to 1000 vaccinations.”
People must be 18 or older to get the Mpox vaccine. As of now, it’s unknown whether vaccinated persons can be carriers and infect unvaccinated individuals. Dr. Fitzgibbons says the vaccine is promising, but it won’t be a perfect solution.
“We’re optimistic that the vaccine is going to be very, very protective, but I'd be cautious to assure that a vaccine is a bulletproof vest,” Dr. Fitzgibbons said.
The Mpox virus is most commonly transmitted through close skin-to-skin and sexual contact. Panelists recommended practicing safer sex and avoiding intimacy if one feels flu-like symptoms or notices lesions.
While Mpox can spread through sexual contact, Dr. Fitzgibbons says it’s not the same as exclusively sexually-transmitted diseases like syphilis or gonorrhea. Mpox is spread much more simply.
“It’s spread when people who have monkey pox are in close contact, perhaps intimate contact, as in the case of, of sex, but in close contact with another person. And that's when the virus is being spread from one person to another,” Dr. Fitzgibbons said.
Men who have sex with men, or MSM, have been shown to be particularly vulnerable to the Mpox disease in 2022. Of all the reported Mpox cases in California, over 85% are among MSM.
But it’s important to note that this disease is not exclusively spreading among MSM.
“We have a number of kids who have it. I read yesterday that there are eight infants who have it in the country. So this is a disease everybody is susceptible to,” said Dr. Charles Fenzi of Santa Barbara Neighborhood Clinic.
With such a disproportionate rate of Mpox affecting queer people, moderator Kristin Flickinger with Pacific Pride drew comparisons to the stigmatization faced by LGBTQ+ people during the AIDS epidemic of the 1980s and 1990s.
“Some people feel hurt and feel angry and see echoes of the eighties and nineties AIDS epidemic, from an information standpoint, from a prioritization standpoint, and just the standpoint of this is an infectious disease, radically impacting one community, the LGBTQ plus community – specifically men who have sex with men,” Flickinger said.
The Pacific Pride Foundation is trying to dispel misinformation and lead an honest conversation with the LGBTQ+ community about what prevention looks like, she said.
“We know how to get checked out. We know how to take a pause. When we need to take a pause, that is very different from saying stop having sex. It's not what anyone is saying. Go get checked, take a pause, come back. We know how to take care of each other,” Flickinger said.
With the Pacific Pride Festival coming up this Saturday, August 27, Flickinger asked the panel if individuals should be concerned about the virus spreading through large crowds.
Dr. Fitzgibbons said that unlike COVID, Mpox is not easily spread through aerosol droplets — meaning it doesn’t spread rapidly through the air like COVID-19.
“Were that the case, we would be seeing a lot more clusters related to these types of scenarios, because there have certainly been infectious people in these situations, and we're not seeing big pockets of outbreaks,” Dr. Fitzibbons said.
“We’ll know much more three months from now, but walking around at the Pride Festival next week, which I’m looking forward to doing – I am not fearful of catching monkeypox in that crowd.”
The Pacific Pride Foundation will host a vaccination clinic on Thursday, August 25 in Santa Maria from 5-8 p.m. You can check your eligibility by contacting the Santa Barbara County Public Health Department at 805-681-5280 or PHDDiseaseControl@sbcphd.org.
You can view a full recording of the virtual town hall here. Updated monkeypox data for California is available here.