Minnesota readies monkeypox response

Minnesota is expanding its response to monkeypox, including more tests and eventually more vaccines, in anticipation of more cases of the infectious disease that is now a global public health emergency.

While cases have been mostly mild and limited to younger men who have sex with other men, health officials said anyone can be infected and they want to stop transmission before the virus spreads broadly and reaches high-risk groups such as the elderly. The state so far has identified 33 cases, mostly among people infected during travel or by people who recently traveled.

"It's not an infection we want people to have," said Dr. Ruth Lynfield, state epidemiologist and medical director for the Minnesota Department of Health, in a briefing on Friday. "Some people may get severely ill. We also want to ensure the outbreak does not increase widely and become established."

Transmission typically occurred from animal to person in regions of Africa where monkeypox is endemic, but the virus this year started spreading from person to person. Sexual activity among multiple anonymous partners at two large events in Europe reportedly was a catalyst for global transmission.

Health officials have encouraged the primary risk group of men who have sex with other men to take preventive steps, such as refraining from sexual activity anonymously or with people who have monkeypox symptoms — including characteristic pimple-sized rashes.

Vaccine is available on a post-exposure basis, and pre-exposure for people at greatest risk for infection, but in limited supply. Minnesota's allocation is 3,000 doses right now with another 7,600 doses expected within six weeks.

"That amount is not nearly enough for the tens of thousands of people estimated to be at high risk in Minnesota," Lynfield said. "Vaccine alone cannot stop the spread of this outbreak. Practicing preventive measures in addition to vaccine is critical."

A troubling scenario would be for the virus to spread widely among people and then back to animals, which could then become reservoirs that keep monkeypox at endemic levels in the U.S.

The country is in for a potential "COVID redux" of failed containment if it doesn't expand vaccine supplies and make them available broadly pre-exposure, said Dr. Gregory Poland, a Mayo Clinic vaccinologist. Men will face stigma or just not come forward if a condition of vaccination is that they disclose sexual behaviors putting them at elevated risk.

"I'm not sure at all that it's possible at this point," he said. "We don't have enough vaccine, we have only just ramped up testing, and we don't have streamlined ways to identify these individuals and provide pre- and post-exposure prophylaxis and treatment."

Lynfield said men who have sex with other men make up the group in which the virus first spread but that anyone is at risk. Infection is largely through contact with wounds, fluids or skin of infected people, or with contaminated sheets, towels or other materials.

The mortality rate in Africa is around 1% of known infections, but only a handful of deaths have been reported in the global outbreak — largely because most of the 21,000 infected people are healthier, younger men. Lynfield said there are still serious risks — with about 10% of infected people needing hospital admissions, lesions threatening blindness if around the eyes and extreme physical pain elsewhere on the body.