By Sharon Otterman and Liam Stack
Late last year, with cases at a trickle, New York City wound down its mpox emergency response. Health officials stopped posting updates about cases. Vaccination vans stopped appearing outside nightclubs. The number of people being vaccinated against the disease flatlined.
But the mpox virus — a close relative to smallpox whose name was changed from monkeypox last year — never completely disappeared.
Now, a year after a global mpox outbreak began and just as Pride celebrations and the summer party season are set to start, public health authorities are warning of a risk of new outbreaks, nationally and in New York City, primarily among men who have sex with men.
Since peaking in the city late last July at almost 100 cases a day, the disease has continued to circulate at much lower levels. Health officials stopped posting case information on the city’s website at the end of last year. The health department said there had been at least 39 mpox cases in New York so far this year, including 20 in January and two in the past month.
Most people who were diagnosed with the disease recently and interviewed did not report having traveled, officials said, suggesting the disease is spreading locally.
Public health researchers are also monitoring a cluster of cases spreading among vaccinated and unvaccinated people in Chicago, raising concern that the protection provided by vaccination may be waning.
New York City has had one of the nation’s highest vaccination rates among people at greatest risk for getting the disease, but about half of those who have been vaccinated received only one dose of the two-dose vaccine, leaving many vulnerable to infection.
“Without renewed prevention efforts, especially vaccination, we are definitely at risk of a resurgence, in fact, a substantial risk of resurgence of mpox,” said Dr. Demetre Daskalakis, the White House’s national mpox response deputy coordinator, at a news briefing this month.
Anecdotal evidence indicates that vaccination may also lead to milder symptoms, and that has held true in the recent Chicago cluster cases, Daskalakis said.
He and other health experts said the key public health message remains the same: “Get vaccinated.”
Mpox, which causes flu-like symptoms and skin lesions that can be extremely painful, has been endemic in parts of Africa for decades. It can infect anyone, but in 2022, it began spreading globally, mainly through close physical contact and almost exclusively in social and sexual communities of men who have sex with men.
The virus largely disappeared from the news as the outbreak waned last year. But the Chicago cluster, which reached 30 cases by May 20, has resurrected concern. According to a health alert from the Centers for Disease Control and Prevention, nine of the first 13 cases in the cluster were among men who had received two doses of the Jynneos vaccine.
Although the vaccine, which the federal government originally developed to fight smallpox, provides strong protection, it is imperfect. In three recent studies, the effectiveness of two doses in preventing infection ranged from 66% to 88%, while the effectiveness of a single dose ranged from 36% to 75%. Protection may wane further over time.
Mpox is a particular risk for people in marginalized communities. Of the 42 people to die in the United States during the outbreak, almost all had poorly managed HIV, and about 40% were homeless, according to an analysis by KFF, a nonprofit health-policy research organization.
After some initial stumbles, New York’s mpox response has been considered a public health victory overall. People lined up eagerly to get the first doses of the Jynneos vaccine, and many gay men changed their behavior while the outbreak was at its height, helping to bring it under control.
But while it was broadly a success story, Joseph Osmundson, a virus expert at New York University, added that “it is much more complicated than that.” With the disease still spreading globally, risks remain; and although he did not think any new outbreak in New York would be as bad as last summer, “there will be cases,” he said.
Callen-Lorde Community Health Center, an LGBTQ clinic with branches in Manhattan, Brooklyn and the Bronx, saw its first new mpox case in months about three weeks ago, said Dr. Marcus Sandling, the director of sexual health. Since then, he has been asking patients about their vaccine status. He has been troubled by their answers.
“Maybe 50% of them” had gotten both vaccine doses, Sandling said. “Maybe.” He said he had vaccinated 10 people in the past few days.
Sage Rivera, the chief development and program officer at Destination Tomorrow, a Bronx LGBTQ center, said the center’s office had received a number of calls from borough residents concerned about the mpox cluster in Illinois and what might happen “should it migrate its way over” to New York.
Heritage of Pride, the nonprofit group that organizes New York City Pride, one of the largest LGBTQ pride celebrations in the world, has not yet planned any specific outreach about mpox for its June events, said Dan Dimant, a spokesperson for the organization. Its community health partners, however, may provide information at booths.
“As an organization, we will do everything in our power to educate the public on making good decisions and getting the proper vaccines, but the onus does remain on individuals to make those decisions as well,” he said.