The Biden administration declared monkeypox a public health emergency on Thursday as cases topped 6,600 nationwide.
The declaration could facilitate access to emergency funds, allow health agencies to collect more data about cases and vaccinations, accelerate vaccine distribution and make it easier for doctors to prescribe treatment.
"We’re prepared to take our response to the next level in addressing this virus and we urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus," Department of Health and Human Services Secretary Xavier Becerra said in a Thursday briefing about the emergency declaration.
A quarter of U.S. cases are in New York state, which declared a state of emergency last week. California and Illinois followed suit with emergency declarations Monday.
The World Health Organization declared monkeypox a public health emergency of international concern last month, a designation reserved for the most serious global disease outbreaks. It has previously been used for Covid-19, Zika, H1N1 flu, polio and Ebola. At least 26,200 monkeypox cases have been confirmed worldwide this year, according to the Centers for Disease Control and Prevention.
Monkeypox is spreading predominantly through male-to-male sexual contact, which was not the case in previous outbreaks of the virus. All but 1% of U.S. monkeypox cases so far are people who were assigned male at birth, the Department of Health and Human Services said last week.
The WHO recently advised men who have sex with men to reduce their number of sexual partners and reconsider sex with new partners while the outbreak is ongoing.
The average U.S. monkeypox patient is around 35 years old, but people of all ages can be infected. The CDC has recorded five cases in children: two in California, two in Indiana and an infant who is not a U.S. resident who tested positive in Washington, D.C.
The California and Indiana health departments declined to provide details about their pediatric cases, but Jennifer Rice Epstein, the public affairs officer at the Long Beach Department of Health and Human Services, said the patient in her city was exposed via a close contact.
As of last week, white people represented 37% of U.S. monkeypox cases, followed by Hispanic or Latino people (31%), Black people (27%) and Asian people (4%), according to HHS.
U.S. officials still think the outbreak can be contained
HHS officials still hope to prevent monkeypox from becoming endemic in the U.S.
"We continue to marshal forward the tools that we need to make sure that we can take on monkeypox and keep it from spreading to the point of becoming endemic," Becerra said Thursday.
"There should be no reason why we can’t stay ahead of this if we all work together," he added.
That work relies primarily on testing, targeted vaccinations and treatment.
As of Thursday, the U.S. had distributed 600,000 of the 1.1 million available doses of the Jynneos vaccine, which is administered as a two-shot regimen. In total, the country has ordered 6.9 million doses. HHS said a shipment of 150,000 doses will arrive in the U.S. in September to then be distributed.
The shot can prevent monkeypox if given before or within four days of exposure. If given within 14 days after exposure, it can ease symptoms.
U.S. testing capacity has also increased, from 6,000 weekly tests in May to 80,000 now.
"Right now we’re really only testing at about 10% of the capacity we have. We are encouraging anyone who has a rash that could be monkeypox to present for testing," CDC Director Rochelle Walensky said Thursday.
Around 14,000 people in the U.S. have received TPOXX, an antiviral drug that is authorized for use against smallpox but can also be used to treat monkeypox. The Strategic National Stockpile contains 1.7 million of the treatments, HHS said. But the drug’s use is for now limited to people with severe disease or a high risk of becoming severely ill. Physicians must also complete extensive paperwork to prescribe it for monkeypox.
Expanded access to TPOXX was among the many reasons that sexual health providers called on HHS to declare a public health emergency.
“It’s unconscionable not to further make changes to make TPOXX accessible to all that need it,” David Harvey, executive director of the National Coalition of STD Directors, said Tuesday on a news call.
Most U.S. monkeypox patients have reported a rash
The most common monkeypox symptoms include a rash — reported in 99% of U.S. cases so far — malaise, fever and swollen lymph nodes. Some patients have also reported chills, headache and muscle pain.
Some people with monkeypox develop just one or two lesions in their rash, while others can develop several thousand, according to the WHO.
A study published last month, which examined monkeypox cases in 16 countries from April to June, found that nearly 65% of people had fewer than 10 lesions. The lesions were most commonly found in the anus or genital area, followed by the torso, arms or legs. A smaller number of people saw lesions on their face, palms or soles of the feet.
Symptoms usually appeared within a week of exposure, the study found. Around 13% of people studied were hospitalized, mostly for pain management.