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As Chicago monkeypox cases drop, experts still ask for vigilance

The quick summer spread of the once rare monkeypox virus jolted Chicago health officials and community leaders into action. Fortunately, the illness’s case counts that rose fast have now fallen fast.

But even as the city’s weekly positive cases drop to numbers not seen since June, the officials responding to monkeypox agree: The virus’s spread isn’t over yet.

“We have to maintain vigilance,” said Dr. Sharon Welbel, Cook County Health’s director of hospital epidemiology and infection control and prevention.

The Chicago Public Health Department reported just 23 cases last week, down from a peak of 142 cases in the last week of July. Chicago’s encouraging numbers match national trends, Welbel said.

She credits the drop-off to the now-wide availability of an effective vaccine. Unvaccinated at-risk people are 14 times more likely to contract the virus than vaccinated people, according to a recent report shared by the CDC.

Behavioral changes among men who have sex with men — who continue to make up most of the local and national cases — have been another essential positive force, she said.

“The strength really comes from within,” she said.

But Welbel’s calendar still remains full of monkeypox-related calls. Even as numbers go down, she said, “the fight isn’t over.”

The decline in cases is a testament to people becoming more careful in their sexual behavior, said Massimo Pacilli, CDPH’s deputy commissioner of disease control. The virus spreads through close physical contact, and while it isn’t just transmitted through sex, sexual transmission has played an important role in its spread, he said.

An increase in vaccine stock has been another important factor in fighting monkeypox, also referred to as MPV.

“Having more vaccine and giving it where it could do the most good early was critical,” Pacilli said.

And yet, despite the encouragement, he thinks that the opportunity to “really control the outbreak” with the new lower transmission levels could be lost without more action.

“I do worry that as cases may be decreasing, there might be this false sense of being overly reassured,” Pacilli said. “I think MPV is really in our communities for some time to come.”

A priority now is vaccinating Black and Latino at-risk men, Pacilli said. The two groups make up a disproportionately high share of monkeypox cases and a disproportionately low share of vaccinations.

Black people make up 28% of cases, but only 13% of those who have gotten their first dose of the vaccine, CDPH data shows. Latino people account for 30% of cases, and only 18% of vaccinations.

The city continues to partner with community-based organizations to do vaccination and education work targeted toward Black and Latino people, Pacilli said.

The drops in case counts aren’t the complete story, said Christopher Balthazar, executive director of TaskForce Prevention and Community Services. The organization works with LGBTQ youth of color and has gotten more than 1,000 people their first doses, he said.

“There are still a lot of folks in our community who are not vaccinated, and they are vulnerable,” Balthazar said.

TaskForce has hosted weekly vaccination clinics throughout the virus’s spread, supported in part by the CDPH. Collaboration with the city, state and local hospitals has been a “tremendous success,” Balthazar said.

However, funding TaskForce’s monkeypox education and vaccination work remains a challenge, he added. The grants that pay for much of the organization’s projects have limited scopes that don’t allow use for monkeypox-focused efforts, so the response to the urgent, spreading virus has gone largely unfunded.

The vaccine was once scarce and offered in extremely limited availability. Access dramatically expanded as federal and local authorities secured more doses and launched a new injection method that allowed for five times as many shots to be given per vial.

As official guidance changed, fighting misinformation and confusion among already skeptical communities took hard work, Balthazar said. Funding is slowly becoming available now, but it’s been the biggest barrier so far.

“It slows down the response and the force of the response,” he said.

The Puerto Rican Cultural Center is hosting clinics that offer the monkeypox shot among a host of other vaccinations. The effort allows for people who might otherwise face hatred for being gay a discrete way to get protection from the virus, said public health initiatives director Ricardo Jiménez.

“When you go in there, nobody knows what you’re going to get,” Jiménez said.

The Cultural Center’s clinics are set up in busy areas in different communities. Organizers play music outside to bring in people and pass out information.

“That normalizes things. They say, ‘Oh yeah, that’s the vaccine.’ They get used to it,” he said.

Nearly 80 people got vaccinated at one mid-August clinic, Jiménez said. Numbers at the clinics have dropped, but efforts to reach out to the still disproportionately infected Latino community must continue, he added.

“I don’t think this is over,” Jiménez said. “I don’t think we’re stabilized yet when you still have a certain population outnumber the others.”

He continues to meet with CDPH health officials and talks about monkeypox every Friday.

Eradicating monkeypox would require mass vaccination, said Dr. Daniel Berger, medical director at Northstar Healthcare Medical Center. That means vaccinating more Black and Latino people and those who have spurned the vaccine.

Berger’s LGBT-focused clinic receives patients from across Chicago because the clinic offers TPOXX, an antiviral being experimentally used to treat severe monkeypox cases. In recent weeks, the number of monkeypox patients coming in has waned.

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“There are a little bit of outcroppings, sprinkles,” he said.

Berger credits the drop in cases to messaging that prompted initially slow to react health authorities to act faster. He hopes the new numbers mean the virus “will be over soon.”

That remains the focus of many fighting monkeypox, Cook County’s Welbel said.

“We need to reach out to people who we know are being disproportionately affected by this,” she said.

“The goal, of course, is to eradicate the outbreak.”

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