CDC expects monkeypox outbreak to grow as total cases surpass 1,400 and vaccine demand outstrips supply

The Centers for Disease Control and Prevention has confirmed more than 1,400 monkeypox infections across 44 states and territories in the U.S. and said it expects the outbreak to grow.

CDC Director Dr. Rochelle Walensky said the demand for monkeypox vaccines is outstripping the available supply, which has led to long lines in places such as New York City — an epicenter of the outbreak.

"We know that this is frustrating," Walensky said in a call with reporters Friday. The Health and Human Services Department is working to increase supply, she added.

Walensky said the agency expects cases to increase through July and August since symptoms of the virus usually start within three weeks of exposure. People who don't yet know they're infected will likely seek medical attention and get tested in the coming weeks.

The U.S. now has the capacity to conduct 70,000 tests per week after recruiting several commercial labs including Quest Diagnostics and Labcorp, Walensky said. The labs test for orthopox, the family of viruses that includes monkeypox. People who test positive for orthopox are assumed to have monkeypox infections, according to CDC official Dr. Jennifer McQuiston.

The tests involve a swab of the painful lesions that are characteristic of the disease, but it can take weeks from the time of exposure for those to develop. Walensky said there are no approved tests that can confirm orthopox another way.

The outbreak right now is primarily impacting gay, bisexual and other men who have sex with men. Of the 700 patients who provided demographic information, the vast majority identified as men who have sex with men, according to Walensky.

More than 11,000 cases of monkeypox have been confirmed worldwide across 55 countries, according to the CDC.

The U.S. has shipped out all doses of the monkeypox vaccine that states have ordered so far, 156,000 shots in total, with the vast majority them delivered in the past week, according to HHS. The federal government made an additional 131,000 doses available to local authorities on Friday, bringing the total supply made available since May to more than 300,000 shots.

The CDC vaccination campaign relies on the two-dose vaccine Jynneos, which was approved by the Food and Drug Administration in 2019 for adults ages 18 and older who are at high risk of monkeypox or smallpox infection.

The U.S. is also working with the Danish manufacturer, Bavarian Nordic, to accept delivery of another 786,000 Jynneos doses currently stored in Denmark. HHS will preposition those doses in the U.S., and they will become available for distribution once the FDA signs off on the company's facility. That approval is expected by the end of the month, according to Dawn O'Connell, the HHS official who leads the office that oversees the U.S. strategic national stockpile.

HHS has ordered 2.5 million more doses of the Jynneos vaccine from Bavarian Nordic that will ship to the U.S. strategic national stockpile over the next year. The U.S. placed an order for an additional 2.5 million doses on Friday, which will ship to the national stockpile in 2023. In total, the U.S. should have nearly 7 million Jynneos doses by mid-2023, according to HHS.

Local health authorities can also request the older generation smallpox vaccine ACAM2000 that is likely effective against the monkeypox virus, but the vaccine can have serious side effects and is not recommended for people with weak immune systems such as those who have HIV, individuals with some skin conditions and women who are pregnant. The U.S has more than 100 million doses of ACAM2000.

CDC recommends that people get vaccinated if they have had known or suspected monkeypox exposures in the past two weeks. Federal health authorities are prioritizing vaccine distribution to places with a growing number of infections but are also offering the shots to all jurisdictions with people who are at increased risk of monkeypox infection, Walensky said.

"It's critically important for states and jurisdictions to quickly and accurately report all of their cases through CDC recommended reporting," Walensky said.

The Jynneos vaccine is administered in two doses 28 days apart. Walensky emphasized that a single dose does not provide sufficient protection against the virus and that it takes two weeks for the second shot to provide full protection.

Monkeypox is primarily spreading through skin-on-skin contact, close face-to-face interactions such as kissing and contaminated materials such as sheets and towels, according to the CDC.

In the past, the disease typically began with flulike symptoms and then progressed to a rash that can spread across the body. But the current outbreak has produced symptoms that are atypical, with some people developing a rash first or without any flulike symptoms at all. Many people have developed a rash, which can look like pimples or blisters, on intimate areas such as the genitals or anus.

Walensky said the CDC recommends that people avoid intimate physical contact with individuals who have a rash that looks like monkeypox, and consider minimizing sex with multiple or anonymous partners. People should also consider avoiding sex parties or other events where people aren't wearing a lot of clothing. Individuals who do decide to have sex with a partner who has monkeypox should follow CDC guidance on lowering their risk, Walensky said.