The San Diego County Board of Supervisors unanimously ratified a local health state of emergency on Aug. 9, in response to the monkeypox outbreak in an attempt to bolster vaccination efforts.

The ratification follows a state declaration and will need to be ratified again every 30 days, as needed. The state of emergency declaration will allow the county to seek state assistance and use public health infrastructure for testing, contact tracing and case investigation. However, many argued in opposition to the declaration, with arguments sometimes delving into conspiracy theories and homophobia.

As of Aug. 10, of the 134 total cases reported throughout the county, all were male and majority self-identified as gay or bisexual. (Source: https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/human-monkeypox/). There have been two hospitalizations and no deaths. While monkeypox has been spreading locally among the LGBTQ+ community, it is not isolated to that subgroup, according to health officials. Currently, the risk of contracting monkeypox for the public remains very low.

“At this time, monkeypox outbreaks are disproportionately impacting our LGBTQ community, but we know it can spread to others,” San Diego County Supervisor Nathan Fletcher said. “And it is vitally important that we not stigmatize any individual, that we not stigmatize any community, that we not cast any aspersions.” Also adding, “This is not a sexually transmitted disease that transmits itself in the gay community. It’s not. That’s just where it began spreading.”

The first case in the county was reported on June 15. The virus has infected people ranging in ages from 21 to 62.

Local leaders have said that the monkeypox virus is much different than COVID-19.

“The situation we face with monkeypox is fundamentally very different,” Supervisor Fletcher said. “We take it very seriously, but as I mentioned, it is exponentially less transmissible. We know more about it. We also have a vaccine at the start of it.”

Monkeypox is generally spread through intimate skin-to-skin contact, resulting from infectious rashes and scabs, though respiratory secretions and bodily fluids exchanged during extended physical episodes, such as sexual intercourse, can also lead to transmission, according to the U.S. Centers for Disease Control and Prevention. But people can also catch the virus through close physical contact in general, such as hugging and kissing, as well as through contaminated materials such as towels or bedsheets. Symptoms include fresh pimples, blisters, rashes, fever and fatigue. There is no specific treatment. People who have been infected with smallpox, or have been vaccinated for it, may have immunity to monkeypox.

Monkeypox is rarely fatal, and no deaths have been reported in the U.S. so far. But the virus causes lesions that can be very painful. Some patients need hospitalization to manage the pain. Infections and exposures among children are still relatively rare, and public health authorities want to make sure the vaccine is available to kids if they are exposed to the virus. According to health officials, the vaccine can prevent infection if given before or shortly after exposure to the virus.

Since late May, the county has received a little over 5,000 doses of monkeypox vaccine (The number of doses received was allocated from the California Department of Public Health (CDPH) to respond to the current monkeypox outbreak.

These doses are then distributed to public and community/hospital vaccination sites to administer). The county has requested over 26,000 doses. To date, over 2,300 vaccines have been administered. The actual number might be higher because it takes a few days for the vaccine registry to be updated. Health and Human Services has made more than 1 million doses available to state and local health departments since May. More than 620,000 doses have been shipped to jurisdictions so far, according to HHS.

The monkeypox vaccine is a two-dose series, administered 28 days apart. Following guidance from the California Department of Public Health, given the low supply of vaccine, the county is presently recommending that first doses be administered to as many eligible people as possible. One dose of the monkeypox vaccine is 80% effective, the county Health and Human Services Agency said. Second doses will be administered when more vaccines are available.

“Our goal is to get one dose into as many people’s eligible arms as possible,” said Dr. Wilma Wooten, county public health officer. “When we get more vaccines, we can start giving second doses for even higher efficacy.”

The Food and Drug Administration expanded its authorization for the monkeypox vaccine on Aug. 9 in a way that would significantly boost the limited supply of shots.

The FDA is also now allowing children to receive the vaccine if they are at high risk of monkeypox infection. Dr. Peter Marks, head of the FDA’s vaccine division, said there has been an increase in possible exposures among children over the past week. Health-care providers can now administer the shots to adults through intradermal injection, or between the layers of the skin. This will increase the supply of doses by as much as fivefold, according to the FDA. The vaccine is traditionally administered through subcutaneous injection, which goes into the fat layer beneath the skin.

The intradermal injections for adults use a lower volume dosage that will allow 400,000 vials in the strategic national stockpile to provide up to 2 million shots, according to Robert Fenton, the White House monkeypox response coordinator.

Children will receive the vaccine through the typical subcutaneous injection. Marks said there isn’t enough data to allow intradermal injections for kids and this method is also difficult to administer to very young children. Jynneos is the only FDA-approved monkeypox vaccine in the U.S. The shots are administered in two doses 28 days apart. Jynneos is manufactured by Bavarian Nordic, a biotech company based in Denmark. Demand for the shots has outstripped available supply as the monkeypox outbreak grows. People have struggled to get appointments and there have been long lines outside clinics around the country.

San Diego County residents can receive information about monkeypox via text. Health officials are sending real-time information about the impact of monkeypox in the region along with details about available services. People can sign up to receive messages by texting COSD MONKEYPOX to 468-311.