A new cluster of smallpox cases in the United States – after nearly seven months of steady decline – is leading health officials to warn of a possible new outbreak this summer.

Chicago health officials recently reported 20 new cases and are urging people to get vaccinated.

Major cities such as Los Angeles, San Francisco and New York are ramping up public awareness campaigns and vaccination programs, especially targeting men who have sex with men and transgender people.

They warn that cases of smallpox, formerly called monkeypox, could easily spread as LGBTQ summer pride parades kick off.

“Spring and summer in 2023 could see a resurgence of smallpox as people gather for festivals and other events,” the Centers for Disease Control and Prevention said in a statement. health alert on Monday.

The CDC has warned that without additional vaccinations and other measures to control the virus, a resurgence could be “as large or even larger than in 2022.”

While anyone can contract Mpoxoma, the virus has hitherto largely affected gay and bisexual men in the US. It is not a sexually transmitted virus, but close physical contact is the main mode of infection.

On May 11, the World Health Organization declared a global health emergency related to mpox, a year after the virus spread beyond endemic regions.

The decrease in incidence over the past year has led to a sharp drop in vaccinations. In Los Angeles County, for example, the number of weekly shots has dropped from 8,000 last year to about 100 to 150 in recent months, officials said.

But Biden administration officials said on Tuesday they were not letting their guard down, especially amid a recent spike in cases in some places.

“Definitely, what we see in Chicago is a reminder that … we are not from the forest. We have a vaccination mission that is not yet completed,” the doctor said. Demetre Daskalakis, Deputy Coordinator of the National Smallpox Response at the White House.

Among other things, his office is moving fast to ensure local health departments have the resources to deal with new cases.

“We are in a place where we would expect to see clusters, but we have our mission to vaccinate people so we can prevent them,” he told The Times.

The current Mpox outbreak is the largest and most geographically widespread since the discovery of the virus in 1958.

Last year, more than 87,000 global cases were reported to the WHO in 111 countries, with 140 deaths reported to the WHO.

The United States has recorded nearly 31,000 cases and 42 deaths in the past year. The current outbreak in the US was first reported in Boston. According to the latest CDC data available, California leads the way with 5,759 cases.

Despite fears of a recovery, the sharp decline in cases – from 600 cases nationwide as of August 1, 2022 to an average of one per week in April – represents something of a success story in suppressing the virus, at least for now.

It also offers lessons for future outbreaks.

Some health experts commend President Biden for aggressive action to address the mox-related health crisis.

Days after the Boston case was confirmed, Biden said the virus is “something everyone should be worried about.”

On the same day, his Ministry of Health and Human Services awarded a contract to a Danish vaccine manufacturer. He has assembled a respected team of coordinators to spearhead the response and has previously reversed President Trump’s decision to pull the United States out of the WHO.

However, the current smallpox outbreak is much larger and wider than previous ones. Previous outbreaks were limited to a few cases that could be traced back to recent travelers to smallpox endemic regions of Africa and were quickly contained.

The current outbreak has resulted in widespread community transmission of the virus and has been found in all 50 states, the District of Columbia and Puerto Rico.

Depleted by the ongoing COVID-19 pandemic, health systems initially struggled to deal with mpox.

Initially, smallpox testing was limited to selective labs and healthcare professionals who had to wade through bureaucracy to order and prescribe Tpoxx, an experimental drug used to treat the virus.

“There were a lot of paperwork you had to fill out in the outdated public health system where you had to go through your local health department, the CDC, to get clearance,” the doctor said. Peter Chin-Hong, professor of medicine and infectious disease specialist at the University of California, San Francisco.

According to Daskalakis, the standard time for filling out a Tpoxx form took doctors two hours before attempts were made to reduce that time to 15 minutes.

Then there were quarrels with a Danish vaccine manufacturer. When some vaccines were available, local health officials struggled to control the distribution, with websites that often crashed when concerned men and transgender people sought to meet.

Some of the delays were as officials debated how best to communicate with the LGBTQ community and what advice to give regarding sexual behavior.

“It was very difficult given the fact that people wanted to be as sexually positive as possible,” Chin-Hong said. “There was a lot of hesitation because you didn’t want to appear as a disgrace to people.”

These early problems may have helped the virus take hold across the country.

“The concern is that the delay has allowed the virus to gain a foothold in the United States,” the doctor said. Bruce I. Lee Professor of Health Policy Management at the City University of New York School of Public Health. “And if that’s the case, then we will continue to pay for not responding faster and more effectively for many more years to come.”

One of the things that helped in the fight against mpox was the LGBTQ community itself.

This community has already survived the HIV/AIDS epidemic, which has claimed the lives of many people. He also saw how public health interventions and scientific breakthroughs, especially in pharmaceutical developments, can not only allow people living with HIV to live long and fulfilling lives, but also prevent new infections through PrEP and PEP.

So when a new virus threatened this community, public health enforcement was strict and—unlike COVID-19—resistance to vaccinations was negligible.

“I can’t imagine anyone who doesn’t want that. In fact, it was the other way around; it has become a highly sought-after commodity,” Chin-Hong said, referring to the vaccine. “The legacy of HIV, I think, has had a lot to do with how the community has come together not only to embrace interventions like vaccines or seek help, but also to activism,” he added.

A survey conducted by researchers at Emory University found that in addition to getting vaccinated, many gay men also changed their sexual behavior in response to the smallpox outbreak. It found that 48% of respondents reduced the number of their sexual partners, and 50% of respondents reduced the amount of sex they had with partners found on dating apps like Grindr and at sex parties.

This change in behavior “I think surprised even people who know the community well, like me,” Chin-Hong said, and contributed to the decline.

However, there is still a lot of work to be done. The CDC estimates that only 23% of people at risk received the vaccine. Perhaps this is a symptom of pandemic fatigue after many unsuccessful attempts to get a vaccine, coupled with a perceived decrease in risk as the number of cases decreases.

The administration hopes that trusted community voices such as Daskalakis, who is gay, will get the message across. smallpox vaccination along with other sexual health methods. “I would tell people it’s very good to be proactive in planning for the summer… checking oil and kicking tires as pride season approaches.”

The final lesson, according to experts, is the importance of global work to identify and fight deadly viruses.

Unlike COVID-19, mpox was nothing new. For decades, countries in West and Central Africa have struggled with small outbreaks.

Experts say that if richer countries like the US did more to share existing treatments and vaccines with these African countries, they could prevent the global spread of a smallpox pandemic.

“While something is a threat in one part of the world, it can very easily spread to other parts,” Li said. “If more efforts are made to fight infectious diseases in countries with fewer resources, it will actually protect the US.”