Update: May 23, 2023 – This blog has been updated to reflect the latest data for Jynneos vaccine effectiveness.

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It’s been almost a year since Oregon reported its first case of mpox. That number has since risen to 279, including two pediatric cases (under age 18). But new cases have been trickling in slowly, and the initial fears shared by health experts about potential spread and illness have shifted to cautious optimism.

“We feel pretty good about the progress we made over the past year in terms of preparedness,” said Dr. Tim Menza, OHA senior health advisor and OHA’s Office of Recovery and Resilience. “Due to the work of the queer and transgender community, local public health partners and health care providers throughout Oregon, the mpox outbreak has been relatively contained in Oregon. We now have the necessary tools to prevent a resurgence.”

Those tools include an ample supply of mpox vaccines, which wasn’t the case a year ago.

“At this point, we encourage anyone who wants to be vaccinated against mpox to get vaccinated,” Menza said. “We also have better access to testing and treatment, stronger community partnerships for outreach, education and vaccine events, as well as very good data on mpox cases to guide Oregon’s outbreak response.”

Mpox causes often painful skin lesions that usually heal in two to four weeks without medical treatment, and it spreads primarily through prolonged and close skin-to-skin contact. While mpox most often spreads during sexual contact, sex is not required for mpox to spread. Out of more than 30,000 cases in the United States since the outbreak began, 42 people have died. The majority of deaths have occurred among people living with advanced or untreated HIV or other immunocompromising conditions. In Oregon, five people have been hospitalized with mpox to date, and none has died.

The state of the mpox outbreak

Globally, the World Health Organization has just declared the mpox outbreak no longer a global health emergency, recommending a shift to a “robust, proactive and sustainable mpox response and control program,” versus the emergency status.

In the U.S., the Centers for Disease Control and Prevention (CDC) has not declared the mpox outbreak over, but things have slowed down dramatically.

Here in Oregon, the rate of new mpox cases peaked in August 2022 at about 10 per week. Now, the state has diagnosed five new cases in the past three months. The question is: do these sporadic new cases represent on-going, steady, low-level virus transmission that’s here to stay, or do they signal a possible future end to all mpox transmission?

Unfortunately, we’re not yet able to answer that question.

Menza is paying close attention to mpox resurgences happening in other places, specifically new clusters of cases in Chicago, France and South Korea.

“Those outbreaks raise our level of concern,” Menza said. “Moving toward summer travel and Pride events across Oregon and the U.S. over the next several months, we could see a similar situation with increased cases in Oregon.”

If you’re planning to travel this summer, especially to places reporting recent clusters of new cases, Menza advises the best way to protect yourself and prevent a resurgence back home in Oregon is to get vaccinated. The Center for Infectious Disease Research and Policy at University of Minnesota offers comprehensive reporting on mpox globally, including case surges.

Vaccine guidelines and effectiveness

The Jynneos vaccine against mpox is available to anyone who wants it, of any age, for free. It is administered in two doses, received at least 28 days apart. If someone received only one dose a year ago, for example, they can still get the second dose now, without restarting the series.

It will take about two weeks after receiving the second dose to reach maximum protection.

People start making antibodies two weeks after receiving the first dose, which will provide up to 75% effectiveness at preventing mpox infection. The second dose will give someone maximum protection of 86% effectiveness.

The vaccine’s protection should last years, though we don’t yet know how many years. However, if someone was vaccinated against smallpox as a child (using the same or similar vaccine), they are not protected today against mpox.

“People who have received two doses should feel pretty confident in their protection,” Menza said. “No vaccine is perfect, however, so breakthrough cases are possible. If you have a spot that’s concerning, you should see a physician and get tested for mpox.”

Only about 25% of Oregonians who could benefit from the vaccine have been fully vaccinated with both doses of Jynneos, which concerns public health experts, considering the new mpox clusters appearing elsewhere.

Jynneos should also be part of routine, comprehensive sexual health care.

“In addition to getting vaccinated against mpox, now is also a great time to do a health check, testing for HIV, gonorrhea, chlamydia and syphilis, and talking to your doctor about medications to prevent HIV infection (HIV pre-exposure prophylaxis, or PrEP) and sexually transmitted infections such as gonorrhea, chlamydia, and syphilis (doxycycline post-exposure prophylaxis, or doxy PEP),” Menza said.

Vaccine side effects

Earlier during the current outbreak, mpox vaccines were administered intradermally (barely below the skin’s surface, like a tuberculosis test), which allowed providers to give a smaller dose, thereby stretching the limited supply. This method caused uncomfortable side effects that could last for weeks, such as injection site redness, swelling and pain. For some, it also left small scars.

“I still have mine,” Menza said. “I have two little permanent scars on my forearm.”

But now that Oregon has a robust supply of Jynneos vaccine, providers are administering it subcutaneously, into back of the arm in between the skin and muscle. The dose is larger and just as safe and effective as the smaller dose, it leaves no scarring, and injection site discomfort is usually mild and short-lived.

How to find the vaccine

Ask your primary care provider about getting the Jynneos vaccine. If you don’t have a health care provider, contact your local public health department, which will either have the vaccine or can connect you with a provider who does.

You can also use the CDC mpox vaccine locator tool (below) to look for mpox vaccination opportunities in your area.

The Jynneos vaccine is not available at pharmacies at this time.

OHA is also partnering with community-based organizations and local public health departments to hold vaccination clinics across the state over the next several weeks, which will be free and open to all. Check out OHA’s mpox webpage for details on upcoming vaccination clinics. The page is updated regularly as new events get added to the schedule.

“Pride should really be about celebrating, rather than fear of mpox,” Menza said. “The way to do that is to get vaccinated and tell your friends to get vaccinated.”