As monkeypox cases grow, King County scrambles to distribute limited vaccine doses

The number of confirmed monkeypox cases in King County is doubling every week — in part because of increased spread of the virus, and in part because of increased testing and detection of cases. To date, there have been 91 monkeypox cases in King County, and 103 statewide.

“This is a significant epidemic, and monkeypox is a serious infection,” said Dr. Matthew Golden, the director of King County’s HIV/STD program and of the county’s sexual health clinic at Harborview. Golden is helping lead King County’s response to the monkeypox outbreak. “But monkeypox isn’t Covid, and it isn’t HIV. I don’t think we think it’s going to have the scale of a Covid epidemic. It’s not easily transmitted through airborne transmission.”

And, he added, it’s not usually fatal, even if untreated. It also does not lead to a chronic infectious disease the way HIV does.

King County is working to distribute vaccines to the most at-risk residents. But the county only has 4,720 doses so far, just 6% of the 80,000 doses Golden estimates are needed to vaccinate all who are most vulnerable. For now, the county's offering the vaccine to people who have recently been exposed to the virus, and some men who have sex with men.

“Other outbreaks have not been concentrated among men who have sex with men, so it’s not like there’s something specific about that population which means that gay men are getting monkeypox and other people cannot,” Golden said. “This is just the characteristics of the current outbreak.”

Anyone can contract monkeypox. But all 91 confirmed cases in King County have been among men who have sex with men. The World Health Organization reports that, globally, most of the cases in the current outbreak have been in urban areas, among men who have sex with men, and they’ve been clustered in social networks.

The available vaccine is a smallpox vaccine, which is thought to be about 85% effective against monkeypox. Recipients need two doses administered about 28 days apart.

The vaccines the county currently has on hand will be available at the sexual health clinic at Harborview, some other clinics, and community vaccine events that the county plans to have up and running by August 8. An agency spokesperson said the most up-to-date information on where to get vaccines will be on the agency’s website.

Because King County has so few doses, its strategy is to start by giving eligible people one dose, and the county hopes to give out second doses when they arrive, as close to the four-week window as possible.

Golden said it’s likely that people have some immunity two weeks after the first dose, and that immunity from the vaccine or from infection is long-lasting.

In the absence of adequate vaccines, Golden said, “Public Health recommends that people at higher risk for infection consider decreasing their number of sex partners and close intimate partners in the short- to mid-term.”

“We’re not asking people to change their lives forever,” he said. “In the end of the day, we all make our own decisions about risk — what risks we’re willing to take. And we’re here to help you make informed decisions.”

Monkeypox symptoms include rashes or sores, flu-like illness such as a fever, and sometimes enlarged lymph nodes or a sore throat.

“No one wants to have this infection,” Golden said. “The lesions are painful. They can persist for a significant period of time. Some people will be sick for up to four weeks.”

That said, he added, “It is not typically a fatal infection. The overwhelming majority of people are going to get better from this.”

The county has some antiviral drugs available, Golden said, so anyone diagnosed with monkeypox should discuss those with their doctor.