NEW ORLEANS (AP) — The mpox health emergency has ended, but U.S. health officials are aiming to prevent a repeat of last year’s outbreaks.

Mpox infections exploded early in the summer of 2022 in the wake of Pride gatherings. More than 30,000 U.S. cases were reported last year, most of them spread during sexual contact between gay and bisexual men. About 40 people died.

With Pride events planned across the country in the coming weeks, health officials and event organizers say they are optimistic that this year infections will be fewer and less severe. A bigger supply of vaccine, more people with immunity and readier access to a drug to treat mpox are among the reasons.

But they also worry that people may think of mpox as last year’s problem.

“Out of sight, out of mind,” said Dr. Demetre Daskalakis, who is advising the White House on its mpox response. “But we are beating the drum.”

Last week, the Centers for Disease Control and Prevention issued a health alert to U.S. doctors to watch for new cases. On Thursday, the agency published a modeling study that estimated the likelihood of mpox resurgence in 50 counties that have been the focus of a government campaign to control sexually transmitted diseases.

The study concluded that 10 of the counties had a 50% chance or higher of mpox outbreaks this year. The calculation was based largely on how many people were considered at high risk for infection and what fraction of them had some immunity through vaccination or previous infection.

At the top of the list are Jacksonville, Florida; Memphis, Tennessee; and Cincinnati — cities where 10% or fewer of the people at highest risk were estimated to have immunity. Another 25 counties have low or medium immunity levels that put then at a higher risk for outbreaks.

The study had a range of limitations, including that scientists don’t know how long immunity from vaccination or prior infections lasts.

So why do the study? To warn people, said Dr. Chris Braden, who heads the CDC’s mpox response.

“This is something that is important for jurisdictions to promote prevention of mpox, and for the population to take note — and take care of themselves. That’s why we’re doing this,” he said.

Officials are trying to bring a sense of urgency to a health threat that was seen as a burgeoning crisis last summer but faded away by the end of the year.

Formerly known as monkeypox, mpox is caused by a virus in the same family as the one that causes smallpox. It is endemic in parts of Africa, where people have been infected through bites from rodents or small animals, but was not known to spread easily among people.

Cases began emerging in Europe and the U.S. about a year ago, mostly among men who have sex with men, and escalated in dozens of countries in June and July. The infections were rarely fatal, but many people suffered painful skin lesions for weeks.

Countries scrambled to find a vaccine or other countermeasures. In late July, the World Health Organization declared a health emergency. The U.S. followed with its own in early August.

But then cases began to fall, from an average of nearly 500 a day in August to fewer than 10 by late December. Experts attributed the decline to several factors, including government measures to overcome a vaccine shortage and efforts in the gay and bisexual community to spread warnings and limit sexual encounters.

The U.S. emergency ended in late January, and the WHO ended its declaration earlier this month.

Indeed, there is a lower sense of urgency about mpox than last year, said Dan Dimant, a spokesman for NYC Pride. The organization anticipates fewer messages about the threat at its events next month, though plans could change if the situation worsens.

There were long lines to get shots during the height of the crisis last year, but demand faded as cases declined. The government estimates that 1.7 million people — mostly men who have sex with men — are at high risk for mpox infection, but only about 400,000 have gotten the recommended two doses of the vaccine.

“We’re definitely not where we need to be,” Daskalakis said, during an interview last week at an STD conference in New Orleans.

Some see possible storm clouds on the horizon.

Cases emerged this year in some European countries and South Korea. On Thursday, U.K. officials said an uptick in mpox cases in London in the last month showed that the virus was not going away.

Nearly 30 people, many of them fully vaccinated, were infected in a recent Chicago outbreak. (As with COVID-19 and flu shot, vaccinated people can still get mpox, but they likely will have milder symptoms, officials say.)

Dr. Joseph Cherabie, associate medical director of the St. Louis County Sexual Health Clinic, said people from the area travel to Chicago for events, so outbreaks there can have ripple effects elsewhere.

“We are several weeks behind Chicago. Chicago is usually our bellwether,” Cherabie said.

Chicago health officials are taking steps to prevent further spread at an “International Mr. Leather” gathering this weekend.

Event organizers are prominently advising attendees to get vaccinated. Chicago health officials put together social media messages, including one depicting three candles and a leather paddle that reads: “Before you play with leather or wax get yourself the mpox vax.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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By Amber Dance

Is COVID surging in the U.S.? Would we even know?

Case counts are rising in the Northeastern U.S., writes German Lopez at The New York Times, but it’s hard to say whether it’s the start of a surge.

“It might be a ripple relative to previous waves,” Harvard epidemiologist William Hanage told Lopez.

A new wave would “wreak unequal havoc,” write a trio of experts in an opinion essay at MedPage Today. A second omicron wave would be extra damaging for the same groups hit hardest by the recent winter surge: Black Americans, young children not yet eligible for vaccination, un-boosted older individuals, immunocompromised people, and members of poor and rural communities where access to antiviral COVID drugs such as Paxlovid is limited.

“We worry that the ‘new normal’ will be plentiful boosters and rapid, easy access to antivirals for the well-off, while the least-off are left behind,” write the authors.

Any spring surge would also be the first real-world test of new safety guidelines the CDC adopted in February, which put more emphasis on preventing severe illness and death rather than infections overall, writes Keren Landman at Vox.

Case counts are becoming increasingly unreliable. More people are using at-home antigen tests that go unreported. At the same time, fewer tests are being performed because health care providers can no longer be reimbursed to test uninsured patients, and many people may be asymptomatic during infection, writes University of Texas epidemiologist Katelyn Jetelina on her blog.

By one estimate, only about 7% of COVID cases are captured in official numbers.

“The country could be in the midst of a surge right now and we might not even know it,” writes Madison Muller at Bloomberg.

Thus far, hospitalization rates remain low, and the CDC’s map still puts most U.S. counties in the green. The fraction of COVID tests coming back positive can also hint at trends.

And one of the best tools is in the sewer, write Lena H. Sun and Dan Keating at The Washington Post. The CDC’s network now monitors wastewater from sites covering nearly one-third of the U.S. population. Virus levels remain low but are increasing in about two-thirds of those sites.

Biden extends federal emergency declaration

The coronavirus pandemic, which has now killed nearly 1 million people in the U.S. and made 2021 the deadliest year in the nation’s history, is still considered a public health emergency, at least until July. Last Wednesday, the Biden administration added another 90 days to the emergency declaration, which has already spanned more than two years.

The move gives states and other agencies more time to prepare off-ramps to normal operations.

It also continues enhancements to healthcare for people on Medicaid and Medicare, writes Noah Weiland at The New York Times.

The emergency declaration extended access to telehealth, an ongoing boon for older and vulnerable individuals who face mobility challenges or don’t want to risk an in-person visit, as well as those in rural areas.

Medicare, as well as private insurers, will continue to foot the bill for at-home test kits while the emergency continues.

The emergency declaration also boosts payments to hospitals caring for Medicare patients with COVID-19.

Ongoing concerns about omicron also led the CDC to extend the mask mandate on public transportation, including airplanes, until May 3.

Philadelphia, meanwhile, has become the first major city to reinstate an indoor masking requirement.

Pfizer’s booster amps up protection in elementary-age children

Kids ages 5 through 11 could be lining up for their boosters within a month or so.

Pfizer announced plans last week to ask the FDA for emergency authorization of its booster in this age group, which has been able to obtain the standard two-dose vaccine series since last fall.

According to a company press release, the booster shot increased the number of antibodies capable of neutralizing both the original coronavirus and the omicron variant.

That’s pretty much all the release says. “The study did not show how long the antibodies last, or test effectiveness against COVID disease,” writes Sharon La Franiere at The New York Times. “The data was not published or peer-reviewed, and at least one expert said it was impossible to assess the study without more information.”

Certain children with weak immune systems in this age group are already advised to get an extra dose, writes Lauran Neergaard for AP.

While pediatric cases are often mild, they can turn severe.

The FDA and CDC “will have to decide if healthy elementary-age kids really need a booster, and if so, when,” writes Neergaard.

Pfizer’s trial provided the booster doses six months after the initial vaccines.

The parents of children younger than 5 are still waiting on the first doses for their kids. The winter omicron wave led to five times as many hospitalizations, compared to the delta surge, among this age group.

Pfizer is testing a third dose in young children, hoping to improve on the lackluster results from just two.

Moderna’s two-dose series yielded as many antibodies as adult vaccination, but was less than 50% effective at stopping omicron infection. Even if regulators are satisfied with those statistics, families still probably have a month or more to wait.

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