Diagnosed monkeypox infections in Hawaii grew to 18 last week. That number may not seem high, but it is troubling that case numbers continue to rise, in the islands and nationwide, for a disease that is far less contagious than the COVID-19 virus, and one for which effective tests and vaccines are available.
The total included 14 cases on Oahu, including one non-resident, one on Hawaii island, one on Maui, and two non-residents on Kauai.
On a national level, fear has grown that the infectious disease may become endemic — a communicable disease with a persistent baseline foothold in the population — so it’s legitimate to keep a wary eye on the state’s reaction. On Aug. 4, the Biden administration declared monkeypox a public health emergency, smoothing access to federal funds and assistance.
It’s imperative that Hawaii commits to constant vigilance and preparation for a rapid response when necessary.
Monkeypox is spread primarily through close skin-to-skin contact. It is more likely to be transmitted through extended physical contact, including sex, but can also spread within a family, or in other situations involving close contact, as between a caregiver and client.
The risk of death or serious illness from the current strain of monkeypox is low — less than 1%, the CDC reports — but people with weakened immune systems, children and pregnant women may be more vulnerable.
“While the risk to most Hawaii residents remains low, local transmission of monkeypox is occurring,” said deputy state epidemiologist Dr. Nathan Tan.
Nationally, monkeypox case numbers grew from one in Massachusetts on May 17 to more than 13,500 last week, according to federal data. Most cases were found among gay and bisexual men.
It’s encouraging that, in keeping with Hawaii’s relatively low numbers of infected individuals, state health officials report they are conducting contact tracing with all confirmed cases.
Adults who test positive for monkeypox and meet criteria are offered the Jynneos vaccine. And beginning Saturday, the Department of Health (DOH) began administering the Jynneos vaccine intradermally — just under the skin — which allows for a smaller effective dose and wider vaccine availability.
More than 1,000 of the 2,800 doses shipped to Hawaii so far have been administered. Second doses are also being offered and encouraged, and anyone who has received a first dose at least 28 days ago can now sign up for a second dose.
The Jynneos vaccine is available to adults who have had close contact in the last 14 days with a person known or suspected to be infected with monkeypox; those who have multiple or anonymous sex partners; those with severe immune compromise, such as active cancer treatment, or certain skin conditions, such as eczema; and those who have a household member or sex partner at high risk. Schedule an appointment online at health.hawaii.gov/docd/mpxvax or by phone at 808-586-4462.
On a national level, criticism of the monkeypox response has centered on delays in authorizing commercial laboratories to administer tests and in granting regulatory approval for obtaining vaccines from the Denmark facility where it’s manufactured, along with the complications doctors faced in obtaining a medication, tecovirimat, that has proven successful in treating monkeypox. However, Hawaii has benefited from a lag in the appearance of monkeypox within the islands, and the CDC has now ramped up its response.
Whether or not monkeypox cases reach reach crisis levels in Hawaii, the state’s ability to identify and respond to an infectious disease when it appears in the islands can be the difference between life and death or severe illness for those at risk. DOH and our incoming governor must be prepared with localized wastewater testing for early detection, promised as a capability this fall, as well as the ongoing ability to roll out diagnosis, treatments and vaccines on an urgent basis.
