Riverside County, California, has reported its first pediatric case of MPX, in a child under 10 years old.
The child, a resident of western Riverside County, is recovering at home and didn’t require hospitalization, health officials said. The public health department is trying to determine how the child became infected with MPX, also known as monkeypox.
Pediatric cases of MPX are rare. According to the California Department of Public Health‘s tally, as of Tuesday — the most recent day for which data were reported — of the 4,453 MPX cases statewide, only seven have occurred among children 15 or younger.
Other pediatric MPX cases have been reported in California, including one in Long Beach that was linked to infected household members and one in Orange County. The child in the Orange County case was said to be improving when the case was announced publicly.
MPX is not easily transmitted — it typically requires close skin-to-skin contact for an infection to occur — but it can be transmitted in a household setting, including on bedsheets or towels that have come in contact with infected lesions. The disease is characterized by virus-filled rashes and lesions that can look like pimples, bumps or blisters.
MPX is more commonly transmitted during intimate encounters, including sex. The rashes or lesions can appear first in the genital area and rectum before spreading to other body parts, and because they can be mistaken for other skin issues, the virus can easily spread during intimate encounters. Risk is higher for people with multiple sexual partners.
Most of the MPX cases in Riverside County have been in the eastern region, in the Coachella Valley. Riverside County has reported 252 cases.
Several other counties in California have more cases: San Diego County has 360; San Francisco, 781; and Los Angeles County, 1,945. Alameda County has 215 cases.
On a per capita basis, San Francisco has the state’s highest rate, with 90 MPX cases for every 100,000 residents. The rate for L.A. County is 19; Alameda County, 13; and San Diego and Riverside counties both have a rate of 11.
New weekly MPX cases are continuing to decline in L.A. County. For the seven-day period that ended Thursday, L.A. County reported 140 new MPX cases, a 25% decline from the prior week, when there were 187. The apparent weekly peak was Aug. 19 to Aug. 25, when there were 313 reported cases.
Nationally, new MPX cases are down nearly 50% since a peak in early August, Dr. Demetre Daskalakis, deputy coordinator for the White House MPX response, said at a news briefing Thursday.
“This is the result of our hard work together to increase the availability and use of testing, make vaccines readily available to the people who could benefit most, providing guidance on how to avoid monkeypox through changing behaviors,” Daskalakis said.
“But, as you’re hearing, our work is far from over,” he added. “Some jurisdictions are still seeing increasing rates of monkeypox infections, while others are seeing a decline.”
More than 59,000 MPX cases have been reported worldwide, including about 23,000 in the United States.
A greater percentage of MPX infections are affecting people of color. Early in the outbreak nationally, MPX cases were predominantly seen in white men, Dr. Rochelle Walensky, the director of the U.S. Centers for Disease Control and Prevention, said at the briefing.
Now, Black men represent 38% of cases; white men, 26%; and Latino men, 25%, Walensky said, citing the most recent weekly data.
Officials are concerned that too few Black and Latino residents who are at high risk have been vaccinated.
Among people who have received their first dose of the MPX vaccine, 47% are white; 21% are Latino; and 12% are Black, Walensky said.
“The percentage of vaccines administered to Latinos or … Black men are disproportionately lower than we are seeing represented in cases,” Walensky said. “It is critical that education, vaccinations, testing and treatment are equally accessible to all populations, but especially those most affected by this outbreak.”
Now comes a harder task, Daskalakis said, “where we need to work to make sure that we continue to get first doses into arms and ease access for second doses. That means we need to use hyperlocal strategies that let us reach deeper into the community.”
They include opening up vaccination clinics where higher-risk people will be located, such as the administration of more than 4,000 doses of vaccine at Black Pride in Atlanta, and working with public health community partners to get vaccine into the arms of people of color, Daskalakis said.
And because data show that most people with MPX either had HIV or a sexually transmitted infection, the CDC has told health departments and HIV prevention community-based organizations that they can use funds and staff dedicated for HIV and STD efforts on MPX efforts, Daskalakis said.
“The same people we need to test for HIV and sexually transmitted infections and lead to prevention and care are the same people who need monkeypox-related services like testing, education, and vaccines,” Daskalakis said.
Los Angeles County confirmed the first MPX death in the nation Monday. The patient was severely immunocompromised and had been hospitalized, said Dr. Rita Singhal, chief medical director for the L.A. County Department of Public Health. No further details were released.
In an advisory, L.A. County health officials noted severe MPX disease has been found in people with inadequately treated HIV, underscoring how essential it is that those at higher risk seek treatment. Authorities are now specifically exhorting healthcare providers to use a drug called tecovirimat — commonly known as Tpoxx — in patients who have or are at risk of developing severe MPX disease.
L.A County also disclosed the nation’s first case of a healthcare employee infected with MPX at work.
Singhal said at a news briefing Thursday that there have been about eight healthcare workers worldwide who have contracted MPX from workplace exposure, some of whom were infected because of a needle stick injury. “Locally for us here, it was not directly a needle stick injury, but it was an exposure at the work site,” she said.
Spread of the MPX virus to health care employees from work site exposures is rare.
(Times staff writer Grace Toohey contributed to this report.)
