The California Department of Public Health (CDPH) has confirmed three unrelated cases of the more severe clade I mpox virus — in people without recent international travel — signaling evidence of community transmission.
Historically, the outbreak in California has been dominated by the less severe clade II mpox. While the CDPH states the risk currently remains relatively low — because transmission continues to occur primarily via close, intimate physical contact (sexual contact, cuddling, massage, sharing bedding or clothing) rather than casual public exposure — the emergence of clade I in people without travel suggests this more severe strain (historically seen in Africa) is now circulating domestically.
The mpox vaccine (JYNNEOS) is recommended for people at higher risk of exposure — men who have sex with men, or those with partners who might. Two doses are required. It’s also wise to stay alert to symptoms (a rash or lesions, especially on or near the genitals/anus, or other unusual spots) or flu-like symptoms and swollen lymph nodes. If symptoms pop up, avoid intimate or close physical contact until you’ve been seen by a health provider.
We spoke to our resident expert, DAP Health Medical Director of Specialty Programs Dr. Jason Halperin.
Are we still telling folks that if they received the series of two JYNNEOS vaccines that no boosters are required?
Yes, the CDC and CDPH do not recommend booster vaccines beyond the initial two doses. This might change — and I would like it to — but no change right now.
How is the new strain different than previous strains?
Clade I is much more severe than the existing clade II outbreak. This is very concerning — a higher mortality rate with more systemic symptoms that resemble a severe flu-like illness. The flu symptoms typically occur before the outbreak of the rash.
I want to be clear and not increase fear. We have only seen three cases, all in Los Angeles County, but since they did not travel out of the country, it must mean community spread. Our best defense is vaccination!
Here is a nice link comparing the two strains. We do not know anything about these three patients, but Los Angeles County Health Officer Dr. Muntu Davis made this statement, which leaves me concerned that clade I was likely transmitted sexually: “The identification of cases of clade I mpox, which may cause more severe illness than the more common clade II, is concerning. Mpox continues to be spread largely through close, intimate contact with symptomatic people, mainly during sexual activity.”
Who can get vaccinated at our Stonewall Pharmacy in Cathedral City?
Our patients can get the vaccine through Stonewall Pharmacy, and it is billed to insurance. If they are our patients, we have seen no out-of-pocket costs for them.
Unfortunately, due to high cost, we can no longer provide the vaccine to community members who are not DAP Health patients. For those individuals, their primary care provider has to send a prescription to their pharmacy to get the vaccine, or they can go to one of the Riverside County free vaccine pop-ups. More info on that at this link.
I would like to push the state and county to restart free vaccination access, especially if we see spread of clade I. We have also seen an increase in clade II cases over the past month. So, vaccination is required for both.
Importantly, the medication TPOXX was shown to be ineffective for mild and moderate disease. It no longer should be prescribed.
What is the treatment once clade I or clade II mpox is diagnosed?
Supportive care remains the cornerstone of mpox management. This includes analgesics for pain, topical steroids for pruritis (itching), stool softeners, and topical lidocaine for proctitis (rectal inflammation).
Does DAP Health have any confirmed mpox cases, and if so, how many?
We have zero clade I cases, but we see one to three cases of clade II mpox per week at our three sexual wellness clinics. I have seen two cases in our Escondido clinic.
Greater Palm Springs Pride is coming up. To avoid stigmatizing the LGBTQ+ community, what message would you deliver if asked if you are concerned about cases spreading during Pride weekend?
We should not stigmatize healthy sex at all! Vaccination ensures protection from severe disease and ensures healthy sex. We should also test as soon as possible if we see lesions. By testing and confirming positivity, we can protect our community. All biomedical tools should be implemented to ensure a fun, safe, sexually liberating Pride, including HIV PrEP, Doxy-PEP, and mpox vaccination.
