Mpox: Current Status, Symptoms, and Vaccination
Wastewater data indicates clade II of mpox continues to be occasionally detected in the Bay Area four years after the initial 2022 outbreak. The CDC now expects additional clade I cases in Europe and the United States.
Current Situation and Spread
The California Department of Public Health reported San Francisco has recorded over 1,000 cases of clade II mpox since 2022, with current data showing an average of fewer than two new cases per week.
The Centers for Disease Control and Prevention (CDC) stated that clade I cases in Central and Eastern African countries initially spread through heterosexual intimate or sexual contact between adults, then likely spread within households including to children.
The CDC noted that while initial cases outside Africa were linked to travel to those regions, by late 2025 central Western European countries began reporting clade I mpox cases among individuals with no documented international travel history. The CDC concluded these European cases were likely related to intimate or sexual exposure among men who have sex with men.
Symptoms and Transmission
The mpox virus spreads through close, usually skin-to-skin contact with an infected person. Transmission can occur through:
- Direct contact with infectious rashes or scabs.
- Intimate physical contact such as kissing or sex.
- Contact with infected bodily fluids or contaminated items.
According to the San Francisco Department of Public Health (SFDPH), symptoms of clade I and clade II mpox are similar and often begin with flu-like conditions.
The virus appears as a rash, sores, or spots resembling pimples or blisters that can occur anywhere on the body including face, mouth, hands, feet, chest, genitals, and anus. These spots typically progress from red, flat spots to bumps that fill with pus and eventually form scabs. Symptoms can be painful, and the CDC provides a photo guide for rash identification.
The incubation period ranges from 3 to 17 days according to the CDC. Individuals with suspected symptoms are advised to consult a healthcare provider or SFDPH clinics for testing.
Vaccination Eligibility and Recommendations
The Jynneos vaccine available in the U.S. is a two-dose series administered approximately one month apart, with maximal immunity developing two weeks after the second dose. The San Francisco Department of Public Health stated the vaccine provides protection against both clade I and clade II mpox.
CDC Recommendations
The CDC recommends the two-dose vaccine for:
- Gay and bisexual men and other men who have sex with men.
- Transgender, nonbinary, or gender-diverse people who in the past 6 months have had multiple sexual partners or a new STI diagnosis.
- Anyone who has had sex at commercial sex venues.
San Francisco Additional Recommendations
San Francisco additionally recommends vaccination for:
- Anyone living with HIV.
- Anyone taking PrEP or eligible for it.
- Sex workers.
In 2024, the CDC updated recommendations to include people traveling to countries with clade I outbreaks who anticipate specific activities including sex with new partners, sex at commercial venues, sex in exchange for goods or services, or sex associated with large public events.
The vaccine was originally approved for people aged 18 and older, but in 2022 the FDA issued emergency-use authorization allowing providers to administer it to people under 18 determined to be at high risk of infection.
Vaccine Access
Individuals with regular healthcare providers are advised to inquire about vaccination through them, with vaccines being free though copays may apply for provider visits. Health insurance should cover vaccine costs for eligible individuals per CDC recommendations.
Those without regular providers or insurance can visit SFDPH-recommended clinics in San Francisco, with appointment or walk-in options available.
Vaccination does not affect immigration status or processes, and immigration status is not required for vaccination.
San Francisco residents and non-residents can access vaccination through SFDPH sites or the state's myturn.ca.gov website.
Some pharmacies offer mpox vaccination appointments, though individuals should verify insurance coverage as out-of-pocket costs may be significant. Individuals with health systems like Kaiser Permanente may need to obtain vaccines directly from system providers rather than pharmacies. Those scheduling pharmacy appointments are advised to verify vaccine availability beforehand.