Since the discovery of monkeypox outside Africa in May, 35,000 cases have been confirmed worldwide. Of these, more than 14,000 were found in the United States, mainly in New York, California, Texas, Florida, and Georgia.
The vast majority of cases are among men who have sex with men, and vaccination campaigns are prioritizing them as a high-risk group. But like Covid-19, both infection and vaccination follow the usual pattern of inequality: more cases in black men, but fewer vaccinations.
And, as with covid, the response has all but ignored one possible outbreak location: prisons.
So far, only one case of monkeypox has been confirmed in a jail or jail at the Cook County Jail in Chicago, one of the largest known sources of coronavirus infection for imprisoned people in the country. More suspected cases have emerged and, like the general population, many have likely escaped testing due to a lack of widespread testing.
Nonetheless, the absence of large outbreaks in prisons should be seen as an opportunity to prevent possible large infection sites local transmission, rather than indicating that prisoners are not at risk.
Prisons and prisons that hold about 2.2 million people in the United States are ideal for exposure to monkeypox. Prisoners are often in crowded spaces and may not be able to avoid close contact with each other or bedding and other fabrics, which are known modes of transmission.
All prisoners are at risk of monkeypox
“Prisons and prisons should definitely be vaccinated as a priority,” said Eric Reinhart, a physician and anthropologist at Northwestern University who studies the role of prisons in infectious disease outbreaks.
But unlike the general population, vaccines should be available to all prisoners, regardless of sexual orientation and habits, said DeAnna Hoskins, director of criminal justice reform group JustLeadershipUSA.
“You can’t really pick and choose — everyone is a sitting duck,” Hoskins said.
Unlike the general population, prisoners are less likely to choose to come forward and have sex with men or with them, she said, both because many do not identify as gay or bisexual love, and because they are concerned that their sexual orientation or activity will be affected if they admit to it.
“It is clear that sexual encounters in prisons are more prevalent because of the longer incarceration for consensual and involuntary sexual activity driven by prolonged periods of time in prison,” Reinhardt said .
Hoskins said correctional officers should also be vaccinated because they often have sex with inmates.
Different priority strategies
Monkeypox is mainly spread through skin-to-skin contact or through fabrics. In addition, Reinhardt said, the incubation period is longer than the new coronavirus, and vaccination can play a role in reducing severity and controlling transmission even after exposure, because individuals are mostly contagious when they develop symptoms.
This makes monkeypox easier to control than Covid-19, even in the prison system. While vaccines are in short supply, it could help create priority groups that are distinct from the general population, delivering vaccines first to prison inmates and staff, and then to people in prisons, who typically stay for shorter periods of time and are less likely to have the opportunity Skin contact or sexual contact.
But that doesn’t mean the population of detention centers outside of prisons isn’t at risk, as the notoriously overcrowded Cook County Jail shows. So while not everyone in the corrections system has access to the vaccine, criminal justice authorities — legally entrusted with the custody and custody of incarcerated people — can introduce other mitigations, such as expedited hearings, bail reform and other ways to reduce prison populations.
“You see people being held in crowded settings like cowsheds and using hot beds — people are rotating while using the same bed, usually with the same sheets — More often in prisons and ICE facilities, which provides a reasonable opportunity for non-sexual transmission,” Reinhardt said.