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This 2003 electron microscope image made available by the Centers for Disease Control and Prevention shows mature, oval-shaped monkeypox virions, left, and spherical immature virions, right, obtained from a sample of human skin associated with the 2003 prairie dog outbreak. Monkeypox, a disease that rarely appears outside Africa, has been identified by European and American health authorities in recent days. (Cynthia S. Goldsmith, Russell Regner/CDC via AP)

The number of monkeypox infections continues to rise in Colorado, but new state data shows evidence that Black and Latino communities have been hit harder.

As of Thursday, the state has confirmed 168 cases in Colorado, stretching back to May. A majority of those cases — 94 — have been confirmed in August, though it is unclear whether that is related to increasing transmission, better testing or both.

Slightly more than half of the cases, about 53%, are in people who identify as white. Nearly 12% of infections are in people who are Black, while about 34% of people testing positive identify as Hispanic or Latino. For comparison, Colorado’s population is 67% white, 4% Black and 22% Hispanic.

“Similar to the data we experienced and what we saw with COVID-19, we are seeing overrepresentation of cases among some of our BIPOC communities,” Dr. Rachel Herlihy, the state epidemiologist, said during a media briefing on Thursday. BIPOC is an acronym standing for Black, Indigenous and people of color.

The disparity is one revelation to come Thursday after the Colorado Department of Public Health and Environment released detailed demographic data on those who have been infected with monkeypox in Colorado. The data help provide a better sense of where monkeypox is currently spreading. And, though it is possible for anyone to contract monkeypox given the right combination of factors, the data provide insight into who is currently most at risk for exposure.

Monkeypox demographic trends in Colorado

A majority of monkeypox cases in Colorado have been in Denver, with Adams, Arapahoe, Jefferson and El Paso counties rounding out the top five. Denver metro area counties account for 114 of the state’s 168 cases.

The average age of those infected is 35, Herlihy said. People between the ages of 25 and 44 make up roughly 75% of the state’s cases. There have been no cases reported among children.

The large majority of those infected are cisgender men — more than 85%. Cisgender women make up 3.5% of cases, while transgender men, transgender women and those identifying as nonbinary make up smaller percentages. The state doesn’t have gender identity information on almost 8% of its cases.

People who identify as gay or lesbian make up the majority of those infected — but not overwhelmingly, showing the danger public health leaders have warned about in linking the disease too closely with the communities in which it happens to be spreading currently. About 66% of infections are in people who identify as gay or lesbian, while about 10% of cases are in those who identify as bisexual and 8% are in those who identify as heterosexual.

Six hospitalizations, no deaths

Monkeypox is an orthopoxvirus that is a less serious but still severe cousin to smallpox. It typically causes a painful rash, as well as flu-like symptoms such as fever and swollen lymph nodes. Six people have been hospitalized for monkeypox in Colorado. There have been no deaths reported.

The sun sets behind the sign atop Denver Health hospital on March 18, 2021. (Kevin Mohatt, Special to The Colorado Sun)

Dr. Connie Savor Price, the chief medical officer at Denver Health, said the disease is showing up in a number of different ways in Colorado. Sometimes people get flu-like symptoms before the rash, sometimes it’s the other way, and sometimes people only get a rash. The rash can also be difficult to diagnose — it may look like cold sores, acne, skin bumps or blisters. She urged anyone with a new rash to contact their health care provider.

Monkeypox can be transmitted in a variety of ways. But Herlihy said transmission in Colorado is thought to be occurring primarily through skin-to-skin contact, especially during sex.

“Based on the data we have seen for this specific outbreak, it does look like sex is the primary route of transmission at this point,” she said. “But we want people to know, obviously, that transmission is possible through other close contact, as well.”

That means it is also possible to contract monkeypox through cuddling and kissing with someone who is infected, though it remains unclear how much transmission is occurring that way. The same is true for two other methods of transmission: by bits of spittle called large respiratory droplets and through what are known as “fomites” — objects like blankets that can be contaminated after directly touching open lesions.

Transmission by large respiratory droplets means it is theoretically possible to contract the virus without touching an infected person. But Herlihy described it as a “minor route” of transmission that likely requires hours of exposure — meaning a typical conversation out in public is unlikely to cause infection.

“The major route of transmission really continues to be that close physical contact, including contact during sex,” Herlihy reiterated.

Clearing the vaccine backlog

The state data helps better explain the restrictive criteria for vaccination.

Currently the vaccine is available only to people ages 18 and older who are a gay or bisexual man, a man who has sex with other men, transgender, non-binary or gender diverse and who have had multiple sexual partners in the past 14 days, had sex with someone they previously did not know in the past 14 days or had close physical contact with people in a venue where anonymous or group sex may occur. Vaccination is also available to anyone 18 and older who has in the past 14 days had close physical contact with someone who had monkeypox.

Vaccine supplies, currently being distributed by the federal government, are tight. But Scott Bookman, CDPHE’s director of disease control and public health response, said projections of the number of doses headed to Colorado in the coming weeks are rising. That should be helpful because Bookman said Colorado has a vaccine wait list of over 1,000 people.

“We are working our way through that,” he said. “We are continuing to expand access to providers across the state.”

Bookman said the state has enrolled 59 vaccine providers and administered more than 3,500 doses of vaccine. But here, too, there is evidence of ethnic disparity.

According to data CDPHE released later Thursday, nearly 74% of the vaccine doses administered so far have gone to white Coloradans, disproportionately higher than the white population of the state. About 4% of doses have gone to Black Coloradans, in line with overall population percentages. But only about 11% of doses have gone to people who are Hispanic of Latino. The state does not have data on race or ethnicity for 3% of the doses administered.

Bookman said the state is working to expand its outreach efforts and work with community organizations to build access and trust where it is needed most.

“Public health is really about a partnership with the public,” he said.

John Ingold

John Ingold is a co-founder of The Colorado Sun and a reporter currently specializing in health care coverage. Born and raised in Colorado Springs, John spent 18 years working at The Denver Post. Prior to that, he held internships at the Rocky Ford Daily Gazette, the Colorado Springs...