By Jacqueline Howard

The monkeypox virus has spread quickly in clusters across the United States — at certain music festivals, pool parties and bathhouses — and now public health officials in areas with a lot of infections want more vaccines made available to help control transmission, which appears to happen when people touch intimately, skin to skin.

“There are two different aspects of this response,” Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials, told media.

“One is heavily concentrated, rather narrowly, on events that occur that can be the hotbeds for the spread,” Freeman said, including large dance parties and pool parties.

“We’re” certainly right now in a phase where we’re having to manage the existing quantity of vaccine and really focus on new cases in high-risk individuals,” she added. “So, not doing prevention efforts just quite yet — but focused on case counts.”Those case counts are on the rise. The number of probable or confirmed monkeypox cases in the United States more than doubled within a single week, jumping from 866 to 1,814 between July 11 and 16.

The latest count from the US Centers for Disease Control and Prevention shows that more than 2,000 probable or confirmed monkeypox cases have been reported nationwide.

Having more vaccine doses available to cities and counties across the country — especially those with rising cases — could help slow the spread of the virus, Freeman said.

Although monkeypox is not a sexually transmitted disease, it spreads through skin-to-skin contact, and in the current outbreak, the virus has mostly been spreading among men who have sex with men.The CDC estimates that more than 1.5 million men who have sex with men are eligible for the monkeypox vaccine in the United States. As of Tuesday, more than 190,000 doses of the Jynneos vaccine — a two-dose regimen manufactured by Bavarian Nordic for the prevention of monkeypox and smallpox — have been pulled from the Strategic National Stockpile to support local monkeypox response efforts, according to the US Department of Health and Human Services.

But some local health officials tell CNN that hasn’t been enough to meet demand.

‘The numbers are obviously getting larger’

For health officials in Dallas County, Texas, the summer started with a monkeypox investigation.In early June, the state identified its first monkeypox case as part of the global outbreak of the rare disease. The patient was a Dallas County resident who had recently traveled to Mexico. Separately, in the days that followed, two more monkeypox cases were identified in Dallas County residents who had recently traveled to Spain and Mexico.

“Our first cases were overseas-travel-related, and then now we’ve had local events,” Dr. Philip Huang, director of the Dallas County Health and Human Services Department, told CNN on Wednesday at the conference of the National Association of County and City Health Officials.”We’re trying to control and contain it, but the numbers are obviously getting larger,” he said.Over the Fourth of July weekend, health officials identified a confirmed case of monkeypox in someone visiting for the Daddyland Festival, a four-day circuit of dance parties with live DJs, nightclub events and pool parties. The person reported attending festival events and private parties while contagious, according to Dallas County Health and Human Services, which added that “there is a concern for local, community transmission for anyone who attended these events and participated in activities that pose a high risk for monkeypox transmission.”At the Daddyland Festival, “thousands of people, largely men who have sex with men, were attending from around the country and around the state. They were coming to party, and that party had a lot of close contact,” Huang said.Around that time, county health officials were notified of an out-of-state visitor with confirmed monkeypox who reported multiple sexual encounters in the sauna of the private men’s club Club Dallas between June 22 and 25.

As of Friday, 29 monkeypox cases have been confirmed in Dallas County residents, and health officials have released public notices about potential exposure at the Daddyland Festival and Club Dallas. Most of the affected people have had swollen lymph nodes and lesions or pustules on the skin that are characteristic of monkeypox, Huang said.”It would be really important for people who’ve attended these to be responsible, to monitor themselves if they attended these events, and if they’re in that group, maybe to hold off participating in these events for now until this is resolved,” Huang told CNN. Across the state of Texas, 81 probable or confirmed cases have been reported, according to CDC data.”For the general population, unless you’re attending these sorts of events or with people that have attended these and in close contact, then the risk is very low,” Huang said. “If you go to the event and there’s a bunch of people who’ve been at it, then you have a higher risk.”

‘The sex and the stigma’

Public health officials emphasize that anyone who comes into contact with a person who has an active monkeypox infection can be at risk of becoming infected with the virus — no matter their sexual orientation — and that the disease should not be stigmatized.

“Anything that has stigma, people are not going to want to report,” Patrick McGough, executive director of the Oklahoma City-County Health Department, told CNN at the public health conference Wednesday. His state has a total of three probable or confirmed monkeypox cases, according to CDC data.There remains some concern more people could be infected with monkeypox but are not getting tested. Those cases then can go unreported.”There’s the anonymous nature of a lot of the sex and the stigma,” Freeman said.”There is also the education around monkeypox in general: Not everybody understands what it is or how you get it,” she said. “At the community level, we have a lot of work to do with health education and promoting testing.”For instance, “in California, we’re hearing that bathhouses continue to be an area that they’re focusing health education efforts on since those particularly focus on men having sex with other men, with many several anonymous partners, in one setting,” Freeman said.But as more people get tested, more cases could be identified, and “we’ll find out more about how widespread it is.”

Man with monkeypox shares what it was like to contract the virus 03:15Additionally, it remains unclear whether the virus is spreading mostly through sexual transmission or through other forms of skin-to-skin contact.”We’re really trying to understand what skin-to-skin contact means and how long it takes to transmit,” McGough said. “It seems to be cluster events where there’s a lot of skin-to-skin or sexual contact.