Georgia has the third-highest rate of monkeypox cases per 100,000 residents in the nation. That beats out the District of Columbia and New York.

The city of Atlanta is home to more than 60% of Georgia’s confirmed cases.

While 4,200 people received their first of two doses of monkeypox vaccine during Black Gay Pride events, former Atlanta mayor and current White House Director of Public Engagement Keisha Lance Bottoms said folks need to return to their providers for that second dose. 

“That’s very important,” Bottoms said. “Some people are a little hesitant because they’re concerned there may be a mark that shows that they’ve been vaccinated and, for whatever reasons, they may not want people to know that. But you can get the vaccination in your back.”

Patients are more likely to have redness and swelling at the injection site with intradermal vaccination; there may also be long-term permanent discoloration or scarring at the injection site, especially for people with darker skin. 

Full immunization is not reached until about six weeks after the first dose is taken.

What is monkeypox?

Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, thus leading to the naming of the disease.

It originates in various wild animals, not only monkeys, and can be transmitted if a person comes into contact with the virus from an animal, a human or contaminated materials.

The virus enters the body through broken skin, the respiratory tract, or mucous membranes in the eyes, nose or mouth.

Human-to-human transmission is thought to occur primarily through large respiratory droplets. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required.

How is monkeypox infection confirmed?

The monkeypox virus can only be confirmed by Centers for Disease Control and Prevention lab testing after a state department of health has reason to suspect it, Dr. Christina Wojewoda said.

Wojewoda is the director of clinical microbiology at the University of Vermont Medical Center, and she chairs the Microbiology Committee for the College of American Pathologists.

“We don’t want people swabbing every little rash that’s out there, overwhelming the public health laboratories (by) testing for things that don’t make any sense at all,” she said.

Officials must make sure that the signs, symptoms, and presentation are consistent before testing is sent from the state lab to the CDC.

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In Georgia, most monkeypox cases affect Black men who have sex with men. Of these, roughly two-thirds are also infected with HIV, according to data from the Georgia Department of Public Health.

Atlanta-based HIV researcher Dr. Melanie Thompson said in August that she was not surprised at the disparity.

“I wish I could say I was shocked by this; I’m extremely concerned about it,” Thompson said. “But the most cynical part of me says it’s just another day in Georgia.”

She explained that of the demographics of people with HIV who present with new HIV diagnoses, 73% are Black and only about 13% are white.

“The disproportionate impact on this community is no surprise, and it’s been that way for decades,” Thompson said. “But it is not really getting better. And monkeypox, again, raises the veil on the disparities that occur in our health system.”

RELATED: COVID-19 Pandemic Exposes Racism, Health Inequities In Georgia

The stigma against communities of color and communities at risk of or positive with HIV can extend to providers themselves.

Thompson also said she thinks HIV care providers stand out in their willingness to offer monkeypox testing to the community of men who have sex with men.

“I know I’ve had several emails and texts and so on from people who have been turned away by their primary care providers, who will not test them for monkeypox,” Thompson said. “But we also have emergency rooms in the city of Atlanta who are refusing to test people for monkeypox.”

There are so many things in our health care system that we know disproportionately impact those in our communities who are most vulnerable, Bottoms said, adding that often the most vulnerable are people of color or in marginalized communities.

And so if that’s happening, she said, that’s extremely disappointing to hear.

“We just want to remind people, you may need to proactively seek a vaccine because there may not be as many mass events like Black Gay Pride to offer vaccines on the spot,” Bottoms said.

This story comes to Reporter Newspapers / Atlanta Intown through a reporting partnership with GPB News, a non-profit newsroom covering the state of Georgia.

Ellen Eldridge | GPB

Ellen Eldridge is a health care reporter for Georgia Public Broadcasting.