Data on wastewater indicates that even four years after the outbreak in 2022, clade II of mpox is still sporadically found in the Bay Area’s wastewater systems.
The California Department of Public Health (CDPH) reports that San Francisco has recorded over 1,000 cases of clade II mpox since the beginning of the outbreak, but recent figures show that the average new cases have fallen to fewer than two per week.
Initially, clade I cases in Central and Eastern African nations spread through intimate or sexual contact between men and women, and this transitioned to household transmission, possibly including children, according to the CDC.
Interestingly, the first cases outside Africa were predominantly linked to travel to those regions. However, by late 2025, some central Western European countries started documenting clade I cases among individuals without any travel history, which the CDC believes were likely due to intimate or sexual exposure among men who have sex with men.
Looking ahead, the CDC anticipates more cases of clade I will surface in both Europe and the United States.
What are the symptoms of mpox, and how does it spread?
The mpox virus transmits through close contact—usually skin-to-skin—with an infected person. This includes direct interactions with rashes or scabs formed by the illness, as well as intimate activities like kissing, cuddling, or sexual encounters. Touching contaminated bodily fluids or items that an infected person has interacted with can also lead to exposure.
Both clade I and clade II mpox symptoms are comparable, with initial signs often resembling flu-like conditions. This is particularly relevant as the Bay Area moves into respiratory virus season.
Texture-wise, the mpox virus appears as a rash or sores that might look like pimples or blisters anywhere on the body—faces, mouths, hands, feet, chests, genitals, and even the anus.
These start as red flat spots that evolve into bumps; eventually, they fill with pus and scab over when they burst. The pain from this can be quite severe. If you’re uncertain about what an mpox rash looks like, the CDC offers a photo guide.
Notably, mpox can have a long incubation period, spanning from three to 17 days before symptoms manifest, according to the CDC.
If you suspect you have mpox symptoms, even if they’re mild, it’s important to contact your healthcare provider promptly or check out one of the SFPDH clinics for testing.
Who’s eligible for an mpox vaccine in the Bay Area?
The available vaccine in the U.S., known as Jynneos, consists of a two-dose regimen spaced about a month apart. Full immunity develops two weeks after the second shot. If you’ve only had one dose, it’s best to seek out the second as soon as you can.
This vaccine offers robust protection against both clade I and clade II mpox, as emphasized in a statement from the SFDPH.
The CDC advises the two-dose vaccine for gay and bisexual men, men who have sex with men, and transgender or gender-diverse individuals who have had:
- Multiple sexual partners and/or
- A recent diagnosis of one or more sexually transmitted infections.
Additionally, vaccination is suggested for anyone who has had sex in venues like bathhouses or sex clubs. For further details, see the CDC’s complete vaccine recommendations.
In 2024, the CDC extended its vaccination guidelines to include individuals traveling to areas with clade I outbreaks. They recommend receiving both doses if you plan to engage in certain activities while abroad, such as:
- Being intimate with a new partner
- Frequenting commercial sex venues
- Exchanging sex for various forms of compensation
- Participating in large public events like parties or raves.
Originally limited to adults aged 18 and over, the FDA in 2022 issued an emergency-use authorization that allows the vaccine to be administered to younger individuals deemed at high risk for infection.
Where can I find an mpox vaccine?
If you have a primary care provider, the SFDPH recommends contacting them first to inquire about the mpox vaccine. The vaccine is free, but a routine co-pay may apply for the appointment.
If you’re eligible, insurance should typically cover the vaccine due to CDC guidelines. For individuals lacking a primary care provider or insurance, there are specific clinics in San Francisco where you can receive the vaccine. Options include scheduling an appointment or visiting a walk-in clinic, depending on what’s more convenient.
(As with the COVID-19 vaccine, the mpox vaccine won’t be a factor concerning public charge issues or immigration processes, and your immigration status will not be queried.)
If you live in or near San Francisco:
For a complete list of mpox vaccine locations in San Francisco, you can check the SFDPH website. Notably, you don’t have to be a resident of the city to get vaccinated there.
You can also find nearby vaccine clinics using the state’s myturn.ca.gov platform.
Getting an mpox vaccine at a pharmacy
Some pharmacies provide online appointment scheduling for mpox vaccinations along with other shots like COVID-19 and flu. However, if you choose this pathway, you’ll need to provide insurance information—and it’s wise to confirm with your insurer that they will cover the costs, as the out-of-pocket expenses can be significant. If your insurance falls short, the SFDPH indicates you can still access vaccinations at their clinics, depending on availability.
If you receive care through a system like Kaiser Permanente, getting the mpox vaccine covered at a pharmacy might not be an option, similar to how flu and COVID-19 shots are handled.
It may be beneficial to call ahead to validate that a pharmacy has the vaccine available before making an online appointment.
