The shortfall of monkeypox vaccine doses in the United States, expected to last for months, is raising urgent questions about how well and for how long a single shot may protect against the virus.
The vaccine, called Jynneos, is approved as a two-dose regimen, but most people at risk of infection have been receiving one dose if they can find it. Now the shortage has led federal officials to consider a rarely used approach: a so-called dose-sparing strategy, which gives shots that each contain just one-fifth of a single dose.
For most recipients, one shot should be enough to ward off serious illness, and there is some evidence that even smaller doses can be effective. But preliminary research suggests that people with H.I.V. or other conditions that weaken the immune system may be less protected than people who dont have such illnesses, according to some experts.
One dose is better than none, said Dr. Alexandra Yonts, an infectious diseases physician at Childrens National Hospital in Washington, D.C. But people with H.I.V. and other immunocompromised individuals need to be aware that they may not have an adequate level of protection from infection, even with vaccination, she added.
Even two weeks after the shot, when the antibody response is underway, immunocompromised people still may need to use all other precautions to prevent being exposed, per public health guidance, she said.
The findings also suggest that some men should be prioritized for full vaccination. Given the supply constraints, that may be difficult.
Federal officials have ordered nearly seven million doses of Jynneos, but the shots will not arrive for months. So far, the Biden administration has shipped about 600,000 doses to states. It said last week that 800,000 additional doses were being allocated to states, but the distribution could take weeks.
Faced with shortages, some cities, including Washington and New York, are restricting second doses to stretch their supplies. Officials at the Food and Drug Administration and the C.D.C. have disagreed with that strategy, noting that Jynneos is approved as a vaccine to be given in two doses spaced 28 days apart.
What to Know About the Monkeypox Virus
What to Know About the Monkeypox Virus
What is monkeypox? Monkeypox is a virus similar to smallpox,but symptoms are less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research. The viruswas primarily found in parts of Central and West Africa, butrecently it has spread to dozens of countries and infected tens of thousands of people, overwhelmingly men who have sex with men.
What to Know About the Monkeypox Virus
How does it spread? The monkeypox virus can spread from person to person through close physical contactwith infectious lesions or pustules, by touching items like clothing or bedding that previously touched the rash, or via the respiratory droplets produced by coughing or sneezing. Monkeypox can also be transmitted from mother to fetus via the placenta or through close contact during and after birth.
What to Know About the Monkeypox Virus
I fear I might have monkeypox. What should I do? There is no way to test for monkeypox if you have only flulikesymptoms. But if you start to notice red lesions, you should contact an urgent care center or your primary care physician, who can order a monkeypox test. Isolate at home as soon as you develop symptoms, and wear high-qualitymasks if you must come in contact with others for medical care.
What to Know About the Monkeypox Virus
I live in New York. Can I get the vaccine? Adult men who have sex with men and who have had multiple sexual partners in the past 14 days are eligible for a vaccine in New York City, as well as close contacts of infected people. Eligible people who have conditions that weaken the immune system or who have a history of dermatitis or eczema are also strongly encouraged to get vaccinated. People can book an appointment through this website.
But as federal health officials declared a public health emergency on Thursday, Dr. Robert Califf, the commissioner of the F.D.A., said the agency was now considering authorizing shots that contain just one-fifth of the regular dose, delivered between layers of the skin instead of under it.
The F.D.A. would need to grant Jynneos an emergency use authorization in order for it to be administered this way.
The dose-sparing approach has been used when supplies of other vaccines are scarce. But giving intradermal shots requires more skill than is needed for more traditional immunizations.
One shot is probably enough to forestall severe symptoms in most people, and the dose-sparing strategy may work just as well. But its unclear whether a scaled-back regimen is enough to prevent infection, and if so, how long that immunity may last, federal health officials said.
Were in a data-free zone, said Dr. Emily Erbelding, an infectious diseases expert at the National Institutes of Health, who oversaw testing of Covid vaccines in special populations.
One oft-cited statistic says that the vaccine is 85 percent effective against monkeypox. That data derives not from trials of Jynneos, but from a small 1988 study that looked at the incidence of monkeypox among people who had been inoculated for smallpox earlier in their lives.
No large clinical trial of Jynneos as a monkeypox vaccine was conducted in humans before its approval. Instead, the F.D.A. relied on measures of antibody responses in small groups of people after immunization with Jynneos compared with those produced by ACAM2000, an earlier vaccine for smallpox.
In studies led by its manufacturer, Bavarian Nordic, two doses of Jynneos yielded antibody levels in humans that were about the same as those after one shot of ACAM2000.
Antibody levels after the first shot of Jynneos initially rose for two weeks and then remained flat until the second dose four weeks later, when they soared to very high levels higher than those recorded with ACAM2000.
Scientists read that to mean if the first dose is not followed by a second, the protection may not be long-lasting.
Ideally, a second dose would be administered if protection for more than that four-week period is desired, Dr. Yonts, who reviewed the data for the F.D.A. as a staff scientist, said.
She added that delaying the second dose to eight weeks might be reasonable. But if its going to be like six months, then I think that prioritization would lean more toward those that are more severely immunocompromised, she said.
Injecting one-fifth of a regular dose of Jynneos between skin layers, as the F.D.A. suggested on Thursday, may be effective, according to limited research. The skin has many more of the immune cells that respond to vaccines.
But the research is very limited. Scientists at the N.I.H. had planned to test the dose-sparing strategy in a clinical trial set to begin in a few weeks. It is unclear whether those plans will be shelved or sped up.
Information about how Jynneos performs in people with H.I.V., particularly in those with severe immune problems, was already scant. In one study conducted by Bavarian Nordic, antibody response to vaccination tended to be diminished: At 28 days after the first shot, 67 percent of those with H.I.V. produced antibodies, compared with 84 percent of uninfected people.
While Dr. Yonts said the data from that trial was not conclusive, reduced antibody response is often seen among immunocompromised people given other vaccines. While evaluating Covid vaccines, for example, researchers found that patients with H.I.V. were more likely to have breakthrough infections.
Individuals with severe or moderate immune suppression are recommended for additional doses of common vaccines, said Keri Althoff, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, who led the Covid vaccine study. As immune suppression increases, the response to the vaccines does decrease.
The C.D.C. and the New York City Department of Health say Jynneos is safe for people with H.I.V., but the agencies have not addressed its effectiveness in that population.
By contrast, health officials in Britain say that for people who are H.I.V. positive or have any other condition or treatment leading to a weakened immune system, the vaccine may not protect you as well.
The vaccines package insert also notes that immunocompromised people may have a diminished immune response.
Two shots may be very important in this population, which is something that is not actually happening in the public health response, said Dr. Chloe Orkin, an infectious disease physician at Queen Mary University of London, referring to immunocompromised people.
But until more doses are available, state and local health departments may not have much of a choice other than to stick with scaled-back regimens.
In an environment of scarcity, we have to do everything we can to get the benefits of vaccine to the city as quickly as possible, said Patrick Gallahue, a spokesman for New York Citys health department, in a statement.
The UK will run out of the monkeypox vaccine despite having one of the biggest number of cases worldwide, triggering warnings that the illness could become endemic.
The country looks likely to exhaust stocks of the vaccine in the next two to three weeks, and then face a delay of almost a month before the next supplies arrive in late September.
An internal NHS England letter has disclosed that there are just 8,300 doses of vaccine left. That has prompted fears among sexual health doctors that the NHS will be unable to inoculate people, including those at highest risk of getting the disease.
Dr Claire Dewsnap, the president of the British Association for Sexual Health and HIV (BASHH), said the letter accurately portrayed the looming unavailability of the vaccine, called Imvanex.
By current estimates, only 8,300 vaccines remain available, with 5,000 earmarked for London, where demand has been the greatest, making it likely that the remaining number of vaccines will run out in approximately 10 to 20 days, leaving a gap in supply until the next shipment arrives in September.
Without urgent action to procure more vaccines and avoid a gap in supply, we risk the disease spreading further throughout the UK and becoming an endemic public health challenge, Dewsnap said.
She praised the Department of Health and Social Care (DHSC) for ordering the vaccine early on in the outbreak, but warned that there is an insufficient supply of vaccines to meet demand and that a significant number of people eligible for vaccination against monkeypox are yet to be vaccinated.
The BASHH estimates that 250,000 doses of vaccine must be procured in order to vaccinate approximately 125,000 eligible people, yet the government has only procured over 100,000 to date.
Dewsnap criticised the DHSC, NHS bosses and the UK Health Security Agency (UKHSA), which has been monitoring the outbreak, for what she said were key failings in their response so far.
In addition to supply challenges, the current vaccination rollout is too slow; with vaccine access hampered by a lack of centralised leadership to coordinate across the various responsible agencies and providers, alongside poor communication about the vaccine to affected communities, she added.
The NHS England letter, which was obtained by the Financial Times, urged the health service to urgently draw up a plan to address the looming three to four-week shortage, bearing in mind these acute supply constraints and the urgency of reaching those at highest risk.
It added: This is clearly all very difficult and very sensitive, and not a position that any of us would like to be in.
One sexual health doctor in London told the Guardian their clinic was likely to run out of the vaccine next week.
My understanding is that there are about 5,100 doses of vaccine left in London for all patients until likely the end of September when 100,000 doses are due to arrive in the country, they said.
Our clinic has only a few doses left that we are having to give out opportunistically and we have been told we are unlikely to get any more doses, so we will likely run out next week.
Britain had recorded 2,859 cases of monkeypox by last Thursday, mainly in men who have sex with men. Worldwide there have been about 30,000 cases and nine deaths.
Clinics are having to shelve plans for vaccination drives as they cannot get the vaccine, the doctor added. At one point the aim was to be vaccinating 10,000 patients a week. Clinics have waiting lists of patients who have been identified as at high risk of infection who have not been vaccinated yet. They are trying to honour appointments for people who have already been booked for the vaccine but are unable to book in new patients.
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The NHS in London has been given the bulk of the vaccine supplies received so far from the manufacturer Bavarian Nordic, as it was the initial centre of the outbreak. However, doctors in Brighton, which has a large gay population, are understood to be concerned that they have been given too few doses, given the demand they are facing.
Dr Mary Ramsay, director of clinical programmes at the UKHSA, told the FT: The thousands of vaccines administered by the NHS to date among those at highest risk of exposure should have a significant impact on the transmission of the virus.
But the London sexual health specialist said: The feeling is that vaccination is the only way we will contain the outbreak long-term. Clearly the longer that it takes to vaccinate the people at risk the more chance the outbreak has to grow and extend.
The DHSC and UKHSA have been approached for comment.
A new study, published in Science Translational Medicine, showcases a new way to effectively deliver vaccines through mucosal tissues in the nose that could lead to better protection against pathogens like human immunodeficiency virus (HIV) and SARS-CoV-2, the virus that causes COVID-19.
Historically, nasal vaccines have been difficult to make successfully. The mucus in the nose typically clears out or breaks down the vaccines components, such as protein antigens, before they can access underlying tissues to activate the bodys immune cells.
The researchers found a way to help vaccine antigens bypass the mucosal barriers in the nose by engineering them to bind onto a protein called albumin, which naturally occurs in the human body and has the ability to get around these roadblocks. The antigens could then effectively hitchhike on albumin to get to their destination to start activating an immune response.
Nasal vaccines have the potential to generate even more immunity than current vaccines, because for many diseases that are transmitted through the upper respiratory system, such as COVID-19, nasal vaccines have the potential to trigger immune responses in the exact areas of infection the nose, mouth and lungs.
Traditional vaccines that are injected are not usually geared toward establishing immunity in these mucosal tissues, explained Brittany Hartwell, first author on the paper and an assistant professor in the U of M Department of Biomedical Engineering. They're more geared toward establishing immunity in the blood sort of like a backup defense. But the idea of establishing immunity in the mucosal areas, like the nose, is that it establishes more of a frontline defense that can better protect against transmission of these diseases.
The new vaccine proved effective at generating immunity not just in the nose, but in other mucosal tissues of the body as well, which include the upper respiratory system, lungs and genitourinary tract. The latter is especially relevant for vaccinating against a virus like HIV, which is transmitted through those sites.
This is really significant for the field of mucosal vaccination, Hartwell said. It shows something new, that weve designed a vaccine capable of overcoming barriers to delivery that have historically plagued the development of other mucosal vaccines. Its particularly relevant right now because were all living in the midst of the COVID pandemic. And as long as theres spread and transmission, the virus has a chance to evolve into new variants with the potential to be harmful. This research shows the development of a different kind of vaccine that could provide even better protection than what we currently have by blocking transmission, preventing us from catching and passing the virus onto others.
Hartwell is continuing to study and develop this new vaccine technology in her lab at the U of M and hopes to adapt it to other diseases and illnesses in the future.
The research was funded by the National Institutes of Healths National Institute of Allergy and Infectious Diseases; the National Cancer Institute; the Marble Center for Cancer Nanomedicine; the U. S. Army Research Office through the Institute for Soldier Nanotechnologies at the Massachusetts Institute of Technology; the Ragon Institute of MIT, Massachusetts General Hospital, and Harvard University; and the Bill and Melinda Gates Foundation.
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About the College of Science and EngineeringThe University of Minnesota College of Science and Engineering brings together the Universitys programs in engineering, physical sciences, mathematics and computer science into one college. The college is ranked among the top academic programs in the country and includes 12 academic departments offering a wide range of degree programs at the baccalaureate, master's, and doctoral levels. Learn more at cse.umn.edu.
New monkeypox vaccine plan may stretch nation's limited supply
The U.S. will use smaller doses of the monkeypox vaccine in order to stretch its supply.
Scott L. Hall, USA TODAY
About 600 doses of a monkeypox vaccine have been administered to Wisconsinites as of Tuesday, the state Department of Health Services said in a press conference Wednesday.
About 200 doses were given at the start of this week and another 300 over last week.
Health officials have confirmed 32 cases of monkeypox in the state as of Tuesday, according to DHS.
So far, the federal government has allocated 5,986 vaccine doses to Wisconsin and 3,286 have arrived in the state so far. The state health agencywill be able to order additional doses on Aug. 15.
Each vial of the vaccine can now be used to vaccinate up to five people from a single dose, following an announcement from the Food and Drug Administration on Tuesday.
The Jynneosmonkeypox vaccine is now available for adults as anintradermal injection, which penetrates only the top layerof skin. Previously, the vaccine was given only as a subcutaneous shot, which is a deeper shot that is delivered to the fat layer under the skin.
RELATED: Monkeypox has spread to Wisconsin. Here's what you need to know about the disease and how to avoid it.
RELATED: Demand for monkeypox vaccine outstrips limited supply of doses available in Wisconsin
Authorization of the alternate method of delivery of the shot stretchessupply of the vaccine fivefold because it uses less of the dose.
"Given the studies that we have, both vaccines the high-dose or low-dose seem to have the same beneficial effect on the immune system," said Dr. Ryan Westergaard, chief medical officer for the state Department of Health Services.
Following the FDA's authorization, DHS is working with vaccinators to provide them with the equipment and training to deliver the vaccines intradermally to extend the state's supply.
There are five monkeypox vaccine hubs forthe state: Medical College of Wisconsin, SSM Health, Mayo Clinic Health System in Eau Claire,the state agency's headquarters in Madison and Prevea Health.
As of this week, 40 clinical and public health siteshave placed orders for the monkeypox vaccine, Westergaard said, but the health departmenthopes to open more vaccination sites as the state gets more doses of the vaccine.
Monkeypoxspreads by closecontact with an infected person's fluids and lesions for a period of time, respiratory droplets from an infected personor by touching items contaminated with those fluids.
"Anyone with skin could be infected by this," Westergaard said.
Doses of theJynneos monkeypox vaccine are available in Wisconsin for prioritized groups:those who have had sexual relations in the last two weeks with someone diagnosed with monkeypox, people who have attended an event or venue with known monkeypox exposure and, notably, gay and bisexual men, trans men and women, gender nonconforming peopleand any man who has had sex with menin the last 14 days.
To reduce spread:
Contact Benita Mathew atbmathew@gannett.com. Follow her on Twitter at @benita_mathew.
Participants
This study enrolled adults aged18years living in Miyagi Prefecture who had a history of recent close (high-risk) contact with COVID-19 cases and had provided their nasopharyngeal swab specimens at a drive-through outpatient clinic for the testing of COVID-19 (Tohoku University Medical Office) at a location away from Tohoku University Hospital in Sendai City, Japan, managed by the local governments and Tohoku University, between January and May 2022. This period corresponded to the sixth nationwide wave of the COVID-19 outbreak, exclusively caused by the Omicron variant. During the study period, a sampling test of the viral genome revealed that more than 99% of the infections in the locality were caused by the Omicron variant. Because the main objective of this study was to evaluate vaccine effectiveness in those who had completed three vaccine doses (three-dose group) compared with those who were not vaccinated (no-vaccine group) or had completed two doses (two-dose group), those who had completed only the first vaccine dose (one-dose group) at the time of the nasopharyngeal swab test were excluded from subsequent analyses. This study was conducted before the fourth dose of COVID-19 mRNA vaccines became available in Japan. A flowchart of the study design is shown in Fig.1.
Flow diagram of the study design. Among the overall individuals tested by reverse transcription-polymerase chain reaction (RT-PCR) test using nasopharyngeal swab samples at a large screening test center in Japan between January and May 2022, (1) adults aged<18years, (2) those without a certain contact history, (3) those who had completed only one vaccine dose, and (4) those who were less than 7days after the last vaccination were excluded. Consequently, 767 adults were eligible for subsequent analyses.
From these tested individuals, information regarding the demographics (age and sex), detailed situation of the contact, vaccine completion status (number of completed vaccine doses and manufacturer of the vaccines), elapsed time from the last vaccination at the time of swab test, and results of nasopharyngeal swab reverse transcription-polymerase chain reaction (RT-PCR) test for SARS-CoV-2 were collected. The timing of nasopharyngeal swab sampling in most enrolled cases was scheduled 45days after contact with COVID-19 cases. Individuals who had already passed more than 14days from the last contact history were not tested at the testing center. To evaluate the effectiveness of the vaccine against COVID-19-associated symptoms 45days after the infection, the presence of symptoms including cough, dyspnea, fatigue and a body temperature37.5 was recorded at the time the PCR swab was taken.
To detect the virus in the sampled swab specimen, RT-PCR was performed to detect the viral nucleocapsid protein set no. 2 (N2) gene. A primer/probe set designed by the National Institute of Infectious Diseases in Japan (NIID_2019-nCoV_N_F2, R2, and P2) was used11. The details of the thermal cycling conditions have been previously reported12.
The closeness of contact with COVID-19 cases was judged using the criteria defined by the government. More specifically, fulfillment of all of the following four criteria was considered to be a close contact history: (1) contact with a patient with COVID-19 from 2 to 14days after the onset of symptoms or positive RT-PCR test results, (2) not wearing masks, (3) contact involving<1m distance, and (4)15min of contact. All other contact patterns with patients with COVID-19 were regarded as lower-risk contacts. The closeness of the contact in each of the tested individuals was assessed in advance before the RT-PCR test by the local government staff in public health centers.
The distributions of non-normally distributed variables were described as the median and interquartile range (IQR; 2575 percentiles). Comparisons of non-normally distributed variables between the two groups were performed using the MannWhitney U test, and those between the groups were performed using the KruskalWallis test, followed by the Scheff post-hoc test. The RT-PCR test positivity rate was used as the marker of the risk of infection in each subgroup, and the rates between those who were not vaccinated (zero-dose group), those who had completed only two doses (two-dose group), and those who had completed all third doses (three-dose group) were compared using the chi-square test. Risk ratios (RR) and 95% confidence intervals (CI) for RT-PCR test-positive participants between those with no vaccination and those who had completed the third booster vaccination were also evaluated. RR was calculated as the risk of infection in the three-dose group divided by the risk in the no-vaccine group. Vaccine effectiveness (%) and 95% CI were estimated as (left(1-RRright)times 100). Sample size calculation was performed before performing the chi-square test, which revealed a required sample size of n=32 in each group for a large effect size of =0.50, (alpha ) = 0.05, and power (i.e., (1-beta ))=0.80. Statistical significance was set at P<0.05. Adjustment for multiple testing was not performed because of the nature of the subgroup analyses in this study. To visually confirm the relationship between the elapsed time from the last vaccination and RT-PCR test-positivity rate in the two- and three-dose groups, the rolling average (5days) of the RT-PCR test positivity rate in these groups was depicted. Statistical comparisons and sample size calculations were performed using R Statistical Software (version 4.0.5; R Foundation, Vienna, Austria).
All methods were performed in accordance with relevant guidelines and regulations. All study protocols were approved by the institutional review board of the Tohoku University Graduate School of Medicine (approval number: 2020-1-535). Informed consent was obtained from all the participants.
WASHINGTON The Biden administration has decided to stretch out its limited supply of monkeypox vaccine by allowing a different method of injection that uses one-fifth as much per shot, according to people familiar with the discussions.
In order for the Food and Drug Administration to authorize so-called intradermal injection, which would involve injecting one-fifth of the current dose into the skin instead of a full dose into underlying fat, the Department of Health and Human Services will need to issue a new emergency declaration allowing regulators to invoke the F.D.A.s emergency use powers. That declaration is expected as early as Tuesday afternoon.
The move would help alleviate a shortage of vaccine that has turned into a growing political and public health problem for the administration.
In less than three months, more than 8,900 monkeypox cases have been reported. The virus spreads from person to person primarily through close physical contact with infectious lesions.
What is monkeypox? Monkeypox is a virus similar to smallpox,but symptoms are less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research. The viruswas primarily found in parts of Central and West Africa, butrecently it has spread to dozens of countries and infected tens of thousands of people, overwhelmingly men who have sex with men.
How does it spread? The monkeypox virus can spread from person to person through close physical contactwith infectious lesions or pustules, by touching items like clothing or bedding that previously touched the rash, or via the respiratory droplets produced by coughing or sneezing. Monkeypox can also be transmitted from mother to fetus via the placenta or through close contact during and after birth.
I fear I might have monkeypox. What should I do? There is no way to test for monkeypox if you have only flulikesymptoms. But if you start to notice red lesions, you should contact an urgent care center or your primary care physician, who can order a monkeypox test. Isolate at home as soon as you develop symptoms, and wear high-qualitymasks if you must come in contact with others for medical care.
I live in New York. Can I get the vaccine? Adult men who have sex with men and who have had multiple sexual partners in the past 14 days are eligible for a vaccine in New York City, as well as close contacts of infected people. Eligible people who have conditions that weaken the immune system or who have a history of dermatitis or eczema are also strongly encouraged to get vaccinated. People can book an appointment through this website.
Even though it invested more than $1 billion in developing the two-dose vaccine known as Jynneos that works against both monkeypox and smallpox, the government has only 1.1 million shots on hand. It needs about three times as many doses to cover the 1.6 million to 1.7 million Americans who, according to the Centers for Disease Control and Prevention, are at high risk of contracting monkeypox.
The vaccine is currently delivered in two 0.5-milliliter doses 28 days apart, with immune protection reaching its maximum 14 days after the second dose, according to the C.D.C.
The shot is recommended by the C.D.C. for people who have been exposed to monkeypox and those who might be likely to get it. Those in the latter category include people identified as a contact of someone with monkeypox, those who know a sexual partner from the last 14 days was diagnosed with the disease and those who have had multiple sexual partners in that time frame in an area with known monkeypox.
Federal health officials said last week that so far, they have distributed about 600,000 doses of the vaccine to state and local jurisdictions.
The Department of Health and Human Services last week also issued a broader public emergency declaration that allowed the federal government to more easily allot money and other resources to fight the virus.
What we consider before using anonymous sources. How do the sources know the information? Whats their motivation for telling us? Have they proved reliable in the past? Can we corroborate the information? Even with these questions satisfied, The Times uses anonymous sources as a last resort. The reporter and at least one editor know the identity of the source.
Research on intradermal injection of the monkeypox vaccine is essentially limited to one study. It showed that when the vaccine was injected between skin layers, it induced an immune response comparable to that from a standard injection into the fat underneath the skin. Federal officials have consulted with a variety of outside groups about switching to the intradermal injection approach, including the Infectious Diseases Society of America, according to people familiar with the talks.
Some outside experts have criticized the data backing up the method for monkeypox as too thin and narrowly focused. The governments decision to go with it is heavily based on a 2015 study that was sponsored by the National Institutes of Health.
Dr. John Beigel, an N.I.H. associate director of clinical research who has briefed federal health officials and the World Health Organization, said that switching to the intradermal method was a better option for preserving vaccine than administering just one of the two recommended doses, as some jurisdictions now do. One shot does not prompt nearly as strong an immune response as two, he said.
The upside is you can stretch out doses, said John P. Moore, a virologist at Weill Cornell Medicine. The downside is, if you cut it too far or take too many liberties, you reduce the efficacy. And how are you going to know that? Its educated guesswork.
The intradermal method can be complicated for vaccinators, who must guide a needle into a thin space. If a vaccinator goes too deep and inserts the dose into fat, the patient might not receive enough vaccine, experts say. But if the needle is not inserted far enough, some of the vaccine could leak back out.
Such shots typically induce more redness and swelling, but are less painful than a standard injection, the 2015 study showed.
They have previously been used in polio vaccination campaigns, for rabies and with tuberculosis skin tests.
The National Institutes of Health had planned further studies into how well such shots work with the monkeypox vaccine, but the results were not expected until the late fall or early winter. Over the weekend, top federal officials came to a consensus that the government needed to embrace the approach now.
Los Angeles County and the city will open a monkeypox vaccination site at Barnsdall Art Park tomorrow, but it will only offer vaccines to people who pre-registered with the county and have been notified that a shot is available.
The new site at 4800 Hollywood Blvd. in the East Hollywood area is expected to vaccinate about 300 people per day, operating from noon to 4 p.m. on Tuesdays and Thursdays, according to county Supervisor Hilda Solis' office.
Monkeypox vaccines remain in short supply, so the site will not be open to walk-in visitors seeking an inoculation. Shots will only be distributed to people who pre-registered and received a text message from the county notifying them that a dose is available.
As the monkeypox outbreak continues, it is critical that we increase accessibility to the vaccine for at-risk communities, Solis said in a statement. With the launch of the monkeypox vaccination site at Barnsdall Park, L.A. County is making it easier for residents in hard-hit communities to get vaccinated. I encourage residents to assess their risk and take steps to protect themselves from monkeypox as we wait for additional doses to Los Angeles County.''
The county declared a local emergency in response to the monkeypox outbreak last week. The state and federal government have also issued such declarations.
According to the county, there were 616 confirmed or presumed cases in the county as of Monday, up from about 500 on Friday. The vast majority of patients are men, with most of them being members of the LGBT community, according to the county.
Monkeypox is generally spread through intimate skin-to-skin contact, resulting from infectious rashes and scabs, though respiratory secretions and bodily fluids exchanged during extended physical episodes, such as sexual intercourse, can also lead to transmission, according to the CDC. It can also be transmitted through the sharing of items such as bedding and towels.
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Symptoms include fresh pimples, blisters, rashes, fever and fatigue. There is no specific treatment. People who have been infected with smallpox, or have been vaccinated for it, may have immunity to monkeypox.
According to health officials, the vaccine can prevent infection if given before or shortly after exposure to the virus.
Gay, bisexual and other men who have sex with men are at increased risk of contracting the virus, according to the CDC.
The county has been slowly expanding eligibility for the JYNNEOS monkeypox vaccine, but supplies remain extremely limited.
In Los Angeles County, monkeypox vaccines are available to people confirmed by the Department of Public Health to have had high- or immediate-risk contact with a known monkeypox patient, and to people who attended an event or visited a venue where they was a high risk of exposure to a confirmed case. Those people are generally identified through county contact-tracing efforts, and they will be notified by the county.
Shots are also available for gay and bisexual men and transgender people with a diagnosis of rectal gonorrhea or early syphilis within the past year. Also eligible for the shots are gay or bisexual men or transgender people who are on HIV pre-exposure prophylaxix, or PrEP, or who attended or worked at a commercial sex venue or other venue where they had anonymous sex or sex with
multiple partners -- such as at a sauna, bathhouse or sex club -- in the past 21 days.
Eligibility was expanded last week to include gay or bisexual men or transgender people aged 18 and older who have had multiple or anonymous sex partners in the past 14 days.
People who believe they fall into any of the criteria can contact their health care provider to see if that provider can administer the vaccine.
Qualified people who do not have a health care provider -- or whose provider does not carry the vaccine -- can either make an appointment at a designated vaccine clinic or visit a walk-in location. Information is available at ph.lacounty.gov/monkeypox. A list of monkeypox vaccine locations is available at http://publichealth.lacounty.gov/chs/DPHMonkeypoxSchedule.pdf.
The county last week activated a website -- ph.lacounty.gov/monkeypoxsignup -- where residents can fill out an online form to see if they may be eligible for a shot and pre-register to be added to a waiting list. But due to overwhelming demand and limited vaccine supplies, the pre-registration process was put on hold late last week.
The county last week also opened a monkeypox vaccination site at the West Hollywood Library, 647 N. San Vicente Blvd., for people who pre-registered for the vaccine. It will be open by appointment only from 9 a.m. to 6 p.m.
The vaccine is a two-shot regimen, so additional supplies will be reserved to provide second doses to those who received the initial shot.
The United States has declared a public health emergency for monkeypox, raising awareness of the outbreak hitting more than 70 countries across the world.
The big picture: Two-thirds of Americans said in a survey from the Annenberg Public Policy Center that they don't think there's a vaccine for monkeypox or they aren't sure. But there is and here's what you need to know about it.
There are two vaccines that are used to prevent monkeypox infections, per the Centers for Disease Control and Prevention.
Both vaccines are smallpox vaccines, which are believed to be effective at preventing monkeypox.
Worth noting: There is currently a limited supply of the Jynneos vaccine. The United States has been placing orders for the vaccine to handle the growing demand for vaccination, health officials told reporters Thursday.
The Jynneos vaccine includes a live virus that doesn't replicate and is associated with fewer adverse effects, the CDC said.
But ACAM2000 is distributed by multiple punctures, leading to potential scarring. The stainless steel needle is dipped into a reconstituted vaccine a method often used for orthopoxvirus vaccinations, the CDC said.
Several observational studies found the smallpox vaccine is 85% effective in preventing monkeypox, the World Health Organization said.
However, this is based on research from the 1980s based on a monkeypox outbreak in the Democratic Republic of Congo.
Heinz Weidenthaler, vice president of clinical strategy at Bavarian Nordic, which makes the Jynneos vaccine, told MIT Technology Review that animal studies found the vaccine offers 80 to 100% protection against the disease.
Worth noting: The CDC said there is no data available for the effectiveness of the vaccines for the current monkeypox outbreak.
The Jynneos vaccine contains a live weakened virus related to monkeypox and smallpox that does not replicate within the human body, per the CDC. You cannot catch monkeypox or smallpox from the vaccine, New York state health officials said.
The ACAM2000 vaccine contains a live version of the Vaccinia virus that is replicated, allowing your body to develop immunity.
For the Jynneos vaccine, adverse reactions include pain, swelling and redness at the spot of injection, according to the CDC.
The ACAM2000 monkeypox vaccine has similar physical side effects from the shot but comes with a higher risk of adverse effects, including myocarditis and/or pericarditis, the CDC said.
The CDC has limited eligibility for those who want a monkeypox vaccine.
What's next: U.S. health officials said Thursday that nearly 800,000 monkeypox vaccine doses will be made available soon for distribution
Go deeper ... 1 in 5 Americans fear they'll get monkeypox
Connecticut rolled out monkeypox testing and vaccination centers this week as cases continued to rise in the state and nationwide. As of Tuesday, the U.S. Centers for Disease Control and Prevention reported 39 cases of monkeypox in Connecticut. The state Department of Public Health says shots are available for queer men and transgender adults over the age of 18 who have had multiple or anonymous sex partners within the last 14 days.
Connecticut Public visited Fair Haven Community Health Care (FHCHC) on Tuesday and heard from patients and providers who say theyve been eagerly awaiting doses of the Jynneos vaccine.
As soon as I saw that first clinic pop up, I just really wanted to get an appointment, said Christopher Marsala, a Branford native who now lives in New London. Because its critical to be part of the solution. Just knowing that it's affecting [...] men who were having sex with men. [...] And being able to have empowered agency with health care, that makes me feel really great.
Efforts to distribute preventive doses of the vaccine are focused on queer men and transgender adults, health officials say, because transmission for this outbreak so far has been concentrated among this population. But all people are at risk of contracting the virus, through any physical contact with anyone who has monkeypox lesions on their skin or by coming into contact with items like bedsheets that symptomatic people have touched.
Ryan Caron King
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Connecticut Public
Theres nothing that makes one community more likely to get it than any other, said Jennifer Suski, medical director of the LGBTQ+ care program at FHCHC. It just happens to be where weve seen the outbreak so far. But really, this is a disease that can affect anybody.
Testing is available for anybody who believes they may have been exposed to the virus.
You can get the vaccine within four days of a known exposure, and that can help prevent the virus as well, Suski said.
Practitioners at the clinic said there has been significant demand for the vaccine.
The response was tremendous, so weve had to get more vaccine to accommodate everybody, said Wendy Cusick, program director of LGBTQ+ care at FHCHC. We did get more vaccine promised [Tuesday], another 50 doses. But we could probably use that up this week. So hopefully there will be more coming to the state.
Connecticut public health officials pleaded for the federal government to fast-track vaccine production earlier this week.
For more information about monkeypox, testing and vaccinations, visit the Connecticut Department of Health monkeypox webpage.
This post has been updated to reflect the number of days vaccines are available for eligible candidates with known exposures.
This week, the state ordered more than 5,000 more doses. It's already received more than 9,600 doses from the federal government.
DENVER Alex Buck first starting looking for a monkeypox vaccine weeks ago.
Ive been trying to get one for a while, he said.
I remember back in early July, there were [very few] in Colorado and a friend mentioned they got one, I looked into it and it was still too late.
He kept searching, and finally secured an appointment this week.
I've been kind of Googling it every few days, like, Do we have more? Can I get more? And I just kind of stumbled onto the Jefferson County Public Health website and they had a phone number you can call to say Call us for monkeypox vax appointments. I called, they asked a few questions, and got me in today. So it worked out really well.
Buck said the shot was pretty easy, especially compared to getting the COVID-19 vaccine.
No symptoms yet, Im waiting with bated breath, he said.
It was a small needle, in the underarm, it was actually really quick and painless, which I was very grateful for.
Monkeypox can affect anyone.
During this current outbreak, most cases have been among men who have sex with men. That population, or anyone who is a close contact to a positive case, are the only ones eligible for the very limited vaccine supply.
Alex shared a photo of himself after his vaccine on social media, hoping to encourage other members of his LGBTQ community to consider getting vaccinated, too.
I felt like I needed to get it because I am in the pool that is eligible, and I want to make sure I can live my life without a.) being worried about it and b.) knowing that Im safe from it, and any partners I have are safe from it, he said.
I felt that responsibility for it, that I'm being responsible for my health and others.
On Thursday, the Biden Administration declared monkeypox a public health emergency in the United States. Cases have topped 6,600 nationwide. Colorado reports a total of 79 cases.
In an email Thursday, state leaders said Colorado had already received 9,665 doses from the federal government. Those doses represent vaccines already administered, scheduled to be administered, or in the process of redistribution to other providers.
The state placed its latest order with the feds for another 5,080 doses on Aug. 1.
For me and a lot of my friends, were tired, Buck said with a brief laugh. Its hard to have to deal with COVID, thats around, it hasnt gone anywhere. Theres just so many layers to it. With COVID I was really excited about the vaccine Im happy to get the monkeypox vaccine but Im a lot more like, sigh. More drama.
For others who may be eligible for the vaccine and considering it, Buck offers this:
Keep an eye out on good information. You do have to do some of your own research, at least that I found. But it's worth it, it was really easy. Anything we can do to keep people safe and keep ourselves healthy is worth it in my opinion.
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