U.S. to stretch monkeypox vaccine supply with smaller doses

As monkeypox cases continue to rise among high-risk individuals, federal officials announced Tuesday they will expand limited vaccine supplies by administering just one-fifth the current dose.

The move would quintuple the existing supply of monkeypox vaccine doses, a priority in hard-hit communities like Los Angeles County and San Francisco, where the virus has been rising rapidly in communities where men have sex with men and vaccines remain in short supply .

The U.S. Food and Drug Administration has granted an emergency use authorization, allowing healthcare providers to use the new vaccination technique for high-risk adults.

“In recent weeks, the spread of monkeypox virus has continued at a rate that has made it clear that our current vaccine supply will not meet current demand,” said FDA Commissioner Dr. Robert Califf in a statement. “The FDA was quick to explore other scientifically appropriate options to increase vaccine access for all affected individuals. By increasing the number of doses available, more people who want to get monkeypox vaccine now have the opportunity to do so.”

Los Angeles County health officials said they are awaiting direction from federal officials and hope to implement the strategy once clinicians are trained.

“With this new alternative regimen that we have just been made aware of, we will now have five times the number of doses,” said Dr. Rita Singhal, Chief Medical Officer of the LA County Department of Public Health. “And that would add quite a bit to our capacity.”

Health experts say one of the only ways to get a handle on the growing outbreak is to drastically increase vaccinations among those at higher risk, adding that the more cases rise, the more difficult it will be to contain the spread. Doctors worry that increased spread could cause the virus to become endemic in wildlife populations, meaning it would be virtually impossible to remove it as a new disease of concern in the US

In an interview earlier this week, UC San Francisco infectious disease expert Dr. Peter Chin-Hong said expanding vaccine availability would be a key factor in responding to the outbreak. Currently, the monkeypox vaccine is given subcutaneously, or under the skin. The newer technique would give a shot intradermally or inject it in a more shallow way.

The expectation earlier this week was that federal officials would not act until more data came in on the effectiveness of the shallower injection method, and that wouldn’t be until late November or early December. However, some scientists pointed out that the intradermal technique has been used in other vaccines, such as yellow fever, when vaccines are scarce, according to Chin-Hong.

If the shallower injection can lead to an increase in antibodies, “I think it’s potentially going to be a good thing,” Chin-Hong said Monday.

At a ward council meeting with his colleagues last week, Chin-Hong expressed concern about the rise in monkeypox cases.

“If you look at the rates of increase, you can see that it’s really approaching an exponential curve. And unfortunately, as those numbers get higher, it’s getting harder and harder to control,” he said.

Anyone can get monkeypox. However, it has spread rapidly in LGBTQ communities, partly because contagious lesions can first appear in the rectum, urethra, and mouth before appearing on the skin, and because the first skin symptoms can appear as harmless as a pimple. This makes it possible to transmit the virus to other people during intimate sexual encounters without those infected knowing they are contagious with the virus.

Cases of men having sex with men and transgender people having sex with men are rising sharply, Chin-Hong said. About 98% to 99% of cases belong to these groups.

The spread of monkeypox cases has also been amplified by Pride events, particularly at gay saunas and pool parties where intimate skin-to-skin contact occurs, Chin-Hong said. The virus is not transmitted through pool water and generally not through surfaces. However, it can be transmitted through infected bed sheets.

As the number of reported cases of monkeypox has continued to rise, officials have scrambled to give as many shots as possible and expand the limited amount of doses.

Gov. Gavin Newsom earlier this month declared a state of emergency over the spread of the virus to “amplify the state’s immunization efforts.” And the White House has declared the disease a public health emergency.

The Jynneos vaccine is a two-dose series, with shots given four weeks apart. It can also be used preventatively and within two weeks of exposure.

However, supplies are limited, leading health authorities to recommend in many cases prioritizing the first doses rather than stockpiling for the second shot.

“While supplies remain tight, vaccinators in California may offer first doses of Jynneos to additional at-risk individuals rather than keeping inventory as second doses for immunocompetent individuals, even if second doses are consequently administered more than 28 days apart,” the guidance said The California Department of Health states.

Ditto for Los Angeles County, where the local Department of Health is “urging all providers to prioritize giving the first doses of the Jynneos vaccine to eligible immunocompetent individuals to protect as many at-risk individuals as possible.”

Singhal said Tuesday LA County continues to prioritize first doses, but noted the federal agency’s decision could allow administrators to take second shots sooner.

Immunocompromised people should get their second dose within the 28-day interval if possible, officials say.

When asked last week about the FDA’s potential action, Los Angeles County Public Health Director Barbara Ferrer said, “We fully support any effort that can be made to increase the number of people vaccinating with the doses can safely raise hand.”

“We would work absolutely hard to make sure we could do that very quickly here in LA County,” she said during a recent briefing.

She noted that such a move “would require more training from vaccine administrators, so we need to look at the network that’s vaccinating now to make sure we can maintain that capacity,” but said “most vaccinators would be able to.” to proceed with subcutaneous injection.”

Singhal said 647 cases of monkeypox have been identified by the LA County Department of Public Health — “double the number of cases 10 days ago.”

As of last Thursday, 1,310 cases of monkeypox had been reported statewide, most of them in LA County and San Francisco.

Of the 885 cases for which data are available, state officials said the vast majority — about 97% — did not require hospitalization. No deaths from the disease have been reported.

However, the number of cases has increased at a faster rate.

“Our pace of new cases has increased over the past few days and that’s certainly a concern,” said Dr. Orange County Assistant Health Commissioner Matthew Zahn during a briefing Thursday. “If you compare us to surrounding counties, certainly LA County, our numbers aren’t that high. But we certainly see our numbers growing in Orange County.”

On Monday, Orange County health officials reported 37 confirmed and probable cases of monkeypox.

https://www.latimes.com/california/story/2022-08-09/u-s-will-stretch-supply-of-monkeypox-vaccine-by-five-times U.S. to stretch monkeypox vaccine supply with smaller doses

Russell Falcon

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