Monkeypox vaccines coming to Philly, but health officials say it’s not enough

Philadelphia’s tally of monkeypox cases is growing, and a shipment of 225 vaccine doses expected to arrive next week falls short of the city’s needs in a growing national outbreak, health department officials told The Inquirer.

The city’s count of monkeypox cases rose to 12 on Friday, a steep increase from two cases reported two weeks ago. Philadelphia has so far received 20 doses of vaccine, said James Kyle, a spokesperson for the Philadelphia Department of Public Health. He declined to say how many have been administered.

“We recognize that in a large metropolitan area on the I-95 corridor, 225 doses is likely less than ideal to address an ever-evolving situation,” Kyle said in an email, though he didn’t specify the volume of vaccine the city might need.

Philadelphia’s 225 doses account for half of the 450 vaccine doses expected in Pennsylvania, which state health officials described as the first shipment in a growing supply. The state’s receiving the JYNNEOS brand of vaccine, preferred due to having less severe side effects. New Jersey is also expecting an additional supply of vaccine but did not specify the amount.

Experts in the spread of infectious diseases say they are increasingly concerned about the slow public health response to the outbreak, so far mostly affecting men who have sex with men. They noted that while testing is expanding, current case counts are almost certainly an undercount across the nation. Some fear that U.S. health authorities are missing the chance to contain the virus.

“It is a bit mind-boggling,” said Jennifer Nuzzo, an epidemiologist at Brown University who studies pandemic preparedness. “COVID is a harder condition to stop. SARS are harder viruses to contain. Monkeypox is a reasonable candidate for containment.”

Pennsylvania reported Friday its count of monkeypox cases has grown to 23, and New Jersey counted 11. Across the country, about 791 cases of monkeypox have been identified, more than four times the number of cases reported two weeks ago.

The virus has not resulted in serious illness or death. It does cause significant discomfort and painful lesions to appear on people’s bodies that can last for up to a month and can leave permanent scars.

Vaccines are not the only limiting factor in the public health response. Experts say there also hasn’t been enough access to testing, which requires sampling fluid from monkeypox lesions. Priorities should include developing a test, possibly using saliva, that can confirm monkeypox infections before lesions form, Nuzzo said.

Health-care providers locally have needed public health departments to authorize tests for the virus, available through state health department laboratories, said John Zurlo, chief of the infectious diseases division at Jefferson Health. That means doctors can have trouble getting approval to test patients whose symptoms do not match the typical profile of the people contracting monkeypox.

“We should be open to the possibility that the epidemiology doesn’t fit the mold,” he said.

Philadelphia announced Friday that LabCorp is the first of what’s expected to be five commercial labs that will test for monkeypox.

Experts are still puzzling over how monkeypox is spreading across the United States, as part of a global outbreak.

About 96% of all monkeypox cases in the U.S. have been among men who have sex with men, Brown’s Nuzzo said, and the median age of infected people is 36 years. It spreads through close contact with an infected person — not necessarily through sex — and there’s no biological reason it couldn’t spread to others.

In its alert to health providers on Friday, the Philadelphia health department noted that monkeypox cases are showing up with different symptoms than in past global outbreaks of the virus. People now are not all developing fever prior to breaking out in rashes or lesions, and those lesions are concentrated in one area, like the genitals, rather than being scattered on the body.

Some people don’t have visible lesions or rash but instead complain of pain around the anus and rectum, or straining, pain, or cramping in their bowels.

» READ MORE: The U.S. has failed to identify some cases of monkeypox, but that may be starting to change

The virus has so far largely been confined to gay or bisexual men, but Nuzzo noted it isn’t unusual for diseases to spread among people with common social connections.

The virus is most easily transmitted through close or intimate contact with an infected person, and can also spread through touching lesions on another person, prolonged aerosol exposure, or contact with objects that previously touched infected rashes or bodily fluids, the CDC reported.

Monkeypox is not a sexually transmitted disease, but there are questions about whether the virus can also be spread through semen.

Nuzzo is concerned the virus could prove more harmful if children, pregnant women, or those who are immunocompromised are exposed.

“The worry is more about what this virus would do if it finds its way into susceptible populations,” she said.

The LGBTQ community has been seeking information, said Michelle Scamuffa, HIV program manager at AIDS Care Group in Sharon Hill, which is offering monkeypox testing.

“They’re certainly paying attention,” she said.

The lack of clear information has hit close to home for Michael LeVasseur, a Drexel University epidemiologist. He said gay friends who were unsure where to get tested have sent him pictures of lesions or rashes, asking if they could be caused by monkeypox.

LeVasseur is concerned that public conversations about the virus’ spread are being hindered by fears of stigmatizing gay or bisexual men.

“Everyone’s worried about stigma, stigma, stigma,” he said. “There’s a difference between we can’t talk about it, because we don’t want to stigmatize people, and this is information this population needs.”

Both the Philadelphia and Pennsylvania health departments distributed informational fliers about monkeypox at Pride events last month, the agencies said, and have reached out to LGBTQ organizations.

The federal government announced this week that 200,000 doses of the vaccine JYNNEOS has shipped or will be sent soon. Vaccines are distributed by federal authorities to state health departments, which then share them within the state.

» READ MORE: Monkeypox is almost nothing like COVID. Here’s what to know, from two Philly scientists who’ve studied it

Initially, doses in Philadelphia will be administered by the health department to people considered high risk, according to Kyle, the department spokesperson.

City and state health departments have been tracing the close contacts of those known to be infected, who are prioritized for vaccination. The state Health Department plans to distribute doses to Pennsylvania regions most affected by the virus.

As more doses become available, Kyle said, the department plans to distribute vaccine to outlets that focus on providing health care for people who are gay, bisexual, men who have sex with men, or transgender people who have sex with men.

Vaccines are given in two doses over the course of a month and are most effective if administered within four days of exposure to the virus, said Jefferson’s Zurlo. But they can still work if a person gets the first dose within two weeks of contact with an infected person.

Monkeypox has an incubation period of five days to three weeks, he said.

Health experts said a widespread vaccination campaign like for COVID is unlikely and not necessary.

Levasseur, the Drexel epidemiologist, said the United States would be wise to follow the more proactive model in Canada and Germany, where vaccines have been available to men who have had sex with two or more other men over a two-week period. Because transmission appears to happen mostly through extended intimate contact, the virus has little opportunity to spread widely.

“We need to start figuring out a way to do a broader screening program, especially with higher-risk populations,” he said.