US to offer monkeypox vaccines in states with high case rates | Medicine

The Biden administration on Tuesday announced plans to step up its response to monkeypox, detailing its plans to offer more vaccines and more testing to those most at risk of catching it, including men who have sex with men. and their partners.

The move comes after pressure from states, which pushed the administration to release more doses of monkeypox vaccine from the strategic national stockpile that is managed by the office of the assistant secretary for preparedness and response in the ministry of Health and Social Services. Critics have also accused the United States of not offering enough tests to monitor the spread of the virus, which is believed to be more widespread than current case numbers suggest.

The new plan addresses both. It will release more vaccine to areas with the highest case rates and ramp up testing, making testing available at five commercial labs in addition to an existing network of public health labs.

On Tuesday, HHS also activated the CDC’s Emergency Operations Center, to give the agency more flexibility and manpower to manage the national response to monkeypox.

The new plan will assign vaccine doses based on case rates in a state, focusing on men who have sex with men and their known partners, as well as anyone who thinks they have recently been exposed to the virus in as an anonymous partner.

“If you are among those who have had known exposure or in a group that is at higher risk for exposure in the past two weeks, here is what we would like you to know,” the CDC director said, Dr. Rochelle Walensky.

“Post-exposure vaccination, or the use of vaccines for post-exposure prophylaxis, is intended to reduce your risk of becoming infected with a monkeypox virus and then becoming ill. Vaccination should take place within two weeks following possible exposure, and the sooner you can get vaccinated after exposure, the better,” Walensky said.

So far in the United States, 306 cases of monkeypox have been identified in 28 jurisdictions. Globally, more than 4,700 cases have been reported in 49 countries, she said.

Currently, 10 states would be considered Tier 1 for priority in ordering vaccines.

The plan comes amid Gay Pride, a month filled with parties celebrating gender and sexual diversity, and a season that many public health officials say will only fuel the spread of the coronavirus. monkeypox, which is spread through close contact, including sex. .

Dr. Walensky said that currently the only people who can receive monkeypox vaccines are those with known exposure.

Given the large number of contacts and the difficulty in identifying all contacts during the current outbreak, the new strategy will recommend vaccines for those with known exposure who are contacted by public health as well as those who have been recently exposed. , but who have not been identified through contact tracing.

This includes those who have had close physical contact with someone diagnosed with monkeypox, those who know their sexual partner has been diagnosed with monkeypox, and men who have sex with men who have recently had multiple sex partners in a place where monkeypox has occurred or in an area where monkeypox is spreading.

The vaccination plan may require the United States to use two different types of vaccines.

The first is a new modern vaccine called Jynneos which is made by a Danish company called Bavarian Nordic. It was evaluated and developed to treat monkeypox infection. The United States currently has 64,000 doses of this vaccine in stock. The government will make 56,000 of these doses available to states in the first phase of the rollout.

The United States has ordered more of this vaccine and the government plans to make available 1.25 million additional doses of the Jynneos vaccine over the summer and fall, the administration said. There are 300,000 manufacturer-held doses currently on the way.

The problem is that the United States does not have enough doses of Jynneos to vaccinate everyone who might want it, so public health officials are also considering using a second, older type of vaccine called ACAM. The ACAM vaccine was developed to treat smallpox. It is given using a double-pointed needle which is repeatedly dipped in the vaccine and used to prick the skin on the upper arm causing a small sore or ‘pocket’ to form.

“It’s kind of an old fashioned technology that I basically don’t know of any clinicians who actually know how to do this. So it’s actually very difficult to deploy because you have to train people on a new vaccine methodology,” said said Dr. Jay Varma, professor and director of the Cornell Center for Pandemic Prevention and Response in New York.

The other complication is that the ACAM vaccine uses a live but weakened version of a virus to inoculate a person.

“It is presumed to be unsafe for use in people living with HIV,” Varma said. The main risk group for monkeypox – men who have sex with men – also have high rates of HIV infection.

On Tuesday, Dr. Walensky said that as more Jynneos vaccines arrive in the United States, the country will adjust its strategy to include more people.

“You know, as soon as we have more vaccines available, we will of course continue to move from a post-exposure prophylaxis strategy, ideally to a pre-exposure prophylaxis strategy,” Walensky said.

On Tuesday, public health experts said the expansion would be significant.

“It is essential that we distribute the vaccine to the population at risk and that we approach the use of the vaccine in the same way as we have approached pre-exposure prophylaxis for HIV,” said Dr Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota.


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