PROVINCETOWN — The global outbreak of monkeypox has continued to expand. There were 23 cases in Massachusetts, 90 in New York, and 5,780 worldwide as of July 1, according to the Centers for Disease Control. But a vaccine strategy to contain it is now underway.
Both the state and federal governments confirmed at the end of June that vaccinating close physical contacts of cases will be the first step toward containing the disease until wider pre-exposure vaccination programs can begin in two or three months.
The current monkeypox outbreak appears to have begun in May and has been spreading mostly through intimate contact within the community of gay and bisexual men, or men who have sex with men.
The disease can spread when the first flu-like symptoms develop (fever, chills, malaise, body aches, and swollen lymph nodes). But it is most easily transmitted through contact with skin symptoms that typically develop a day or two later, according to Mass. Dept. of Public Health Assistant Commissioner Kevin Cranston.
Those symptoms include rash and characteristic swollen pox. The disease is painful, and although it tends to clear up on its own in about four weeks, it can leave scars.
Most cases are occurring through “sexual or really, really direct personal contact,” according to DPH epidemiologist Catherine Brown, and all transmission has been from people with symptoms, according to Cranston.
Monkeypox was discovered in the 1970s and is closely related to smallpox, so there are vaccines that prevent it. If given to a patient after exposure to the virus but before the first symptoms appear, one of the vaccines, Jynneos, can prevent the disease from developing.
The incubation period of the monkeypox virus, or MPV, can be 6 to 21 days, so reaching the contacts of newly discovered cases and inoculating them against the disease is the current priority for the state DPH and the CDC.
“Post-exposure vaccination in Massachusetts is going to be prioritized,” said Brown. “We are deploying this vaccine within hours to the places where patients will receive it.”
There’s a need for a public health practice people got familiar with during the pandemic — contact tracing. “Every time a case of monkeypox is identified, the DPH, local boards of health, and health care providers work together to identify their close contacts,” said Brown.
Then, vaccination is recommended only for high-risk, close-contact exposures, she said. That is, “direct contact, while someone is symptomatic.”
Because the Jynneos vaccine is being deployed from federal stockpiles and production contracts, federal rules will govern its use, Brown said. That means health officials in other states should also be following guidelines on vaccinating contacts.
The Biden administration published its monkeypox vaccine strategy on June 28. It includes a CDC recommendation of vaccination for “confirmed exposures and presumed exposures.”
According to the statement, “This includes those who had close physical contact with someone diagnosed with monkeypox, those who know their sexual partner was diagnosed with monkeypox, and men who have sex with men who have recently had multiple sex partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading.”
Right now, the state’s capacity to process monkeypox tests is limited because viral DNA must be manually extracted from test samples at the lab. For that reason, each test has to be authorized by the DPH. Still, Brown said, “People are getting results in less than 36 hours — mostly within 24 hours.”
Within two weeks, the DPH is expecting testing capacity to expand dramatically, when the CDC and FDA validate an automated process of DNA extraction.
Additionally, the Biden administration is looking to expand testing capacity by authorizing five commercial laboratories to process tests.
The federal vaccine strategy also says that, as supplies increase over the summer, jurisdictions can expand availability of the vaccine to a “broader population of individuals at risk.”
The federal government expects to receive an additional 240,000 doses in the coming weeks, and more than 750,000 doses over the summer, the statement says. An additional 500,000 doses should arrive in the fall. It also says the government will be working to ensure vaccines are being made available to communities most at risk and where transmission has been highest.
Still, Brown said that pre-exposure vaccination for “everybody who might want it” is a ways off.
“The feds are very clear that there’s not going to be enough vaccine to do pre-exposure for everybody who might want it,” said Brown. “We’re going to have to be thoughtful and careful about how we apply a prioritization system.”
With 1.6 million doses expected this year, a pre-exposure campaign is likely in the cards. In the meantime, people who have been in very close physical contact with a person who had symptomatic monkeypox should contact their health-care provider directly, said Cranston and Brown.