Seeking the monkeypox vaccine? Here’s why you probably won’t find it yet in Fresno County
With one case of monkeypox confirmed and other suspected cases for which lab tests are pending, health officials in Fresno County say they have a mere 20 doses of vaccine available to combat the spread of the virus.
“This is, to say the least, a current source of frustration to us because we just don’t have that supply of vaccine,” said Dr. Rais Vohra, interim health officer with the Fresno County Department of Public Health. “Just like in the very early days of COVID, our demand was much greater than the supply (of vaccine), so we’re having to make some very hard decisions.”
The county identified its first monkeypox patient, a young man, on Monday. In a media briefing Wednesday, Vohra said that man is recovering at home and is in stable condition.
“Right now Fresno County has 20 doses (of monkeypox vaccine) in its refrigerators,” said Joe Prado, the health department’s assistant director. “Because of the limited doses, we’re going to focus on close contacts (of confirmed patients) only at this time, and any of our clinical personnel who have had exposure to a monkeypox patient. This is a limited resource.”
The monkeypox vaccine regimen includes two doses for a person to be fully protected, Vohra said.
As more doses become available from the state Department of Public Health, Prado and Vohra said, eligibility to the vaccines will be expanded. “There is some indication that in August we should see some increased supplies in the state of California and Fresno County,” Prado said.
Other California counties are receiving more vaccine from the state, Vohra added, because they’ve had more monkeypox cases. With only one patient so far, he said, the issue isn’t serious in Fresno County so far.
“At this point we don’t have 20 close contacts that we’ve identified” from the first patient,” Vohra said. “It’s just a matter of time before we get more cases confirmed. We’ve got several suspected cases that the labs are getting done … so we may have more cases sooner rather than later, which would not surprise us.”
How does someone catch monkeypox?
Monkeypox is not a new virus, but prior to the current outbreak in the United States, it has been rare outside of countries in central and west Africa where it is endemic. “It’s been around for 50 years,” said Dr. Geetha Sivasubramanian, director of the infectious disease program at UCSF-Fresno. “It’s uncommon to see out outside of its endemic countries in such numbers that we are seeing now.”
The virus is closely related to smallpox, an often-deadly virus that was declared eradicated worldwide in 1980. “It’s a very mild variety of infection compared to what smallpox used to be,” Sivasubramanian said.
The disease gets its name from the rash that characterizes it. In previous outbreaks, “usually patients have a three- to four-day incubation period of … a flu-like syndrome, Sivasubramanian said. “They’ll have fever, body aches, headaches, maybe their lymph nodes will swell, and then the rash starts.”
The rash shows up as “fluid-filled lesions” that in this outbreak are showing up primarily in the genital area or around the mouth and face, she said. “Those lesions stay for about two weeks and then crust and fall off, then new skin forms on top.” While a person has active lesions, Sivasubramanian added, they are contagious “and they can give the infection to folks that come in close contact with the lesions or respiratory secretions.”
Once the lesions have healed, a patient is no longer contagious, she said.
Historically, there have been two types of monkeypox, Sivasubramanian said. One can occasionally cause severe infections, while the second is usually very mild. “We’ve been lucky that (the mild form) is the strain that’s been passing in the infections in this epidemic,” she said. “Most of the cases have been mild; hospitalizations have been rare. We’ve not had any deaths in the United States in this outbreak.”
Who’s at risk?
In the current outbreak, “what we are seeing is men are predominantly getting affected from this, but what is driving it is close contact,” Sivasubramanian said. “The virus spreads through very close contact and also through droplets during close contact. So any intimate physical activity – kissing, sex – is how this is spreading.”
Vohra cautioned that currently, “people need to know that men who have sex with men that are having multiple partners are at the greatest risk.”
“If you have a rash, get it checked out,” he added. “It could be monkeypox, but it could also be any number of sexually-transmitted diseases, none of which are normal, and we have treatments for them.”
Vohra and Sivasubramanian both said testing for monkeypox is quickly becoming more widely available, both through the county health department as well as through commercial testing labs.
But monkeypox is not considered a sexually-transmitted disease like syphilis, herpes and other infections, Sivasubramanian noted. People can also contract the virus from objects, linens and clothing that have come into contact with fluids from an infected person.
“I don’t think the virus knows our gender or orientation,” she said. “The reason this is happening in our men-having-sex-with-men community right now is that’s where it started and that’s where the close contacts are happening.”
But “this virus can infect anybody. Anyone who’s in close contact with someone who has an infectious rash is at risk,” Sivasubramanian added.
“It can affect women and other populations as well. …I don’t think we can get callous that this is going to stay within the men-who-have-sex-with-men community alone. It’s not a virus that has traditionally, historically been a sexually transmitted disease.”
This story was originally published July 20, 2022 at 6:05 PM.
