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In late July, the Allegheny County Health Department (ACHD) announced expanded access to the monkeypox vaccine on a case-by-case basis. Monkeypox has emerged as a public health concern in recent months. But what is monkeypox?
Monkeypox is an Orthopoxvirus, in the same viral family as smallpox.1 It is spread from person-to-person through direct contact with infectious rash, scabs, bodily fluids, respiratory secretions with prolonged contact (i.e., kissing, sex), or materials such as clothing or bedding that have been exposed to the rash or bodily fluids.1 Despite the heightened awareness surrounding monkeypox as of late, it is not a novel disease. It was first identified in monkeys in 1958 and in humans in 1970, with the first case in the United States noted in a 2003 outbreak transmitted from animals imported from Ghana.1 This incident represents the first time that monkeypox was reported in humans outside of Africa.2 At that time, the Centers for Disease Control (CDC), Food and Drug Administration (FDA), and governmental agencies developed guidance for healthcare professionals and animal handlers, deployed smallpox vaccine and treatments, and developed laboratory testing for the disease.1 Symptoms of monkeypox include a fever, headache, swollen lymph nodes, chills, aches, fatigue, respiratory symptoms, and the hallmark pox-type rash which appears as blisters on the face, genitals, hands, feet, or inside the mouth.1,2 In general, monkeypox tends to cause a milder infection as compared to smallpox, and is not spread as easily.1,2 Treatment for monkeypox is largely supportive care and symptom management. Anti-viral medications may alleviate symptoms, but there are currently no approved treatments.1,2
Presently, there are 2 vaccines in circulation for preventing monkeypox -JYNNEOS (Imavamune) and ACAM2000. ACAM2000 is FDA approved as a smallpox vaccine but it can be utilized against monkeypox due to the similarity of the viruses. It should not be administered in pregnancy, immunocompromised patients, patients with atopic dermatitis or eczema, or patients with pre-existing heart conditions.3,4 JYNNEOS is a newly developed vaccine against smallpox and monkeypox. It is indicated for adults requiring either pre or post-exposure prophylaxis to monkeypox and should be administered ideally within 4 days post-exposure, but can be administered up to 14 days post-exposure.1,5 It requires 2 doses, given 4 weeks apart and patients are fully protected at 2 weeks after the second dose is received.1,5 JYNNEOS contains gentamicin, ciprofloxacin, and chicken protein, so providers administering the vaccine should be aware of these potential contraindications.5 Both vaccines have similar side effects traditional to most vaccines including fatigue, injection site pain, headache, and myalgia.3,5 The supply of JYNNEOS will be increasing in the United States over the course of the next few months as local agencies prepare for increased transmission, however, there is no data at this time on the effectiveness of these vaccines on the current monkeypox outbreak.
Recently, there has been an increase in the number of confirmed monkeypox cases in the United States. Between May 2022 and July 2022, 4,539 cases have been reported across the country, of which 114 are in Pennsylvania.1 Globally, there have been over 20,000 cases across 77 countries since January 2022, 71 of which have not historically reported monkeypox.1 But should we be worried?
In general, monkeypox poses minimal concern for the general public due to low transmission rates, low severity of illness, and widespread smallpox vaccination in most Americans over the age of 50 which offers some protection against monkeypox. The Advisory Committee on Immunization Practices recommends vaccination as pre-exposure prophylaxis for personnel working with these viruses in labs, but no recommendation has been made for the general population or those with immunocompromising conditions.1,4 To reduce risk of infection, it is important to avoid contact with infected animals or materials that might be contaminated with the virus, wash hands, practice safe sex, disinfect surfaces, and use personal protective equipment when caring for those who have the virus.1,2
If you have any questions or concerns regarding a potential exposure to monkeypox or more information on the virus, please consult your local health department or healthcare provider. Information on the ACHD annoucment and locations for vaccines can be found here: Monkeypox | Health Department | Allegheny Home (alleghenycounty.us).
Kelly Cornuet is a board-certified pharmacist with a passion for public health policy and education, vaccine safety, and epidemiology. She aspires to work in the public health sector, improving health for marginalized communities in the Pittsburgh area.
References:
- Monkeypox. Centers for Disease Control and Prevention. Monkeypox | Poxvirus | CDC. Updated June 30, 2022. Accessed July 28, 2022.
- Monkeypox. Cleveland Clinic. Monkeypox: Causes, Symptoms, Treatment and Prevention (clevelandclinic.org). Updated June 16, 2022. Accessed July 28, 2022.
- ACAM2000 (smallpox vaccine) [prescribing information]. Cambridge, MA: Sanofi Pasteur Biologics; May 2017.
- Rao AK, Petersen BW, Whitehill F, et al. Use of JYNNEOS (smallpox and monkeypox vaccine, live, nonreplicating) for preexposure vaccination of persons at risk for occupational exposure to orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices – United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:734-742. DOI: http://dx.doi.org/10.15585/mmwr.mm7122e1.
- Imavamune (smallpox and monkeypox vaccine [live-attenuated, non-replicating]) [product monograph]. Newmarket, Ontario, Canada: Progress Therapeutics Inc; November 2021.
Kelly Cornuet
Kelly Cornuet is a board-certified pharmacist with a passion for public health policy and education, vaccine safety, and epidemiology. She currently works for Genesis Medical Associates, Inc where she works on various population health initiatives to improve the lives of those in the greater Pittsburgh area.
