Monkeypox

[belkinDC]

Curious for those who have gotten the shot, were there any notable side effects? I didn’t experience anything from my 2 Pfizer COVID doses, but did have about a day of flu-like symptoms after Moderna booster, as well as a sore shoulder that persisted for ~6 weeks (I think perhaps the pharmacy tech may have been off-target with the injection site).

[Guest]

3 hours ago, belkinDC said:

Curious for those who have gotten the shot

Re: Jynneos mpox vaccine

no side effects whatsoever. it’s a very small needle (like insulin) and subcutaneous injection, not intramuscular. It’s really cold, so that feels weird and they do it in the tripcep area.  some people feel tenderness at injection site & that’s it. 

[belkinDC]

https://www.nytimes.com/2022/07/25/nyregion/nyc-monkeypox-vaccine-doses-denmark.html

As Monkeypox Spread in New York, 300,000 Vaccine Doses Sat in Denmark

The federal government adopted a wait-and-see response to the monkeypox outbreak, calling for more vaccines to be delivered only after cases were growing exponentially.

By Joseph Goldstein and Sharon Otterman

July 25, 2022Updated 6:52 p.m. ET
 

On the Thursday before Pride Weekend last month, hundreds of men dropped what they were doing and raced to a city-run health clinic in Manhattan. Finally, more than a month after monkeypox appeared in New York City, a vaccine was being made available to sexually active gay and bisexual men, among whom the virus was rapidly spreading.

But there was a catch: There were only 1,000 doses available. Within two hours, the only clinic offering the shots began turning people away.

At that same moment, some 300,000 doses of a ready-to-use vaccine owned by the United States sat in a facility in Denmark. American officials had waited weeks as the virus spread in New York and beyond before deciding to ship those doses to the United States.

Even then, there was little apparent urgency: The doses were flown piecemeal, arriving in shipments spread out over more than a week. Many didn’t arrive until July, more than six weeks after the first case was identified in New York City.

By holding back the doses, an early opportunity to contain or slow the largest monkeypox outbreak in the country appears to have slipped by. On Saturday, the World Health Organization declared monkeypox a global health emergency. At least 16,000 cases have been reported around the world, with about 3,000 in the United States. Infections in New York City make up nearly a third of the national case count.

Limited testing means those numbers are likely a significant undercount.

The federal response to monkeypox, including the limited testing capacity, has echoes of how public health authorities initially mismanaged Covid-19.

With monkeypox, however, the federal government had a powerful tool to slow the spread from the start: an effective vaccine.

Yet the government was slow to deploy the vaccine, which was originally developed and stockpiled for use against smallpox, activists say.

“The U.S. government intentionally de-prioritized gay men’s health in the midst of an out-of-control outbreak because of a potential bioterrorist threat that does not currently exist,” said James Krellenstein, a Brooklyn-based gay health activist, who has been urging health officials to make the vaccine more widely available since June.

The federal official in charge of the agency that manages the United States’ supply, Gary Disbrow, said the government was “moving very quickly because we take this very seriously.”

“We thought it prudent to get as many doses as we had available over here, fully understanding that if the doses are not used there would be a potential impact on smallpox,” he added. “We moved very quickly based on the number of cases we saw.”

Called Jynneos, the vaccine is effective against both smallpox, which generally has a 30 percent fatality rate, and monkeypox, which can be severe but has a far lower fatality rate.

When monkeypox was first detected in the United States in mid-May, there were some 2,400 doses on U.S. soil, in the federal government’s strategic national stockpile, used mainly to protect lab workers and Centers for Disease Control and Prevention personnel engaged in research, officials said.

The United States also owned well over a million Jynneos doses in vials — and enough vaccine for millions of more doses that had yet to be filled into vials — in Denmark, where the producer of the vaccine, Bavarian Nordic, is headquartered.

Much of that supply was tied up in bureaucratic red tape because the Food and Drug Administration had yet to inspect and certify a new facility outside Copenhagen where the company now fills the vaccine into vials — an issue that has yet to be fully resolved.

But there were 372,000 doses owned by the United States that were ready to go. These doses, stored at the company’s headquarters, had been filled into vials earlier, at a different facility with the necessary F.D.A. approval.

Rather than quickly transfer those doses back to the United States and begin administering them, however, the federal government adopted a wait-and-see attitude. In the first few weeks after monkeypox was detected in the United States, the government requested only 72,000 of the 372,000 doses.

The job of managing the country’s supply of Jynneos falls largely to the Biomedical Advanced Research and Development Authority, or BARDA, a federal agency that develops and procures drugs and vaccines to protect against pandemics, bioterrorism and other hazards. The authority supported development of the vaccine following the terrorist attacks of Sept. 11, 2001, as the federal government worried about the use of weaponized smallpox.

One reason that federal officials were reluctant to order all available doses early on involved cold storage and shelf life. The storage facilities in America where the doses would be kept weren’t as cold as the Denmark facility, said Dr. Disbrow, a senior official at the Department of Health and Human Services who runs BARDA.

“So if all the doses were not necessary for the outbreak,” he said, “their shelf life would be dramatically shortened.”

Joseph Osmundson, a microbiologist and queer activist, said that the monkeypox outbreak may not have been the emergency that the federal government had prepared for — weaponized smallpox — “but this is an emergency nevertheless.”

“There is no excuse for this level of bureaucratic inaction,” he said.

The first monkeypox case to be detected in the United States this year was identified in Massachusetts on May 18. New York City identified a case the next day. On May 20, BARDA requested that Bavarian Nordic send over 36,000 doses, a spokeswoman for the agency said. They arrived five days later.

On May 27, BARDA requested another 36,000 doses, which arrived two weeks later, Dr. Disbrow said. By then, 16 cases of monkeypox had been detected in New York City, along with cases in 14 other states and the District of Columbia.

Dr. Disbrow said that only so many doses could be transported per flight. In an email, a spokesman for Bavarian Nordic explained that each large order required some lead time. The company has to first receive containers, known as cocoons, from the shippers and then “freeze them to temperature for five days” before packing them with vaccine.

As of June 10, the federal government had distributed just a few thousand doses of monkeypox vaccines to states, officials said in a call that day with reporters. A senior Health and Human Services official, Dawn O’Connell, said the United States would receive 300,000 doses of Jynneos “over the next several weeks.”

Except, the U.S. government hadn’t yet requested them. “That order came in late June,” a Bavarian Nordic spokesman said.

Dr. Disbrow, the BARDA director, gave a similar timeline in an interview, although a spokeswoman for the agency subsequently said the government asked for those doses earlier, on June 14.

By all accounts, the first shipments of the remaining 300,000 doses did not begin arriving until June 29 or 30, several days after the New York City Pride March and related festivities, and they arrived in several shipments, Dr. Disbrow said.

But many of the doses did not arrive until July. Bavarian Nordic said some were delayed in part because they had to be driven from Copenhagen to Germany, because airline pilots were on strike at SAS, the Scandinavian airline.

Asked about the delays, the BARDA spokeswoman, Elleen Kane, said that if one counted only “business days” the time lag was shorter.

Mr. Krellenstein, the activist who leads a group, PrEP4ALL, which works to increase access to daily medication that prevents H.I.V. infection, was one of the first to be vaccinated during New York City’s first window, on June 23. But he received a deluge of text messages from friends who said they’d missed out.

That evening, Mr. Krellenstein called a health activist he knew in Boston: “We said, ‘Oh, my God, the doses aren’t coming. What’s going on?’”

He said he was stunned to learn that most of the doses were stuck in limbo in Denmark awaiting the F.D.A. facility inspection.

Along with several H.I.V./AIDS activists, including some from the group ACT UP, Mr. Krellenstein began demanding meetings with White House and federal health officials to learn more about the hold up.

“Those doses likely would have been sufficient to stem the initial outbreak, if they had been mobilized and administered in the U.S.,” Mr. Krellenstein wrote in an email to several Biden administration officials in mid-July.

A spokeswoman for Health and Human Services, which oversees BARDA, responded by suggesting that more doses hadn’t been needed earlier, noting that initially the C.D.C. had only endorsed the vaccine for a limited group: known contacts of monkeypox patients.

Though New York City had by June 23 decided to offer the vaccine more broadly — to all men who had recently had sex with multiple or anonymous male sexual partners — the federal government did not endorse that move until June 28.

By early July, it was clear that the spread of monkeypox was accelerating among men who have sex with men in New York City.

Sergio Rodriguez, 39, a transgender queer man who lives in the East Village, said he tried to get vaccinated before Pride Weekend, but was turned away. He hooked up with a few people, and about a week later, began to feel abdominal pain, swollen lymph nodes and body aches. Lesions then spread across his body, and some made it excruciating to urinate.

“I’ve actively been trying to do things to support myself because I knew that I would be at high risk,” he said.

“It’s really frustrating,” he added, that the government “was not set up to adequately meet the demand.”

The situation in New York City had been especially frustrating. By the end of the first week of July, there were already more than 200 known cases in New York, but the city had received only 7,000 doses.

When the city received an additional 14,500 doses the following week, the available vaccination slots were taken within seven minutes of being posted online.

Lawrence Gostin, a former C.D.C. adviser who directs the O’Neill Institute for National and Global Health Law at Georgetown University, said it was clear based on recent conversations he had with White House officials that they were searching for a czar-like figure to run the monkeypox response, in what would be an acknowledgment of the need for more sweeping action by the federal government.

Several administration officials confirmed that such a search was underway. Raj Panjabi, the White House director of pandemic preparedness, has so far overseen monkeypox response efforts.

One White House official familiar with the administration’s response said that while it was also considering declaring a public health emergency, there was still an active discussion about what powers such a declaration might provide. Mr. Gostin said officials were working to determine how such a move could potentially free up funds for research, vaccines and treatments.

The flow of vaccine doses to New York has begun to increase; the city has now received 46,000 of them. But online appointments are still snapped up within minutes. And by now, monkeypox has spread widely enough in New York City that epidemiologists doubt it can be contained anytime soon.

[kjun12]

Lengthy and thorough.  I appreciate that you found and distributed this.

[macaroni21]

https://www.bangkokpost.com/thailand/general/2353912/capital-on-alert-for-monkeypox

However, the Phuket Express reports that the patient was not a recent tourist but had been in Thailand since last year and overstayed his visa.

https://thephuketexpress.com/2022/07/22/update-nigerian-man-confirmed-as-thailands-first-case-of-monkey-pox-being-traced-by-police-after-vanishing-act-was-on-overstay/#l61p26bpz01idete6ec

[reader]

From Thai PBS

Now testig wastewater for monkeypox at Bangkok airport

Sewage at Bangkok’s Suvarnabhumi Airport is being tested for the monkeypox virus by researchers from Naresuan University in the northern province of Phitsanulok. The tests can detect traces of the virus in wastewater immediately – even before the infected person begins to show symptoms – and could be used as a “budget surveillance measure” to catch and control local outbreaks early on.

Authorities are ramping up monkeypox prevention measure since Thailand’s recorded its first case of the virus in Phuket last week and since the World Health Organisation declared the monkeypox outbreak a “global health emergency” on Saturday, after 16,000 cases were recorded in 75 countries.

According to research, the monkeypox virus can be detected in feces between 7 – 14 days of contracting the virus, often before the infected person begins to show symptoms. Therefore, testing wastewater could help to locate and control the disease before an outbreak occurs.

Dr. Thanaphon Penrat from the Ministry of Higher Education, Science and Research Innovation said the idea is not only preventative, but cost-effective…

“Monkeypox does not spread easily but has a fatality rate ranging between 1-10%. Testing wastewater for traces of monkeypox at airports and tourist destinations is the cheapest way of finding early-warning signs of monkeypox outbreaks.”

Testing wastewater could be a sensible way to screen tourists arriving in Thailand for monkeypox instead of testing every person who comes through the airport. Introducing pre-arrival or on-arrival monkeypox testing for individual arrivals could be catastrophic for Thailand’s tourism industry, which has only just started to recover since the removal of Covid-19 related entry requirements.

==================

From The Nation

40 year old smallpox vaccines effective against monkeypox

Thailand has a stockpile of smallpox vaccines in cold storage which were produced more than 40 years ago in 1979 and 1980. Not only are the vaccines still effective against smallpox, but they are 85% effective against monkeypox too, according to Thailand’s Department of Medical Sciences (DMS).

The vaccines could be used in the instance that the global monkeypox outbreak becomes a public health emergency in Thailand and the government is unable to procure fresh, more recently produced vaccines.

There are 10,000 vials in storage which each contain 50 doses of the vaccine, amounting to around 500,000 doses in total. The vaccines are left over from when smallpox was completely eradicated in Thailand by 1980. The vials are from 13 batches, produced in 1979 and 1980, have been stored at 2-8 degrees Celsius for over 40 years.

[Riobard]

I think the stockpile, though not specified, is Smallpox vaccine Dryvax, as storage in powdered form (freeze-dried) is mentioned in Thai media. Its age suggests it is not the derivative ACAM2000. There is little enthusiasm among scientists for its current use compared to MVA-BN. Safety profile concerns, not concerns about degree of protectiveness. Here is an article that elaborates …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179474/

[Riobard]

Next potential crisis: Bifurcated needle supply chain for countries choosing long-stored vaccine supplies. 

[Riobard]

None of the Canadian provinces engaged in Imvamune rollout at this time is offering the second MVA-BN dose (aka Imvamune, Jynneos, Imnavex) except to those considered to be immunocompromised. That subgroup would be accessing the full vaccination regimen, or the 2nd dose according to the 4-week interval, within their medical specialty programs.

Folks including foreign nationals that have easily accessed the first dose at the designated walk-in Monkeypox vaccination centre in Montreal will not be granted the 2nd dose 28 (or 28+) days later if they show up hoping for it. It’s not an issue for me because I am satisfied that my broad-spectrum orthopox immunity has been given a sufficient boost with the single dose several weeks ago, having received childhood Smallpox vaccination some 60+ years ago.

Canada is currently offering only a single dose (except for above-mentioned provision) irrespective of Smallpox vaccination history. This is based on pragmatic considerations of unknown supply-demand in the shorter term as well as clinical data that supports the notion of fairly immediate and sustained protection from a single dose.

The demand in Montreal had fizzled but I imagine uptake will increase this week due to the International AIDS Conference hosted here this year, presumably many attendees not accessing MVA-BN in their home nations, including European Union that just approved it but has inadequate supply. 

[belkinDC]

Got my first dose today from county Health Dept. in Northern VA. Was advised they would reach out in 3 weeks to schedule 2nd dose, which they aren’t scheduling on-site in case there are any supply issues. I asked about the possibility of supply issues and the nurse told me they were well under utilization for the doses they had been allocated and she didn’t foresee that being an issue. I was the only client there during the 30 minutes that it took, despite there being ~10 staffed nurse stations setup for vaccine administration.

I do think they could be doing a better job advertising the availability of the shot; as mentioned previously I only found out it was available to the broader MSM population in my jurisdiction (not just close contacts) from a guy on Scruff.

[Riobard]

DC has just pivoted to the single-dose playbook. I would think other jurisdictions will follow suit.

For VA I nominate the term ‘Virjynneos’ for enhanced public awareness. 

[Guest]

2 hours ago, belkinDC said:

I do think they could be doing a better job advertising the availability of the shot;

tell your friends and those in your social networks - it’s a grassroots thing. help whomever you can w information 

[fedssocr]

2 hours ago, belkinDC said:

Got my first dose today from county Health Dept. in Northern VA. Was advised they would reach out in 3 weeks to schedule 2nd dose, which they aren’t scheduling on-site in case there are any supply issues. I asked about the possibility of supply issues and the nurse told me they were well under utilization for the doses they had been allocated and she didn’t foresee that being an issue. I was the only client there during the 30 minutes that it took, despite there being ~10 staffed nurse stations setup for vaccine administration.

I do think they could be doing a better job advertising the availability of the shot; as mentioned previously I only found out it was available to the broader MSM population in my jurisdiction (not just close contacts) from a guy on Scruff.

I'm also in NoVA. What were the criteria for getting the vaccine? I think I saw in NYC one of them is multiple sex partners over the past 2 weeks

[edit] Actually I found the criteria for my county on the health department website

Monkeypox Vaccine Interest Survey

A A A |

This form is to gather information from those interested in a monkeypox vaccine.

Currently, you may be eligible for vaccine if you are :

A Virginia resident and 18 years of age or older

AND

• Gay, bisexual, and other men who have sex with men and have had multiple or anonymous sexual partners; OR
• Transgender women and nonbinary persons assigned male at birth who have sex with men; OR
• Sex workers (of any sex); OR
• Staff (of any sex) at establishments where sexual activity occurs (e.g., bathhouses, saunas, sex clubs); OR
• Persons (of any gender or sexual orientation) who attend sex-on-premises venues (e.g bathhouses, sex clubs).

[belkinDC]

1 hour ago, Slvkguy said:

tell your friends and those in your social networks - it’s a grassroots thing. help whomever you can w information 

Absolutely. I also added a PSA to my Grindr profile since that’s how I found out about it myself.
 

 

4 hours ago, Riobard said:

DC has just pivoted to the single-dose playbook. I would think other jurisdictions will follow suit.

Glad to see this - as @Slvkguymentioned in the other thread, one shot gives good protection for two years - by which point presumably any supply issues will be long gone. I had read elsewhere that CDC was recommending (mandating?) that local health departments follow the 2 dose regimen as that’s what the FDA label indicates. But good to see some common sense prevailing, and hopefully the US will soon be in a position - and willing - to share doses with other countries who don’t have the benefit of our stockpile, such as it is.

[Riobard]

.

[reader]

The Health Ministry has identified a "foreign male" as the source of Thailand's second case of monkeypox. Let's hope this doesn't turn into another "dirty foreigners" episode.

From Khaosod English / Thaiger

A Thai man in Bangkok has tested positive for monkeypox, becoming Thailand’s second recorded case of the virus since the global outbreak began in May this year.

At 2:30pm today, Public Health Minister Anutin Charnvirakul revealed that the positive result from Wachira Hospital in Bangkok had been confirmed by the Ministry of Health.

The 47 year old Thai man started to feel ill on July 12. Two days later, the man developed a fever, body ache and swollen lymph nodes. A week later, a rash appeared on his genitals, torso, face and arms which is when the man went to be tested at the hospital.

The man told the doctors he had sex with a foreign male, who he suspects gave him the virus. He will isolate at the hospital for 21 days.

Director-General of the Department of Disease Control Dr.Opas Karnkawinpong said that ten people from one household in Bangkok are at high-risk of contracting the virus after having close contact with the man. All ten will be tested for the virus, observe their symptoms and be tested again after 21 days.

[scott456]

On 7/26/2022 at 4:06 PM, fedssocr said:

 

Monkeypox Vaccine Interest Survey

A A A |

This form is to gather information from those interested in a monkeypox vaccine.

Currently, you may be eligible for vaccine if you are :

A Virginia resident and 18 years of age or older

AND

• Gay, bisexual, and other men who have sex with men and have had multiple or anonymous sexual partners; OR
• Transgender women and nonbinary persons assigned male at birth who have sex with men; OR
• Sex workers (of any sex); OR
• Staff (of any sex) at establishments where sexual activity occurs (e.g., bathhouses, saunas, sex clubs); OR
• Persons (of any gender or sexual orientation) who attend sex-on-premises venues (e.g bathhouses, sex clubs).

All available Monkeypox vaccine appointments across the country are filled.  And there is no more vaccines coming.

[belkinDC]

8 hours ago, scott456 said:

All available Monkeypox vaccine appointments across the country are filled.  And there is no more vaccines coming.

Not to be argumentative, but do you have a source for either claim? Just yesterday, HHS announced the shipment of an additional 786,000 doses, based on the FDA's inspection approval of the Bavarian Nordic plant where they were made which had kept them from being deployed thus far. https://www.cnbc.com/2022/07/27/us-to-release-786000-additional-monkeypox-vaccine-doses-as-outbreak-spreads.html

[scott456]

4 hours ago, belkinDC said:

Not to be argumentative, but do you have a source for either claim? Just yesterday, HHS announced the shipment of an additional 786,000 doses, based on the FDA's inspection approval of the Bavarian Nordic plant where they were made which had kept them from being deployed thus far. https://www.cnbc.com/2022/07/27/us-to-release-786000-additional-monkeypox-vaccine-doses-as-outbreak-spreads.html

I am speaking based on my experience in the past week.  All appointments in any city in the west coast are filled.  And there is no more vaccines until further notice.  I would be happy to fly to any city in North America (Canada, U.S., Mexica) to get this Monkeypox vaccine.  Just let me know 

[belkinDC]

2 minutes ago, scott456 said:

I am speaking based on my experience in the past week.  All appointments in any city in the west coast are filled.  And there is no more vaccines until further notice.  I would be happy to fly to any city in North America (Canada, U.S., Mexica) to get this Monkeypox vaccine.  Just let me know 

Over at “the other board” it is being reported that clinics in Canadian cities (Montreal and Toronto) are offering the vaccine freely regardless of residency status. I would inquire for more current details before booking a flight but it might merit further investigation if you’re willing to travel that far. https://www.companyofmen.org/topic/134695-monkeypox-a-new-worry-for-gay-and-bi-men/page/16/

[belkinDC]

It was also reported there that the Gay & Lesbian center in Hollywood was offering vaccine on the spot during routine STI checks.

[Riobard]

42 minutes ago, belkinDC said:

Over at “the other board” it is being reported that clinics in Canadian cities (Montreal and Toronto) are offering the vaccine freely regardless of residency status. I would inquire for more current details before booking a flight but it might merit further investigation if you’re willing to travel that far. https://www.companyofmen.org/topic/134695-monkeypox-a-new-worry-for-gay-and-bi-men/page/16/

I started posting Montreal details in this very GG thread 6 weeks ago if anybody wants to scroll back, inquire here, or DM me.  You can get into the walk-in vaxx site in The (Gay) Village in seconds without a booking. Bring passport for ID.

I was in that neighbourhood last week for routine HIV PrEP STI panel nearby and there was nobody seeking Imvamune (Jynneos) but about 20 personnel twiddling their thumbs and an ample supply of doses. (The thumbs thing these days means keeping busy on smartphones.)

I think Toronto is very easy as well, likely particularly Metro Hall on Bay St. & Queen St area, but I don’t have details … well, now I do … see below. 

[Riobard]

It appears that CDC has re-stratified Jynneos eligibility. Whereas I think it was PrEP or PEP, that remaining the categorization in Canada, it is now PEP for confirmed exposure, PEP++ for high-risk groups, and PrEP for occupational (eg, laboratory) risk. PrEP will represent a minimal proportion of supply allocation. It will be interesting to see the relative proportions of the new supply allocated for PEP versus PEP++. 

[Riobard]

I just discovered that I can easily access Toronto schedules for anyone that wishes to target a specific date, if you don’t have Twitter. Otherwise, enter “Imvamune Toronto” in a Twitter search, or Google “Imvamune Toronto” to access site locations, days, times. Not all sites in Toronto are open all 7 days of the week.

In contrast, the main Montreal walk-in site where I received my dose early June is still open every day. The daily schedule spread also seems to be broader than Toronto sites as well, where strategizing timing travelling in and out may require more planning or the greater likelihood of necessitating an overnight in Toronto.

 

[reader]

From Bangkok Post

Officials step up monkeypox screening of air travellers

The Public Health Ministry is ramping up the screening of air travellers from countries reporting a spread of monkeypox to step up precautions against the disease.

Public Health Minister Anutin Charnvirakul said the screening is being conducted at airports and targets travellers from outbreak countries.

He said monkeypox is not a serious disease and it is not highly transmissible without direct contact with bodily fluids or lesions or prolonged contact with an infected person.

Generally, most patients are able to recover at home, he said.

"Monkeypox can be avoided if we take precautions and abstain from risky sexual behaviour," Mr Anutin said.

The minister added that monkeypox vaccines will initially be kept for immunisation of frontline healthcare workers first.

Dr Sopon Iamsirithaworn, deputy director-general of the Department of Disease Control, said the department has told quarantine offices at international airports across the country to step up the screening of arrivals from countries where monkeypox outbreaks are taking place.