Michigan monkeypox cases quadruple in 3 weeks as vaccine rules change, access improves featuring Dr. Gretchen Snoeyenbos Newman

Dave Garcia couldn’t get a dose of the Jynneos monkeypox vaccine before he left Michigan for vacation at the end of June.

Supply was so limited, even people at high risk for contracting the virus weren’t able to get it. The federal government was distributing Jynneos from the Strategic National Stockpile only to states with outbreaks, and Michigan’s first known case wasn’t identified until June 29.

But when Garcia traveled to Montreal in the first week of July, the Canadian government had set up vaccination tents in the street in Village Montreal, an area internationally known as an LGBTQ+ destination.

Garcia got a dose even though he’s an American citizen.

Clinical laboratory scientist Thanh Le, 37, of Lansing, mixes 15 microliters of the master mix formula with 5 microliters of an extracted DNA sample to run tests for orthopox at the Sparrow Hospital lab in Lansing, on Thursday, Aug. 11, 2022. The combined sample is placed in the Cobas Z 480, which analyzes the sample for orthopox. If the result turns out to be positive, they rerun the process to specifically test for monkeypox.

Monkeypox not ‘just a queer problem’

“They said the virus doesn’t care” about his citizenship, Garcia told the Free Press, and it doesn’t care about a person’s sexual orientation, either.

“This virus got a foothold in the gay community to start. It could have been any community,” said Garcia, who is the executive director of Affirmations in Ferndale, the largest LGBTQ community center in Michigan. “If we don’t get ahead of this thing, then it’s going to start affecting the straight community very soon, more so than it already is.”

Too many people have the attitude that the global outbreak of monkeypox, which has grown to nearly 32,000 cases in 89 countries as of Friday, is “just a queer problem,” he said. They have a false sense of security that “it’s not gonna affect me. I think that’s a mistake.”

So far, the vast majority of the people who’ve contracted the virus are gay and bisexual men — though cases also have been identified in others.

“We’ve seen cases in women. We’ve seen cases in children,” said Dr. Matthew Sims, director of infectious diseases research at Beaumont Health. “I just read about the first case where it jumped to a doctor who was treating a patient that was in Israel.

“This is not a disease that’s limited to that population in any way, shape or form. It just started there, and it’s spread there, and we have to be concerned that it can jump out.”

Garcia, who also serves on Oakland County’s Monkeypox Task Force, said he worries that if — or perhaps when — monkeypox begins spreading more widely among the general population, “they’re gonna blame us.”

Too little, too late?

Public health leaders hope to avoid that kind of stigma with the monkeypox outbreak, which, as of Friday, had swelled to more than 11,000 people in the U.S. — 92 of whom are from Michigan, according to the U.S. Centers for Disease Control and Prevention.

Cases in Michigan have quadrupled in less than three weeks — on July 25, the state had only 23 known cases. Doctors told the Free Press it’s likely many more people have the virus who are yet to be tested.

Some say the U.S. response to the outbreak has been too slow, as access to testing, supply of vaccines and treatments remain limited.

“Sometimes actions speak louder than words,” said Dr. John Brooks, infectious disease specialist and chair of the emerging pathogens response team at McClaren Health Care. “We knew there was an outbreak occurring. We had ample supply of vaccination in (the Strategic National Stockpile), but yet we chose not to do something about it as a government.

“You can easily interpret that as either they completely misread it and said, ‘This is going to go away in a month,’ and it didn’t, which is not likely. Or it was … lack of response because it didn’t seem to affect the general public.”

U.S. Health and Human Services Director Xavier Becerra declared monkeypox a public health emergency on Aug. 4 — almost two weeks after the World Health Organization made a similar declaration. The first U.S. case in this outbreak was identified May 18.

“It’s available in the stockpile and they just called it a public health emergency now, so there was a bit of delay,” Brooks said. “From a public health point of view … if it is a vaccine-preventable disease, you probably should get on it as fast as you can.”

Michigan follows plan to ‘stretch’ monkeypox vaccine doses

Since the start of the outbreak, the federal government has distributed 670,000 doses of the Jynneos vaccine to states from the stockpile, according to the White House. Parts of the U.S. hardest hit with outbreaks — such as New York, California and Florida — are getting bigger shipments than places where fewer cases have been identified.

So far, Michigan has gotten 7,600 vials of the Jynneos vaccine, which is authorized to prevent both smallpox and monkeypox or limit symptoms after exposure.

The state also has gotten “hundreds” of doses of tecovirimat, the antiviral drug sold under the brand name Tpoxx, said Chelsea Wuth, a spokesperson for the state health department.

Of the 7,600 vaccine vials that have been delivered to Michigan, 1,294 doses had been administered as of Aug. 10, Wuth said, adding, however, that “there is still a lag in reporting.”

Another 400,000 vaccine vials of the Jynneos vaccine are to be distributed nationally in the coming weeks, but federal regulators are hopeful five times that number of people can be immunized with those vials under a new plan to stretch available doses.

The U.S. Food and Drug Administration authorized a plan last week to split a single vial of the Jynneos vaccine five ways by injecting it intradermally — between the layers of the skin — rather than subcutaneously, under the skin. That means 400,000 vials have the potential to immunize as many as 2 million people.

The FDA’s decision was based on a single 2015 study of smallpox vaccine in 524 people. It showed similar rates of effectiveness when a smaller amount of vaccine was given intradermally when compared with a larger subcutaneous dose.

Michigan’s health department revised its strategy Friday to recommend intradermal injections in line with guidance from the U.S. Centers for Disease Control and Prevention.

To preserve doses of the Jynneos vaccine, the Michigan health department in July said it would give people only a single dose — even though the FDA authorized a two-dose series spaced 28 days apart. It said it would offer second doses “when more vaccine is available.”

Now, state health officials are opening up second doses, delivered intradermally, to Michiganders 28 days after the first.

Where to get monkeypox vaccine in Michigan

As vaccine doses arrive in Michigan, they are being delivered to hubs established at health departments in Oakland, Washtenaw, Kent, Kalamazoo, Grand Traverse, Ingham, St. Clair, Bay and Marquette counties as well as the District Health Department 10 in the northwestern Lower Peninsula and Wayne State University’s STI Clinic, Wuth said.

“Every local health department should be able to vaccinate with Jynneos and can request vaccine through a hub,” Wuth said.

Dr. Natasha Bagdasarian, the state’s chief medical executive, urged anyone at risk for contracting the virus to call their local health department to get a vaccine.

The Oakland County Health Division so far has gotten 1,580 vaccine doses and distributed 380 to other health departments, local clinics and other health care providers, said Kate Guzman, administrator of medical services for the county.

It is running a daily monkeypox vaccine clinic out of its north health center in Pontiac, with the capacity to administer about 70 shots per afternoon, she said. Appointments can be made by calling the Nurse on Call line at 800-848-5533.

The city of Detroit Health Department also has vaccine doses available to residents 8 a.m.-4:30 p.m. Mondays-Fridays at 100 Mack Ave. and at the Wayne HIV/STI Clinic, 50 E. Canfield. The Wayne HIV/STI Clinic also is open 8 a.m.-12:30 p.m. on the first and third Saturdays of each month.

For details, call the Detroit Health Department nurse hotline at 313-876-4444 or send an email to [email protected].

Vaccine availability expands to clinics, events

“There are definitely anxieties about whether there’s going to be enough vaccine, how to get vaccine and how we can ensure that vaccine access is equitable across different communities,” said Teresa Roscoe, chief operating officer of Corktown Health, a primary health care center focusing on the LGBTQ+ community in Detroit.

But now, doses are starting to make their way out of local health departments and into community organizations and other clinics.

Corktown Health is planning its first monkeypox vaccine clinic on Aug. 17, and will post information on its website, https://corktownhealth.org/, as soon as details are available.

“Part of our mission here is making sure that we are reaching community members,” Roscoe said, “making sure that we’re reaching racial and ethnic minority people, that we are reaching low-income individuals and people who are not always as well connected with resources.”

Affirmations in Ferndale partnered last week with the Oakland County Health Division to host its first monkeypox vaccine clinic, too, administering 100 shots. Another is planned for Aug. 16.

Volunteers were to be at Royal Oak Pride Saturday, recruiting up to 100 people to take monkeypox vaccines through a partnership that included Affirmations, the Oakland County Health Division and the Berkley-based Be Well Medical Center.

Vials of the vaccine also are being delivered to area homeless shelters, Guzman said. And Oakland County’s harm reduction team, which also provides hepatitis C testing and Narcan distribution, is offering monkeypox vaccines through its mobile unit in Pontiac, on Eight Mile Road and in Hazel Park and Ferndale.

‘Everybody eventually is gonna need to be vaccinated’

Of the 200 vaccine doses the Be Well Medical Center has already gotten, 192 have been administered, said medical director Dr. Paul Benson, who added that he is “waiting patiently” to get more.

He’s convinced the U.S. still has a chance to end this outbreak with widespread vaccination, but that would require the public to be willing to take the vaccine, and resources from the government to deliver them.

“Assuming we are going to eradicate monkeypox, everybody eventually is gonna need to be vaccinated,” he said. “The public needs to be aware of that.”

But with three infectious diseases now drawing down those resources — monkeypox, HIV and coronavirus — he’s concerned about the ability of an already-stretched health care system to fully respond to them all, he said.

Funding for HIV research, treatments and programs could be left “high and dry.”

HIV stigma carries over to monkeypox

“For people who lived through the ’80s and ’90s, we remember a lot of this stigma, a lot of the incredible homophobia that was associated with HIV,” said Dr. Gretchen Snoeyenbos Newman, an infectious disease doctor at the Detroit Medical Center and director of the Wayne State University adult HIV program.

Monkeypox, she said, is bringing back not-so-fond memories of that time.

“It restigmatizes them. It pushes people deeper into the closet; it adds more shame,” Newman said. “And it gives the rest of the country a false sense of security. It’s not necessarily an STD, but it is passing between sexual networks and what we know is that no sexual network is closed.”

Monkeypox is not like HIV. It is an illness that, while painful, typically goes away on its own after about four weeks. The vast majority of people survive the monkeypox strain that’s circulating globally now. There also is a vaccine and treatment for monkeypox. HIV, however, was a death sentence in the 1980s. At that time, there were no treatments; there’s still no vaccine.

Yet, Newman said, “the homophobia, the transphobia that we are seeing wrapped up in monkeypox … will lead to poor health outcomes for people who are stigmatized, but also gives the rest of the country, the straight community, a false sense of security.”

She fears public sentiment about a day care worker in Illinois who had monkeypox and potentially exposed children, “could pivot very quickly” to the powerful question about whether queer people should be allowed to work with young children.

“This is all part of the same toxic stew. We can expect that people who have jobs will get monkeypox, that’s normal.”

‘Isolation is long,’ could affect job security

Because monkeypox is contagious for up to four weeks — until lesions are fully healed with new skin growth beneath them — people who contract the virus may worry about job security, too.

Employers who discover a worker has monkeypox might not be supportive when that person needs three or four weeks off work to isolate and recover, said McLaren’s Brooks.

“Isolation is long,” he said, averaging about 21 days for most people. “It’s an issue.”

And because spread of the virus so far has predominantly been among gay men, it may also “out” people who aren’t ready to be open about their sexuality, said Dr. Allan Frank, associate medical director at Corktown Health. That may make them more hesitant to get a vaccine.

“If you can imagine, perhaps, someone that doesn’t identify as gay or bisexual but does have sex with (people of) both genders. That person may not feel comfortable showing up for a vaccine, saying, ‘Well, gee. This is only for gay people,” Frank said.

For some workers who contract the virus, taking time off to isolate could be problematic, said McLaren’s Brooks.

Some people don’t have that luxury to work at home.

For them, “if you can’t come to work, you don’t have a job,” said Chris Sutton, broadcast coordinator and vaccine ambassador for LGBT Detroit.

Those who are living paycheck to paycheck could be financially devastated by a monkeypox infection.

“It’s not so much that monkeypox may be deadly, but the stigma and isolation around you, how that affects someone’s livelihood, can be just as fatal on another level,” said Sutton, a lifelong Detroiter who is gay and got his first dose of monkeypox vaccine Monday at Wayne HIV/STI clinic in Detroit.

“Anyone can get this virus … and if you do become infected with this virus … (you shouldn’t feel) that makes you less than or that you should feel ashamed or that you deserve be devalued … or harassed.”

Behavior, not sexual orientation, spreads virus

Frank said it’s vital to separate sexual identity from the behaviors that can lead to monkeypox transmission, which didn’t happen with HIV.

“Because of the focus on sexual orientation rather than activity, an epidemic of HIV that could have easily been curtailed much earlier ended up spreading into a variety of communities,” Frank said. “People thought, well, if they’re not of this particular sexual orientation, they’re not going to be at risk. And as a result, the second wave of the epidemic occurred in women of color and children.

“I’m hoping that we’ve learned our lesson … and focus on the types of behaviors that lead to monkeypox.”

Those behaviors aren’t limited to sex. Monkeypox can spread through hugging or cuddling an infected person if there’s skin-to-skin contact, he said.

Dancing or going to a concert in a crowded venue where your skin may be touching another person’s skin can spread it, too.

“You just have to have close physical contact,” said Frank, who also is assistant professor of medicine at Wayne State University. “It is behaviors and contact, not sexual orientation that spreads this disease.”

Brooks added that the risk is extremely low in most day-to-day activity.

“You’re not going to get it on the subway,” Brooks said. “You’re not going to get it on the bus. You’re not going to get it in the grocery store line because it appears (to) require a prolonged contact time” for transmission.

He said it might be risky to go to saunas or bathhouses right now.

People whose jobs may expose them to the virus ought to consider wearing gloves — such as those with jobs in health care, massage therapists and cleaning crews who change bedsheets and handle towels, Beaumont’s Sims said.

There is concern, too, about the potential for outbreaks among athletes in contact sports, such as wrestling, and on college campuses as classes resume for the fall term.

“This is a disease that spreads through intimate contact — plain old skin-to-skin contact, even non-intimate. … You have to be careful when you’re in certain situations,” Sims said.

“If you’re at a crowded bar and it’s hot and you’re all in short sleeves and you’re rubbing up against each other because you’re moving through a crowd or you’re on a dance floor that’s crowded and you’re dancing up against each other, these are things that can spread it in large groups.”

Read, “Michigan monkeypox cases quadruple in 3 weeks as vaccine rules change, access improves” from the Detroit Free Press.