Monkeypox was the last thing on Erica’s mind recently when her brother called to say he had tested positive for the virus after spending a week at their South Orange home.
After raising a toddler during the COVID-19 pandemic, she thought she was done learning about unknown infectious diseases. Now she once again had to worry about her 3-year-old daughter Cate.
“I was really worried about her and what monkeypox would mean to a child,” said Erica, who asked that the family last name not be used. Exposure was only allowed for adults 18 and older.
“Now I’m panicking,” she recalls.
But a vaccine held in reserve for a potential smallpox terrorist attack and the coordinated efforts of a private medical practice and state and federal officials averted the worst.
Monkeypox, a viral disease that originated in animals and was once found only in a few African countries, has spread across the globe in recent months. The World Health Organization has reported more than 3,400 cases in 50 countries. In the United States, 2,108 cases have been confirmed through Tuesday – an unprecedented outbreak that experts say is likely a large outnumber.
New York has become an epicenter: 639 people have so far tested positive for orthopox – the family of viruses that includes smallpox, cowpox and monkeypox – and are suspected to have monkeypox. New Jersey had 45 confirmed or probable cases Tuesday, mostly in North Jersey, the health department said.
These numbers are expected to increase.
Symptoms usually develop three weeks after exposure. Testing has increased in the past two weeks as several commercial labs have added the ability to analyze swabs from skin lesions. “We expect cases to increase” through the end of July and August, said Dr. Rochelle Walensky, director of the federal Centers for Disease Control and Prevention, on Friday.
With long lines for testing and appointments unavailable for vaccines in New York City, critics have said the failures of the early COVID-19 response have been repeated since monkeypox arrived in the United States in mid-May. With too few tests, it was impossible to measure the extent and location of the spread of the virus. Both testing and treatment were scarce, and the criteria for both were strict. Now, some warn, the virus will be impossible to contain.
The vast majority of cases in the current outbreak have been reported in men who have sex with men, but the virus can infect anyone. The main route of transmission is skin-to-skin contact, with the lesions appearing as a blister-like rash — small bumps with blistered ends. Towels or bedding that have touched the lesions can transmit the infection, as can close face-to-face interaction, such as B. Kissing.
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In South Orange, 3-year-old Cate was definitely exposed, her mother said. She was so happy to see her uncle when he visited in June that she ran to his bed every morning after waking up. She loved to cuddle. The whole family was in close contact with the visitor, but Erica was particularly concerned for her daughter, she said as she shared her experience, pointing to the talkative child in a sundress and shoes with rainbows on them.
Little is known about monkeypox in children. Among the 700 confirmed cases in the United States during the current outbreak, for which demographic information is known, none were younger than 18, a CDC official said Friday. Almost all were males, and only eight were identified as female at birth.
For people who are exposed, there is a vaccine that can prevent or lessen the severity of monkeypox symptoms. In some places, such as New York City, demand has far outstripped supply. The New York City Department of Health and Human Services website for vaccination appointments has crashed twice and currently has no appointments available.
But Erica and her daughter were lucky.
dr Ashish Parikh, Summit Health’s chief quality officer, to whom Erica turned for her care, explained that when the vaccine is given within the first four days of exposure, the chances of contracting the disease are significantly reduced . “If you take it a few days later,” he said, “you can still get the disease, but it reduces the chances of it becoming very severe.” They were more than four days after exposure, but the benefits of the Vaccination justified the effort to obtain it, he said.
The JYNNEOS vaccine, designed to prevent smallpox, has been stockpiled as part of the federal government’s National Strategic Stockpile in case a virus, once eradicated, is ever released. The vaccine against monkeypox, a related virus in the orthopox family, is also known to be effective, although how effective it will be in this outbreak is unknown. It’s given as a 0.5 milliliter injection twice, 28 days apart, said Laura Balsamini, director of pharmacy services at Summit Health.
New Jersey has been allocated 2,700 doses, according to the state Health Department — including 2,400 in recent days. As of Monday, 24 doses had been used. Erica and Cate each received two.
Because supplies are limited, the vaccine was only used for people with known exposure to someone who tested positive for monkeypox.
But on Tuesday Gov. Phil Murphy announced a policy change to “include New Jerseyers who are at high risk of exposure to the virus in the past 14 days.” The vaccine is currently available by agreement through three community partners, the health department said. They are:
- Hyacinth AIDS Foundation/Project Living Out Loud!, Jersey City: 201-706-3480
- The Prevention Resource Network, a Visiting Nurse Association of Central Jersey program, Asbury Park: 732-502-5100
- North Jersey Community Research Initiative (NJCRI), Newark: 973-483-3444, ext. 200
“As the state receives additional supplies, the ministry will continue to expand access to the vaccine,” Health Commissioner Judy Persichilli said on Tuesday. At the moment, in addition to people with known exposure, other people who are eligible for the vaccine are people who have attended an event where there has been a known exposure to monkeypox, and people who “Iidentified as gay, bisexual, or men who have sex with men, and/or transgender, gender nonconforming, or nonbinary, and who have had multiple or anonymous sex partners in the past 14 days,” the health department said Tuesday.
For Erica, it was an easy call: She had known exposure to a person who tested positive. A contact tracer from the New York City Department of Health alerted New Jersey health officials that Erica and Cate had been exposed. She was eligible.
Cate’s case was different. Because of Cate’s age, her doctor needed special approval from the Food and Drug Administration to give her the vaccine. The pediatrician applied for an investigational new drug application for a single patient, which was approved as soon as possible, said Abby Capobianco, an FDA spokeswoman. Numerous similar requests have also been approved, Capobianco said.
Balsamini, Summit Health’s pharmacy director, was at a Paul McCartney concert when an assistant commissioner at the state health department texted her. He said a federal government courier would drive a cooler containing the four vaccine vials to the medical group’s offices in Florham Park the next morning, the bank holiday of June 16. Balsamini met the courier and stashed the vials in the pharmacy’s freezer.
Erica received her first shot that day and Cate received hers the next day after FDA approval.
Both felt fine afterwards, with mild pain or itching at the injection site, they said. Last Friday they each received a second injection.
Neither developed monkeypox.
If they had developed the telltale rash or flu-like symptoms, a treatment developed for smallpox is available. Critics of the federal response have said that, too, is difficult to achieve. The New Jersey Health Department has doses of the treatment known as TPOXX. It will be provided with oversight over its use to doctors who request it, a spokeswoman said.