Monkeypox vaccines available to very select ‘high risk’ group in Jefferson County due to limited doses

Editor’s Note: Monkeypox is not specific to the LGBTQ+ community. It is affecting us the most because it came into contact with our community first. We are a close-knit community that usually stays within our safe social circles, leading to transmission among our community. This article will be updated once more information is available.

Monkeypox weighs heavy on the minds of many within the LGBTQ+ community. We’ve heard horror stories of painful lesions in unwanted places as well as stories about waiting in line for hours to get a vaccine just to be turned away due to a lack of vaccine quantity. Currently, there are close to 10 confirmed cases in all of Kentucky.

Louisville Metro Public Health officials spoke to LGBTQ+ leaders today about obtaining vaccines in Jefferson County. Since the county only received about 540 doses of vaccines, LMPH said they decided to divide them up amongst Primary Care Physicians (PCPs) within Louisville that already serve “high risk” populations.

There will be NO community vaccine events at this time due to the stockpile shortage, LMPH officials said. Also, only people that have a PCP that were sent the vaccines will be able to receive it and they must meet specific criteria. There is no “waitlist” to get on within LMPH to get the vaccine. CONTACT YOUR PCP. Editor’s note: If you don’t have a PCP, Queer Kentucky suggest looking into other counties in Kentucky to see if they are providing appointments outside of PCPs.

“We’ve been so overwhelmed with all of the calls, asking about the vaccine, we needed to put a voicemail up to have people contact their provider,” said Jeff Howard, the Louisville Metro Department of Public Health and Wellness medical director. “The vaccine is in incredible short supply and we’re hoping to get 540 more doses from the state to get out in a preventative manor, but we’re still vaccinating the most at risk first.”

In contrast, Lexington-Fayette County Health Department will begin making same-day post monkeypox vaccine appointments for qualified individuals starting on Thursday, August 4. Call the Fayette County Health Department to discuss specific eligibility. The phone number is (859)899-2222.

Part of the eligibility for vaccines in Jefferson County is people must be individuals that identify as gay, bisexual, men who have sex with men, transgender, gender non-conforming, and/or non-binary people. LMPH officials said women who have sex with men who have sex with men could be included in later rounds of the vaccine, and the same with sex workers.

There are three different strategies in distributing the vaccine

If you are gay, bisexual, men who have sex with men, transgender, gender non-conforming, and/or non-binary people AND fall within one of the below categories, you are currently eligible for the vaccine. Remember, in Jefferson Co. only PCPs will have vaccines.

Monkeypox Vaccine Post-Exposure Prophylaxis (PEP)

For the current outbreak, this approach can be considered as “standard PEP” for monkeypox. People can be vaccinated following exposure to monkeypox to help prevent monkeypox illness. It is important that states and other jurisdictions identify contacts of confirmed or probable monkeypox cases to offer vaccine for PEP and to monitor for any early signs of illness.

Outbreak Response Monkeypox Vaccine Post-Exposure Prophylaxis (PEP)++

People with certain risk factors are more likely to have been recently exposed to monkeypox. This includes gay, bisexual, men who have sex with men, transgender, gender non-conforming, and/or non-binary people. People that have had gonorrhea or syphilis within the past 12 months, and people that have had multiple sex partners over the last two weeks. The PEP++ approach aims to reach these people for post-exposure prophylaxis, even if they have not had documented exposure to someone with confirmed monkeypox.

Monkeypox Vaccine Pre-Exposure Prophylaxis (PrEP)

This approach refers to administering vaccine to someone at high risk for monkeypox (for example, laboratory workers who perform diagnostic testing to diagnose monkeypox).

LMPH officials said that they looked into purchasing the vaccine from the manufacturer, but the worldwide supply is so low that it has to be restricted to the strategic national stockpile.

Tips on minimizing the risk of contracting Monkeypox include

It should be noted that if you are vaccinated, these risk mitigation acts should still be utilized. People are not considered FULLY vaccinated until TWO WEEKS after SECOND dose. This dose is four weeks after your first dose.

• Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox.
• Do not touch the rash or scabs of a person with monkeypox.
• Do not kiss, hug, cuddle or have sex with someone with monkeypox.
• Do not share eating utensils or cups with a person with monkeypox.
• Do not handle or touch the bedding, towels, or clothing of a person with monkeypox.
• Wash your hands often with soap and water or use an alcohol-based hand sanitizer.

Officials stated that Monkeypox can also be transmitted during an incubation period and/or with a case with little to no symptoms of Monkeypox.

“Some people’s symptoms were only inflammation of rectum,” Howard said. “Checking for full rash/lesions on a sexual partner won’t always be full proof, but still helpful. Most people with monkeypox will at least have cold like symptoms.”

Vaccine being utilized in Kentucky: JYNNEOS

• JYNNEOS contains a live Vaccinia virus that does not replicate efficiently in human cells.
• It is administered as two (0.5 mL) subcutaneous (under the skin) injections 28 days apart.
• The immune response takes 14 days after the second dose for maximal development.
• JYNNEOS is licensed by the FDA for use in the prevention of smallpox or monkeypox in people ages 18 years and older. Use in younger populations currently requires requesting and obtaining a single patient emergency use authorization from FDA for each person under 18 years. CDC is developing an Expanded Access Investigational New Drug (IND) protocol to allow broader use of JYNNEOS in the pediatric population.
• The effectiveness of JYNNEOS against monkeypox is supported by clinical studies demonstrating a comparable immune response to ACAM2000 and animal studies.
• There are no data yet on the effectiveness of JYNNEOS for PEP, PEP++,  or PrEP from the current outbreak. Although this is also true for ACAM2000, there is evidence that the precursor for ACAM2000 was effective in eradicating smallpox. Public health officials have concern about the lack of real-world effectiveness data for JYNNEOS, especially because a second dose of JYNNEOS was required in a clinical study to reach the same maximal antibody response seen with ACAM2000 at the 4-week timepoint, and a correlate of protection has not been defined (i.e., it is not known what level of antibodies is needed to prevent Monkeypox virus infection).
• Adverse reactions after JYNNEOS include injection site reactions such as pain, swelling, and redness. Fatigue, headache, and muscle pain were the most common systemic reactions observed after JYNNEOS in a clinical trial.
• JYNNEOS is safe to administer to people with HIV and eczema or other exfoliative skin conditions.
• While there are no data in people who are pregnant or breastfeeding, animal data do not show evidence of reproductive harm; pregnancy and breastfeeding are not contraindications to receiving JYNNEOS.
• Please see the JYNNEOS Special Considerations section for guidance on contraindications and precautions and additional clinical considerations for use of JYNNEOS.