Missouri health officials raise risk of monkeypox, anger over limited vaccine supply

JEFFERSON CITY – State and local health officials are taking steps to prevent the spread of monkeypox in Missouri, but limited vaccine availability is hampering those efforts.

Gov. Mike Parson’s administration on Wednesday required state or local health departments to be notified within a day of monkeypox cases being identified.

The emergency order issued by the Missouri Department of Health and Senior Services puts the virus on par with other infectious diseases such as cholera, polio and measles.

“Monkeypox virus has not previously been required to be reported, but due to its severity and the rapid increase in the number of cases, local health authorities or DHSS must be notified within a day. Appropriate measures will be taken,” the rule states.

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Monkeypox belongs to the same family of viruses as smallpox. It usually starts with flu-like symptoms and swollen lymph nodes, followed by a rash. The illness usually lasts two to four weeks.

It can be transmitted through intimate physical contact; touching personal items such as clothing or bedding; skin-to-skin contact with rashes, scabies, or body fluids; or respiratory droplets spread by kissing or coughing.

There are currently over 12,689 cases of monkeypox in the United States. 10 people have died due to the current epidemic.

As of Tuesday, the U.S. Centers for Disease Control and Prevention reported 24 cases in Missouri, up from 18 last week.

But University of Washington infectious disease expert Dr. According to Joseph Cherabi, regional health officials have tabulated about 20 cases in St. Petersburg. Louis area only, so hopefully the new rule will provide more accurate information about the outbreak in Missouri.

Cherabi, who sees patients at Barnes-Jewish Hospital, said more people are coming to emergency rooms or clinics with painful sores associated with monkeypox or concerns they’re dealing with.

The vaccine is best given within four days of exposure and not after the onset of symptoms.

‘Immediate Danger’

The new DHSS rule comes into effect in August. 29, states that “there is an immediate threat to the health, safety, or welfare of the public that requires immediate action.”

The new rule follows the agency’s decision last week to distribute doses of the monkeypox vaccine to the state’s five regional distribution centers: Kansas City, Springfield, Columbia, Butler County and St. Louis. Louis County DHSS spokeswoman Lisa Cox said.

with St. Louis County had the highest number of cases, receiving the most vials for distribution at 1,900.

Also last week, the US Food and Drug Administration approved a new strategy for extending doses: injecting the vaccine into the top layer of skin rather than fat tissue, known as “intradermal injection.”

Intradermal injections allow vaccinators to use only one-fifth of the original dose, thereby roughly quintupling the current supply.

A 2015 study found this method to be effective and safe. Two more doses are required four weeks apart, and immunocompromised people receive the full dose in adipose tissue, Cherabi said.

Increased vaccine availability has allowed vaccinators to expand who is eligible for the shot, but demand still exceeds supply nationwide.

In the past, only close relatives (primarily family members and sexual partners) of monkeypox patients could receive the vaccine. Now those at high risk of contracting it can also qualify.

It has been found that men who have sex with men are affected by the disease, and it is most often contracted during sex. Those who engage in high-risk sexual behaviors such as multiple partners and transactional sex are prime candidates for the vaccine, health officials said.

To identify those at high risk, DHSS created an online survey for residents on Friday. The results are sent to local health departments, which then coordinate with people to prescribe vaccines. More than 1,300 people filled out the online survey, Cox said.

Local health officials say they want to vaccinate more people, but most doses will go to states with the most cases and people at risk.

For example, federal data shows that for August. 12, Florida (with 1,268 cases) received almost 66,000 vials, and Missouri slightly more than 5,200.

“Please know that your health is doing the best we can with the funds we’ve been given,” said Nebu Kolencheri, director of communicable disease control at St. Louis. Louis County Department of Public Health.

‘Adding’

Dr. Matifadza Hlatshwayo Davis, Director of Health, City of St. Petersburg. Louis told an audience during a virtual town hall discussion Tuesday night that state and local health officials have been calling for more doses for weeks.

“You can’t imagine how frustrating it is for us to have to make these decisions around such a small vaccine pool,” Davis said. The goal is to prevent disease, not to play catch-up.

“In public health, we need to make plans like this,” he said, “especially after what we’ve learned from COVID.”

Davis and Colenchery said their departments are working to prepare for increased vaccinations by planning vaccination sites, training nurses on the new injection method, having enough needles and collaborating with public health providers who are gay or who care for gay men. bisexual patients.

Staff created monkey disease webpages, brochures in multiple languages, and social media and public service announcements to educate residents about symptoms, testing, and prevention.

“We have to make sure we’re not vaccinating the most privileged people in our population who can come to the clinic with a drop,” said Cherabi, who is also the assistant medical director of the county’s sexual health clinic. .

“We want to make sure we’re vaccinating people fairly … and that means listening to the community and seeing where we can meet with them to help them get access to the vaccine.”

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