Monkeypox was the last thing on Erica’s mind recently when her brother called to say he’d tested positive for the virus after spending a week at her South Orange home.
After parenting a toddler through the COVID-19 pandemic, she thought she was done learning about unfamiliar infectious diseases. Now she had to fear yet again for her 3-year-old daughter, Cate.
“I was really worried about her, and what monkeypox meant for a child,” said Erica, who asked that the family’s last name not be used. Her concern mounted when some quick research revealed that the vaccine used to prevent monkeypox in patients with direct exposure was only approved for adults 18 years old or older.
“Now I’m panicking,” she recalled.
But a vaccine held in reserve for a potential terrorist attack using smallpox, and the coordinated efforts of a private medical practice and state and federal officials, kept the worst from happening.
Monkeypox, a viral disease that originated in animals and was once found in only a few African nations, has spread around 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 had been confirmed as of Tuesday — an unprecedented outbreak that experts say is likely a huge undercount.
New York has emerged as an epicenter: 639 people have tested positive so far for orthopox — the family of viruses that includes smallpox, cowpox and monkeypox — and are presumed to have monkeypox. New Jersey had 45 confirmed or probable cases Tuesday, mostly in North Jersey, the state Department of Health said.
Those numbers are expected to grow.
Symptoms usually take three weeks after exposure to develop. Testing has increased over the past two weeks as several commercial laboratories have added the capability to analyze the swabs of skin lesions. “We anticipate an increase in cases” through the rest of July and August, Dr. Rochelle Walensky, director of the federal Centers for Disease Control and Prevention, said Friday.
With long lines for tests and appointments unavailable for vaccines in New York City, critics have said the mistakes of the early COVID-19 response have been repeated since monkeypox arrived in the United States in mid-May. With too little testing, it has been impossible to measure the extent and location of the virus’s spread. Both tests and treatments have been in short supply, and the criteria for getting either has been 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 primary route of transmission is through skin-to-skin contact with the lesions, which appear as a blistery rash — small pimples with bubble tops. Towels or bedding that has touched the lesions can transmit the infection, as can close face-to-face interaction, such as kissing.
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In South Orange, 3-year-old Cate had definitely been exposed, her mother said. She was so happy to see her uncle during his June visit that she ran to his bed each morning when she woke up. She loved to cuddle. All of the family had been in close contact with the visitor, but Erica worried for her daughter in particular, she said as she recounted their experience and pointed to the chatty child clad in a summer dress 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 has been younger than 18, a CDC official said Friday. Almost all were men, and only eight identified as female at birth.
For people who are exposed, there is a vaccine that can prevent or lessen the severity of monkeypox symptoms. Demand in some places, such as New York City, has far exceeded supply. The New York City Health Department website for vaccine appointments crashed twice and currently has no appointments available.
But Erica and her daughter were lucky.
Dr. Ashish Parikh, the chief quality officer for Summit Health, where Erica turned for her care, explained that the vaccine, if given within the first four days after exposure, significantly reduces the chance of getting the disease. “If you take it a few days beyond that” he said, “you might still get the disease, but it reduces the chance of it being very severe.” They were more than four days past exposure, but the benefits of vaccination justified the effort to obtain it, he said.
The JYNNEOS vaccine, developed to prevent smallpox, has been stored as part of the federal government’s National Strategic Stockpile in case that once-eradicated virus ever was released. The vaccine is also known to be effective against monkeypox, a related virus in the orthopox family, although it’s unknown how effective it will be in this outbreak. It is given twice, 28 days apart, as an injection of 0.5 milliliters, said Laura Balsamini, head of pharmacy services at Summit Health.
New Jersey has been allocated 2,700 doses — including 2,400 within the last few days, according to the state Health Department. Twenty-four doses had been used as of Monday. Erica and Cate each have received two.
Because supplies are limited, the vaccine has been used only for people with a known exposure to someone who has tested positive for monkeypox.
But on Tuesday, Gov. Phil Murphy announced a change in policy to include “New Jerseyans who are at high risk of having been exposed to the virus in the past 14 days.” The vaccine currently is available through three community partners, by appointment, the Health Department said. They are:
- Hyacinth AIDS Foundation/Project Living Out Loud!, Jersey City: 201-706-3480
- The Prevention Resource Network, a program of the Visiting Nurse Association of Central Jersey, Asbury Park: 732-502-5100
- North Jersey Community Research Initiative (NJCRI), Newark: 973-483-3444, ext. 200
“As the state gets additional supply, the department will continue to expand access to the vaccine,” Health Commissioner Judy Persichilli said Tuesday. For now, besides those with a known exposure, others who are eligible for the vaccine include people who attended an event where a known monkeypox exposure occurred, and people who”Identify as gay, bisexual, or men who have sex with men, and/or transgender, gender non-conforming, or non-binary and who have a history of multiple or anonymous sex partners within the past 14 days,” the Health Department said Tuesday.
For Erica, it was an easy call: She had a known exposure to a person who tested positive. A contact tracer from the New York City Department of Health alerted health officials in New Jersey that Erica and Cate had been exposed. She was eligible.
Cate’s case was different. Due to Cate’s age, her doctor needed special approval from the Food and Drug Administration to give her the vaccine. The pediatrician applied for a “single-patient investigational new drug” permit, which was approved as quickly as possible, said Abby Capobianco, an FDA spokeswoman. Numerous similar applications have also been approved, Capobianco said.
Balsamini, Summit Health’s pharmacy director, was at a Paul McCartney concert when a deputy commissioner at the state Health Department texted her. He said a courier from the federal government would drive a cooler with the four vials of vaccine to the medical group’s Florham Park offices the following morning, the federal Juneteenth holiday. Balsamini met the courier and stored the vials in the pharmacy freezer.
Erica received her first shot that day, and Cate received hers on the next day, after the FDA granted approval.
Both felt well afterward, with some minor soreness or itchiness at the injection site, they said. Last Friday, they each received a second shot.
Neither developed monkeypox.
Had they developed the telltale rash or flulike symptoms, a treatment developed for smallpox is available. Critics of the federal response have said this, too, is difficult to obtain. New Jersey’s Health Department has doses of the treatment, known as TPOXX. It is provided to physicians who request it, with oversight for its use, a spokeswoman said.