Monkeypox (MPX) cases continue to increase in the United States and across the globe. Concurrently, the availability of the best vaccine option— Jynneos—is constrained. As Bloomberg reported Wednesday, the Jynneos manufacturer isn’t certain it can meet demand. The U.S. has bought some time by switching to a dose-sparing strategy that involves giving the vaccine
Forgive my dispondance. After the past couple years, I have zero confidence that the public would willingly or properly care for their vaccination site to prevent complications for themselves or others.
Here you missed an opportunity to illustrate how unprecedentedly safe the Covid-19 vaccinations are and how wild the claims of many anti-vax scoffers are. It also shows how cautious FDA and their advisers were.
You cite that ACAM2000 vaccine could produce myocarditis/pericarditis in 1 in 175 people.
On the other hand, for Covid-19 vaccines, a study conducted in Denmark "found a higher risk for myocarditis or pericarditis following mRNA-1273 vaccination compared with BNT162b2 when evaluating the risk after dose 2 in male individuals aged 12 to 39 years. The corresponding rates of myocarditis or pericarditis within 28 days of vaccination in the Denmark study was 1.8 per 100 000 vaccinated individuals (95% CI, 0.8-3.4 per 100 000 vaccinated individuals) for BNT162b2 and 9.4 per 100 000 vaccinated individuals (95% CI, 5.0-16.0 per 100 000 vaccinated individuals) for mRNA-1273; dose 1 findings were not reported." Covid-19 vaccines are more than 600 times safer in this regard.
Until we run out of Jynneos, or have more compelling data about how risky monkeypox is in children, I don’t think ACAM is a realistic option.
As you know the mRNA vaccination rate in children in the US against Covid is shamefully low, and these vaccines are comparatively much easier and safer.
I truly hope we never learn the fatality rate of this monkeypox strain in children, or start seeing disfiguring rashes in suffering little ones. It’s good to have this conversation now, but very targeted vaccination of exposed, high risk, and ring individuals still makes sense to me.
If the risk benefit analysis someday soon favors ACAM, it’s going be a hard sell, even for vaccine lovers like myself.
Thanks for this ghost of Christmas future… I hope the story never comes to be.
PS - more likely we will rely upon TPOXX treatment I’m guessing
I do think it may be time to roll out ACAM2000 to stop this monkeypox outbreak from becoming endemic in the US, but I understand the hesitation to do it. The public is generally quite intolerant of even minor vaccine complications, and ACAM2000 doesn’t just cause complications, it outright kills one to two people out of every million who receive it. How do we control the fallout from that, so that we don’t further the anti-vaccination attitudes already too prevalent in this country, and how do we decide where the threshold lies when using a dangerous vaccine is warranted?
I'm curious if we've studied the effectiveness of various routes of tranmission. Like other poxes, MPX is spread through physical contact, but I'm curious if how effective those routes of transmission are. Obviously sexual contact is some of the most intimate contact, and sexual activity appears to be the primary method of transmission. Noting this, it appears other physical contact can cause transmission, such as household transmission, but if that form of transmission has an R-eff of less than 1, then we could expect outbreaks outside of most at risk groups to pretty quickly die out. The R-eff of transmission via sexual activity does appear to be higher than 1, but the current vaccination strategy would help reduce that number, hopefully building immunity in most at risk groups and turning the tide on this outbreak.
Apparently the anti-vaxxers' idea of "personal freedom" is being reflected in statehouses and state legislatures all over the country. It's well organized and if successful will cripple public health in the states it gains traction in, replacing public health with personal health. It's hard not to feel despondent.
I remember having the smallpox vaccination as a kid (maybe in the late 1950s or thereabouts) and had that unique scar for quite a while afterwards. Do we know how long that immunity lasts?
This is a very tough decision. My vote is roll it out immediately, knowing the risks. The primary consideration for me is to stop the virus from gaining a foothold. But perhaps give people a choice as to what to get if both Jynneos and ACAM are available. Maximizing gain or minimizing risk? Very tough call. It doesn't help that the Jynneos maker, Bavarian Nordic says they won't be able to meet demand.
It’s time for the ACAM2000 conversation
Forgive my dispondance. After the past couple years, I have zero confidence that the public would willingly or properly care for their vaccination site to prevent complications for themselves or others.
Here you missed an opportunity to illustrate how unprecedentedly safe the Covid-19 vaccinations are and how wild the claims of many anti-vax scoffers are. It also shows how cautious FDA and their advisers were.
You cite that ACAM2000 vaccine could produce myocarditis/pericarditis in 1 in 175 people.
On the other hand, for Covid-19 vaccines, a study conducted in Denmark "found a higher risk for myocarditis or pericarditis following mRNA-1273 vaccination compared with BNT162b2 when evaluating the risk after dose 2 in male individuals aged 12 to 39 years. The corresponding rates of myocarditis or pericarditis within 28 days of vaccination in the Denmark study was 1.8 per 100 000 vaccinated individuals (95% CI, 0.8-3.4 per 100 000 vaccinated individuals) for BNT162b2 and 9.4 per 100 000 vaccinated individuals (95% CI, 5.0-16.0 per 100 000 vaccinated individuals) for mRNA-1273; dose 1 findings were not reported." Covid-19 vaccines are more than 600 times safer in this regard.
Until we run out of Jynneos, or have more compelling data about how risky monkeypox is in children, I don’t think ACAM is a realistic option.
As you know the mRNA vaccination rate in children in the US against Covid is shamefully low, and these vaccines are comparatively much easier and safer.
I truly hope we never learn the fatality rate of this monkeypox strain in children, or start seeing disfiguring rashes in suffering little ones. It’s good to have this conversation now, but very targeted vaccination of exposed, high risk, and ring individuals still makes sense to me.
If the risk benefit analysis someday soon favors ACAM, it’s going be a hard sell, even for vaccine lovers like myself.
Thanks for this ghost of Christmas future… I hope the story never comes to be.
PS - more likely we will rely upon TPOXX treatment I’m guessing
I do think it may be time to roll out ACAM2000 to stop this monkeypox outbreak from becoming endemic in the US, but I understand the hesitation to do it. The public is generally quite intolerant of even minor vaccine complications, and ACAM2000 doesn’t just cause complications, it outright kills one to two people out of every million who receive it. How do we control the fallout from that, so that we don’t further the anti-vaccination attitudes already too prevalent in this country, and how do we decide where the threshold lies when using a dangerous vaccine is warranted?
I'm curious if we've studied the effectiveness of various routes of tranmission. Like other poxes, MPX is spread through physical contact, but I'm curious if how effective those routes of transmission are. Obviously sexual contact is some of the most intimate contact, and sexual activity appears to be the primary method of transmission. Noting this, it appears other physical contact can cause transmission, such as household transmission, but if that form of transmission has an R-eff of less than 1, then we could expect outbreaks outside of most at risk groups to pretty quickly die out. The R-eff of transmission via sexual activity does appear to be higher than 1, but the current vaccination strategy would help reduce that number, hopefully building immunity in most at risk groups and turning the tide on this outbreak.
Apparently the anti-vaxxers' idea of "personal freedom" is being reflected in statehouses and state legislatures all over the country. It's well organized and if successful will cripple public health in the states it gains traction in, replacing public health with personal health. It's hard not to feel despondent.
https://khn.org/news/article/anti-vaccine-state-lawmakers-gain-ground-childhood-shots/
I remember having the smallpox vaccination as a kid (maybe in the late 1950s or thereabouts) and had that unique scar for quite a while afterwards. Do we know how long that immunity lasts?
Echoing a previous comment, I am 75.....received smallpox vaccination on left arm(with scar to prove it)
in early 1950s. Am I still probably immune against smallpox and, to the main point, monkeypox? Could Katelyn please address this.
Do those who received the original smallpox vaccine - late 1960s-early 1970s - have immunity to monkey pox?
This is a very tough decision. My vote is roll it out immediately, knowing the risks. The primary consideration for me is to stop the virus from gaining a foothold. But perhaps give people a choice as to what to get if both Jynneos and ACAM are available. Maximizing gain or minimizing risk? Very tough call. It doesn't help that the Jynneos maker, Bavarian Nordic says they won't be able to meet demand.