Riverside County waiting to receive monkeypox vaccines, outlines distribution plan

Riverside County's public health department is working to secure vaccines to protect those most at risk of monkeypox infection, the director of disease control said Tuesday.

Barbara Cole said the county has asked the California Department of Public Health for vaccines and Cole is hopeful they will arrive in the next few weeks. In addition to possibly preventing monkeypox, the vaccine may also lessen symptoms in people who have been exposed.

There have been at least 61 probable and confirmed cases reported in California and at least one probable case in Riverside County. Eisenhower Health confirmed Wednesday the probable case was from the Coachella Valley. In total, three Riverside County residents have been tested for monkeypox, Cole said.

Monkeypox is a rare disease caused by the monkeypox virus. The first human case was reported in 1970 in the Democratic Republic of Congo, according to the Centers for Disease Control and Prevention. The virus is usually found in Central and West Africa and does not occur naturally in the U.S., but recent national cases have been discovered due to international travel or animals imported from areas where the disease is more common.

People usually become infected through close contact with skin lesions or bodily fluids of infected animals or humans (alive or dead), including droplets, and can also be spread through sexual contact. Those at highest risk for monkeypox are gay, bisexual or other men who have sex with men, but the virus can infect anyone.

Symptoms can occur five to 21 days after exposure, and include fever, headache, muscle aches, swollen lymph nodes, rash and lesions often in the genital and perianal region. Illness typically lasts for two to four weeks. According to the CDC, monkeypox is fatal in as many as 11% of people who become infected.

Once vaccines become available in Riverside County and if someone has been confirmed as being potentially exposed, they would receive the post-exposure Jynneos vaccine, Cole said. They would have a number of options to choose from to receive their shots:

• If they want to get vaccinated at their health care provider, Riverside County Public Health will be able to get the vaccine to that provider within one day. If needed, the department will provide information on the vaccine and how to administer it.

• People would be referred to a Riverside University Health System community health center for vaccination.

• A "response team" would go out and administer vaccines.

The Jynneos vaccine, approved in 2019 by the Food and Drug Administration for the prevention of smallpox and monkeypox in people ages 18 and older, requires two doses, four weeks apart. The CDC is also investigating a measure to allow the vaccine to be used in children.

The vaccine may be used after exposure to help prevent severe illness.

Cole said the department will be working with health care providers that serve individuals at increased risk for monkeypox. Contingent upon receiving the vaccine, the department would establish which providers would have shots available.

"It's not for everyone," she said about the pre-exposure vaccine. "We're going to look at people at the highest risk for contracting it and that will be the target."

Palm Springs-based DAP Health, a center that provides comprehensive health care services, has requested vaccines, Senior Marketing Manager Dustin Gruber said in an email. When vaccines become available, "it is our understanding ... DAP Health may be a partner site for RUHS-Public Health," Gruber added.

He added that DAP Health has not seen any confirmed exposures or illnesses as of Tuesday.

"Dr. Shubha Kerkar, director of infectious disease services at DAP Health, is in the forefront of educating staff and assisting with appropriate messaging for patients and the community. As with any potential outbreak, we focus on community education and diligent evaluation of any person appearing with symptoms that could indicate Monkeypox, or who indicates they have had exposure to someone with a confirmed case," Gruber said. "We maintain vigilance to assure safety for our patients and our staff, and provide education to all clinical staff to assure they have the most current information."

Eisenhower Health spokesperson Lee Rice said in a statement that if vaccines are "distributed to our region and specifically our health system, Eisenhower will provide the vaccine per Centers for Disease Control and Prevention guidelines and as directed by the Riverside County Department of Public Health."

"At this time, Eisenhower Health can only provide the vaccine for the recommended use of vaccination after exposure as directed by Riverside County Public Health on a case-by-case basis. There has been no prescribed directive or vaccine supply provided for administration of pre-exposure prophylaxis for at-risk patients," Rice said. "On June 28, 2022, the federal government indicated that it will release more vaccines to areas with the highest case rates. Riverside County Public Health has outlined its plan for distribution once they receive a supply from the California Department of Public Health. This distribution may take some time."

One doctor says Riverside County 'is behind the eight ball'

But some believe the response from the county comes too late.

Dr. Phyllis Ritchie, a board-certified infectious disease specialist and CEO/founder of PS Test, said a local patient came into her STI clinic last week after they were notified by the Los Angeles County Department of Public Health that they may have been exposed to monkeypox at a recent Los Angeles Pride event.

The individual did not have lesions, but they were exhibiting flu-like symptoms, such as a sore throat and achiness, Ritchie said.

She called Riverside County Public Health, expecting officials to provide the individual with a post-exposure vaccine. However, Ritchie said the department did not have vaccines available and advised the individual to go to Los Angeles County.

"It's a shame that Riverside County is behind the eight ball," Ritchie said, especially given the large LGBTQ+ population in the Coachella Valley. "Because Palm Springs is the hub for this particular population, Riverside County really needs to be a step ahead, particularly since COVID-19 was something everyone had to play catch up on. We should have learned from COVID."

Ritchie believes that "everybody probably at that Pride festival was a potential exposure," and that there are "many more (cases) in our area that haven't been seen or haven't been diagnosed."

She said she's disappointed that swifter action hasn't been taken by the county, such as securing vaccines sooner and providing them in the Coachella Valley. Ritchie said she has offered to partner with the local public health department and administer the vaccine at PS Test, but she has not received a definite answer yet.

The infectious disease specialist also would like to see better guidance and education available to providers and patients.

"I know this mostly from infectious disease journals, but if a patient has pox-like lesions, you send them home and tell them to wait until they heal," she said. "But we really haven't been given guidance on how to test, phone numbers to call."

Cole said: "We have been responsive, and as we've gotten information, it has been shared." For example, she said the health department reached out to medical providers in May and issued a public health advisory with testing recommendations, infection control and treatment consideration. Also available to the public is a frequently asked questions page on monkeypox.

Before vaccines are secured in the county, Cole said anyone who believes they have been exposed to monkeypox should contact their healthcare provider. They will perform an assessment to determine if an individual needs to be tested for the virus, report to Riverside County Public Health and then the health department would coordinate next steps. The nearest lab that tests for monkeypox is located in San Bernardino County, she said.

There have been at least 305 confirmed cases of the virus in the United States as of Tuesday. Globally, the virus has been reported in at least 49 countries.

Global vaccine distribution

Other states and countries are working to provide vaccinations for those at high risk of infection.

New York City's health department and hospitals have been administering vaccines to those who suspect they have come into contact with someone with monkeypox. The department last week opened a vaccine clinic eligible for all gay, bisexual and other men who have sex with men who have had multiple or anonymous sex partners in the last two weeks.

In the United Kingdom, where Britain has the largest monkeypox outbreak beyond Africa, vaccines are now being considered for those at the highest risk. A survey of those infected in the U.K. found 96% were men who were gay, bisexual or had sex with other men.

The CDC also recommends vaccinations for lab and medical personnel — and any other people — who might be exposed to monkeypox.

The U.S. has 100 million doses of the smallpox vaccine ACAM2000, the CDC says. Research from Africa suggests the vaccine is at least 85% effective in preventing monkeypox, the agency says.

However, the vaccine, which is delivered by multiple punctures of a bifurcated or forked needle rather than a shot, can have some side effects, according to the FDA, including the inflammation and swelling of the heart and surrounding tissue, inflammation of the brain (encephalitis) and the spread of the virus to the rest of the body or to others they come into contact with.

The vaccine is not made from the smallpox virus, but from a poxvirus similar to smallpox.

The monkeypox and smallpox vaccines, when given within four days from the date of exposure, the CDC says, can prevent onset of the disease — and possibly lessen symptoms if given up to two weeks after exposure.

What is the Jynneos vaccine?

The Jynneos vaccine is considered safer than alternatives because it is made from a virus that is related to smallpox and monkeypox, but is less harmful. Research that led to its approval found Jynneos created an immune response similar to that of the smallpox vaccine. Research data suggests the vaccine is at least 85% effective in preventing monkeypox, according to Johns Hopkins Center for Health Security.

Studies done in the Democratic Republic of the Congo found none of the 1,600 health care workers vaccinated developed monkeypox over two years, the journal Science reported. However, the research did not include a control group and one person did get monkeypox after the study period.

The Department of Health and Human Services, within its Strategic National Stockpile, has more than 36,000 courses of Jynneos and expects to get about another 500,000 total delivered this year, according to the CDC.

USA Today contributed to this report.

Ema Sasic covers entertainment and health in the Coachella Valley. Reach her at ema.sasic@desertsun.com or on Twitter @ema_sasic.

This article originally appeared on Palm Springs Desert Sun: Eisenhower Health confirms probable monkeypox case in Coachella Valley