Column by Dr. Richard Sternberg

Monkeypox Vaccines

There are several things to remember about the current monkeypox outbreak for those of us in Otsego County.

According to the county health department website on Monday, there are no cases identified locally. Vaccine for monkeypox is not available locally. After checking the New York State Department of Health website (www.health.ny.gov) it appears that the closest location for vaccine is Albany County. I would suggest if you qualify for the vaccine and want to receive it, you or your health care provider can contact the Albany County Department of Health or the state. You can find criteria for eligibility at www.cdc.gov.

It is important to note that COVID is still a high-risk disease. For those of us in this area we should not lose sight of the fact that we need to continue to work on prevention of its transmission. Nevertheless, monkeypox is serious and can cause organ damage, disfigurement, and occasionally, death. It has to be dealt with to slow and hopefully stop its spread. It has been declared a Public Health Emergency of International Concern by the World Health Organization and a Public Health Emergency by President Biden.

There are three vaccines developed for smallpox that are being considered for use in preventing (and treating to a small extent when given early in the disease process) monkeypox. Only one is licensed for monkeypox by the U.S. Food and drug Administration. This is called Jynneos or MVA-BN in the U.S. The other two are called ACAM2000 and LC16m8. The Jynneos is considered the safest and therefore is the drug of choice. It is delivered by injection under the skin, by two doses, four weeks apart. It doesn’t form a scab, like the delivery of the other vaccines. It works because it contains a form of the pox virus called vaccinia that is not able to replicate in the body. The other two contain a form of vaccinia that can replicate and therefore cause some people to feel sick.

Smallpox vaccines are being used for monkeypox because all poxviruses are similar and protection against one either by immune response to infection or vaccination seems to protect against all to some extent.

Countries no longer vaccinate against smallpox because it was thought to be eliminated in the 1970s but viral cultures have been kept in government laboratories. The reason that vaccinations for this exist at all is because of the concerns of governments that it could possibly escape into the population by either accident or intention and because it works against the other pox viruses. Since the end of routine smallpox vaccinations which was enabled by the elimination of smallpox in the world population, which was one of the the most successful, global health initiatives ever, the frequency of outbreak of other pox viruses has increased.

WHO has stated that “vaccination against smallpox was demonstrated through observational studies to be about 85% effective in preventing monkeypox.” This number comes from observations of a single outbreak in the Congo during an outbreak of monkeypox in the 1980s. There is no other data available to determine efficacy. This is also why other public health measures are necessary to fight this disease.

Right now, there is estimated to be only about 16 million doses globally, clearly not enough if the current outbreaks cannot be contained. The company that manufactures Jynneos is stepping up production.

Our local public health department has recommended contacting your primary care physician if you have symptoms or have been exposed. Not everyone has a primary care physician or can reach them in the four-day window of opportunity after symptoms begin to have a benefit from immediate vaccination. I’d suggest you also contact your county health department, the state health department, and possibly the Albany County Health Department since as of my writing this, it is the closest entity with vaccine.

Dr. Richard Sternberg, retired Bassett Hospital orthopedic surgeon, is providing his professional perspective during the COVID-19 threat.
Also a village trustee, he lives in Cooperstown.