With demand skyrocketing for the country’s limited supply of monkeypox vaccine, US authorities have approved a new injection method to expand doses, but that doesn’t mean the push for injections in places like San Francisco will subside immediately.

Bay Area officials say they still need the federal government’s manual on changing how injections are given, with additional training needed for many immunization staff.

The new method will only use a fifth of the previously administered dose, but “you have to get it right”, and that means ensuring healthcare providers are trained in the nuances of precision, said Dr. Peter Chin-Hong, an infectious disease expert. with UCSF.

“There is no other choice,” he added. “Given the anemic influx of vaccine doses, there won’t be enough for many, many months.”

California Department of Health officials predict it will take a long time to implement the new emergency use authorization, granted Tuesday by the Food and Drug Administration, to administer smaller doses of the Jynneos vaccine using an injection between layers of skin rather than into deeper fatty tissues.

Studies have shown that this method can elicit a stronger immune response, but it is not commonly used in the United States, requiring clinician training before it becomes widely available.

“That would allow a lower dose to be delivered intradermally,” Dr. Erica Pan, the state epidemiologist, told medical professionals during a Tuesday briefing. “We will need to work closely with all of you and the health services to implement this.”

It is therefore unclear when enough providers will be trained to achieve a fivefold increase in the state’s supply of monkeypox vaccines.

“I hope they can do it as soon as possible,” Chin-Hong said, noting that the injection method has been widely studied for polio and yellow fever. “We are on the steep curve of people getting sick, getting infected and spreading. On the hospital side where we see the most serious cases, the number of patients doubled last week.

California reported a cumulative total of 1,733 monkeypox case Tuesday, with nearly a third of those concentrated in San Francisco and Alameda counties. Although anyone can catch monkeypox, the outbreak is still largely contained in networks of men who have sex with men and is believed to be spread primarily through prolonged skin-to-skin contact, including sexual activity.

The San Francisco Department of Public Health said it welcomes “all possible avenues that would allow us to get more people vaccinated against monkeypox as soon as possible.”

But as of Wednesday, the department was awaiting federal and state guidelines on the injection change, including instructions on dose extraction and administration, and said, “The SFDPH should understand the adjustments that should be brought to operations to ensure San Francisco vaccine providers continue to reach as many people who need the vaccine as quickly and equitably as possible.”

It also provides instructions from state health officials on how to account for and record each dose when multiple doses are withdrawn from single vials.

“We are also aware that the intradermal method of vaccine delivery, in which a dose is injected between layers of skin, will require updated protocols and additional training for many vaccinators and may be slower to administer,” said the California Department of Public Health. said in a statement to The Chronicle.

Across California, 98% of cases for which demographic data is available are male and 96% are gay or bisexual, according to state data compiled in The Chronicle’s monkeypox tracker. Monkeypox, which can produce painful lesions, is not a sexually transmitted infection, but sustained contact in intimate encounters can lead to transmission. Only 3% of those infected had to be hospitalized.

The Alameda County Health Department also said it is awaiting direction from the state and federal government before changing how it administers monkeypox vaccinations.

“Efforts to increase access to the monkeypox vaccine are appreciated and would be implemented, pending guidance, if determined to be in the best interest of communities in Alameda County affected by this outbreak,” said Neetu Balram, county public information officer.

White House officials said Tuesday that the new method is a game-changer and would allow them to stretch the 400,000 vaccine vials available into about 2 million smaller doses.

“It’s safe, it’s effective, and it will dramatically increase the volume of vaccine doses available to communities across the country,” White House monkeypox response coordinator Robert Fenton told reporters.

While that won’t completely reduce current demand, they said, it will at least help ease some of the pressure.

About 1.6 million to 1.7 million Americans are considered by federal authorities to be most at risk of contracting the disease, mostly HIV-positive men or men who are at higher risk of contracting it. Vaccination of this group would require more than 3.2 million shots, with full vaccination consisting of two shots per person.

“Gay, bisexual, and other men who have sex with men in recent history have demonstrated significant confidence in vaccines. … I imagine we will likely run out of vaccines before we run out of weapons,” White House deputy monkeypox response coordinator Dr. Demetre Daskalakis told reporters.

The scarcity of vaccine supplies has made roll-out to the eligible population extremely slow for many. On August 4, the Biden administration declared a national health emergency related to monkeypox. San Francisco and California issued similar proclamations days earlier.

California has only received 109,000 doses of the vaccine so far, Pan said, although the state expects another allocation next week. Jurisdictions can order additional vaccine supplies beginning Aug. 15 or when they have used 90% of their current vaccine allocation, according to the White House.

“One of the concerns I have with these delays is fairness,” Chin-Hong said. “You need to be electronics savvy and able to take time to queue for vaccines. It doesn’t work for gig workers or (those who are) locked in with their sexuality. Even if they do it with the five-to-one vaccine, there will be holes they have to fill. »

Aidin Vaziri (he/him) is a writer for the San Francisco Chronicle. Email: [email protected]


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