DENVER – Colorado has ordered small amounts of an FDA-approved monkeypox vaccine to protect health care workers and people directly exposed to the virus as cases of the disease continue to slowly increase across the state.
Around 100 doses of the JYNNEOS vaccine have been ordered by the Colorado Department of Public Health and Environment (CDPHE) to vaccinate intermediate and high-risk health care workers and people considered to be at higher risk for catching monkeypox, said Scott Bookman, director of the CDPHE’s Division of Disease Control and Public Health Response.
A mass vaccination campaign is not on the table at this point as the risk to the general public remains low and because the U.S. has only a limited number of vaccines in its stockpile, he said.
“I really do want to call out that this is a very different situation than the COVID-19 response that we have been talking about over the last two years,” Bookman told reporters during a news briefing Wednesday. “This virus is not nearly as transmissible. We are not seeing widespread transmission at this point.”
Five cases of the monkeypox virus have been identified in Colorado since the first presumptive case was announced in late May, state health officials said, though they added some of those cases are still pending official confirmation from the U.S. Centers of Disease Control and Prevention (CDC). None have resulted in hospitalizations or deaths.
The five Colorado cases have been among men who have sex with men or people who have recently traveled internationally to countries where an outbreak of monkeypox is taking place.
The CDPHE has so far not identified instances of community transmission, but state epidemiologist Dr. Rachel Herlihy said that it doesn’t mean it hasn’t already occurred in Colorado.
While health officials have identified international travelers and men who have sex with men as a higher-risk group for contracting monkeypox, anyone – regardless of their sexual orientation – can still catch the virus if prolonged close contact with an infected person or area takes place. Brief interactions without physical contact are unlikely to spread the virus, health officials stressed.
What is monkeypox?
Monkeypox is caused by an infection from a virus in the same family as smallpox, causing a similar (but less severe) illness, according to Harvard Health. Complications can include pneumonia, vision loss due to eye infection, and sepsis, a life-threatening infection.
Up until this year, the illness – which was first discovered in 1958 – was mostly concentrated in parts of western and central Africa, but an outbreak is currently being reported in more than 40 non-endemic countries across the world.
Health experts are looking into why this large outbreak is happening, as those who've come down with the illness have not traveled to or from a place where the virus is usually found and have had no known contact with infected animals. Additionally, there seems to be more person-to-person spread happening than in previous outbreaks, they said.
There are two known types of monkeypox — the West African strain, which has a 1% fatality rate; and the Congo Basin strain, which has a 10% fatality rate. The current outbreak happening outside of Africa comes from the West African strain, according to health experts.
About 5% of people who contract monkeypox die.
How does monkeypox spread?
People in areas where monkeypox cases occur more often are typically exposed through bites or scratches from infected rodents and small mammals, while preparing wild game, or having contact with an infected animal or possibly animal products, health officials say.
Because that hasn’t been the case here in the U.S., health experts believe spread is mostly happening after close contact with the rash, sores or scabs from a person infected with monkeypox.
The virus can also spread from one person to another through large respiratory droplets (but this likely requires prolonged face-to-face contact, so it's not a bad idea to continue wearing a N95 respirator or its equivalents) and through intimate contact, such as having sex and exchanging bodily fluids, or by sleeping next to someone who is infected with the virus.
Other human-to-human avenues for monkeypox spread can happen through contaminated clothing or linens, though that’s a less common route, Herlihy said.
While walking next to someone in the street is unlikely to spread the virus, the CDC is currently investigating whether the disease can be spread asymptomatically, just like COVID-19. Health officials are also investigating whether the virus could be present in semen, vaginal fluids, and fecal matter.
What are some symptoms I should watch out for?
Symptoms of monkeypox are similar to, but less severe, than those of smallpox, according to the CDC.
The illness begins with a fever, a headache, muscle aches and exhaustion. Backaches, swollen lymph nodes and chills can also afflict a person infected with monkeypox, but not always.
The incubation period for monkeypox is usually between a week and 14 days, but symptoms can appear in as little as 5 to as long as 21 days, the CDC notes.
Health officials say it may take one to three days (sometimes longer) after a fever breaks out before a person infected with the virus starts developing a rash, which usually begins on the face and spreads to other parts of the body, including the palms, arms, legs, and most recently, the genital area.
The rash can also appear inside the mouth, the chest or anus, Herlihy said, adding it can also be localized to a certain region of the body. The rash may be painful or itchy.
The rash will then change from small, flat spots to tiny blisters (called vesicles) which are similar to chickenpox, which then turn to large blisters filled with pus, health officials say. It can take several weeks for the blisters to scab over.
The virus can be transmitted from when symptoms start until all lesions have healed and new skin has formed, Herlihy said. The illness can last anywhere from two to four weeks.
If you can stomach it, the CDC has a helpful guide to help you recognize monkeypox infection here.
How can I lower my chances of catching monkeypox?
If you're sexually active, the CDC recommends you talk to your partner about any recent illness and check for new or unexplained sores or rashes on your body or your partner’s body, including the genitals and anus.
If you or your partner have recently been sick, currently feel sick, or have a new or an unexplained rash or sores, do not have sex and see a healthcare provider, the agency states.
"If you or a partner has monkeypox, the best way to protect yourself and others is to not have sex of any kind (oral, anal, vaginal) and not kiss or touch each other’s bodies while you are sick, especially any rash or sores," a fact sheet from the CDC on safer sex and monkeypox reads. "Do not share things like towels, fetish gear, sex toys, and toothbrushes."
If you or your partner have (or think you might have) monkeypox and you decide to have sex, the CDC asks you to consider the following to reduce the chances of spreading the virus:
- Have virtual sex with no in-person contact.
- Masturbate together at a distance of at least 6 feet, without touching each other and without touching any rash or sores.
- Consider having sex with your clothes on or covering areas where rash or sores are present, reducing as much skin-to-skin contact as possible.
- Avoid kissing.
- Remember to wash your hands, fetish gear, sex toys and any fabrics (bedding, towels, clothing) after having sex
- Limit your number of partners to avoid opportunities for monkeypox to spread.
The CDC guidelines do not state the use of condoms, but it's always a good idea to wear one to not only prevent a monkeypox infection, but also many of the other sexually transmitted infections a person could be exposed to when having sex.
What should I do if I believe I’ve come into contact with someone who has monkeypox?
Michelle Barron, medical director of infection control and prevention for UCHealth, previously told Denver7 the first thing people should do if they think they've come into contact with someone who has monkeypox is to thoroughly check and examine the skin "quite well."
You'll also want to contact your doctor if you start developing a rash that looks something like this and get tested for monkeypox.
If you test positive, the CDPHE asks that you isolate at home, stay away from people, pets, and stay home from work until all lesions heal and new skin forms.
You’ll eventually get a call from a public health official who will ask about any potential exposure you may have had, including any recent travel, close contacts and/or medical visits.
If you’ve been identified as a potential case, the CDPHE asks that you return these calls so that you may be interviewed for contact tracing purposes. The interview will be completely confidential.
“The goal is to prevent spread,” Herlihy told reporters Wednesday.
What treatments are available for people who have monkeypox or who may have been exposed to the virus?
The CDPHE said Wednesday people who are identified as contacts of a case will be monitored for symptoms for 21 days after their last contact with a positive case, to quickly identify individuals who may go on to become monkeypox cases and get them treatment to prevent an infection from developing, she said.
One such treatment is the JYNNEOS vaccine, which is thought to have an 85% efficacy rate against monkeypox.
The vaccine uses a live version of the smallpox virus that has been engineered to prevent it from replicating or causing infection in the body, but which can still activate an immune response to mount defenses against both the smallpox and monkeypox virus. It was approved by the U.S. Food and Drug Administration (FDA) in 2019, according to TIME.
Herlihy said that while it is best to get the vaccine within four days of exposure, it may also be helpful up to 14 days after exposure to the virus.
While there’s no other specific treatments for monkeypox infection, some FDA-approved antivirals that may be effective for monkeypox include cidofovir, brincidofovir, and tecovirimat.
The CDPHE has created a website with public resources, fact sheets, and more, to keep Coloradans updated as the disease continues to spread.
As of Wednesday afternoon, a total of 156 monkeypox cases have been reported across 23 states and Washington, D.C. in the U.S., according to the CDC. More than 3,100 cases have been reported thus far across the globe in 41 non-endemic countries, the latest data shows.
The World Health Organization (WHO) will convene Thursday to decide if the growing monkeypox outbreak warrants being declared a public health emergency of international concern, which would give it the same designation as the coronavirus pandemic and the ongoing effort to eradicate polio, according to the Associated Press.