A new trial is getting underway in San Diego and across the nation that aims to further stretch the supply of monkeypox vaccine as demand continues to outstrip supply.
According to the county health department’s most recent update, the region has so far received about 8,000 vials of the vaccine, far fewer than the 33,468 requested. Vaccination clinics are already squeezing up to five doses out of every vial by injecting smaller amounts of the protective product just under the skin, using an “intradermal” technique similar to the one used to administer tuberculosis tests.
Research has shown that shallow injections do not require a large volume of vaccine because the skin is loaded with specialized immune system cells primed to quickly detect incoming threats from viruses to bacteria.
While using as little as one-fifth of a vial per recipient is already underway after the federal government approved the practice on Aug. 9, experts suspect that an even smaller amount — perhaps one-tenth of a vial per person in a two-dose series — might be all that is needed to trigger the body to start producing protective antibodies and other immune system components capable of preventing infection.
UC San Diego is among eight medical providers nationwide set to launch a trial that will compare smaller one-fifth- and one-tenth-sized doses of the Jynneos vaccine delivered below the skin to full vials injected at full depth.
“If we can show that they’re all equivalent, we can spread out the available supply of vaccine and administer preventative vaccine doses to more people,” said Dr. Susan Little, the trial’s local principal investigator and an infectious disease specialist at UCSD.
UCSD’s Antiviral Research Center has already started screening potential participants online at bit.ly/ucsdmonkeypox with doses expected to start going in arms next week.
But, as is the case with tuberculosis tests, intradermal vaccination leaves a distinctive raised bump on the forearm after injection, and that mark, officials explained during a monkeypox town hall Tuesday evening, has come with its own complication.
Sponsored by U.S. Reps. Sara Jacobs and Scott Peters, the online event featured commentary from a range of experts, including Kim Fountain, deputy chief executive officer of the San Diego LGBT Community Center. Fountain said the distinctive raised bump is causing some to balk at getting the shot.
“These men are terrified of being stigmatized because somebody might see that red spot on them, whether it’s their family or employer or friend, whoever it may be,” Fountain said.
Though anyone can be infected by the monkeypox virus, the current worldwide outbreak has most often affected gay and bisexual men. According to the county health department’s most recent update, 321 cases have been detected locally. Demographic information is available for 313 of that total, with 308 listed as men. About 93 percent of those who responded said they are part of the LGBTQ community.
Dr. David “Davey” Smith, an infectious disease specialist at UCSD who said he has treated many patients with monkeypox infections, confirmed that there is concern with any telltale sign that vaccination may leave. Some, he added, have been concerned about the mark that the deeper-injected shot leaves where it is generally administered on the back of the upper arm.
Those in the LGBTQ community have long faced difficulties with equal access to health care services, and that disparity, the physician and researcher added, has sometimes come into play during the current monkeypox outbreak.
“There is this disconnect of talking to somebody’s health care provider about their sexual activity because there is this stigma that they think they’re going to get in a medical setting that can keep them from getting the care that they need,” Smith said.
In some cases, he added, patients have had to find their own way to his services after their regular health care provider was unsure how to proceed after they tested positive.
“It was less on the side of doctors not wanting to help as it was ‘I don’t know what to do, you need to go find somebody else who can help you,” Smith said.
While most monkeypox infections resolve themselves after a few weeks of discomfort, some experience sore throats so severe that they end up getting admitted to hospitals for narcotic pain medication. The virus can also cause severe constipation that ends up requiring a short hospital stay to resolve, and pox can very occasionally appear in very private and sensitive locations that end up requiring surgery.
Those who do not end up in a hospital bed still face difficulties beyond coping with their symptoms. Federal guidelines recommend isolation until pox have healed, which can take several weeks. Being out of work for so long can force employees to disclose the reason why they are calling out sick, and can also create financial difficulties.
“It can hit people pretty hard if they don’t have a month of sick time or if they need that paycheck,” Davey said.
According to the county health department, a total of 10 people across the region have needed hospital stays due to monkeypox. There have been no deaths.