As the outbreak escalates, the Philadelphia Health Department faces logistical challenges and cultural concerns as it approaches decisions on how to roll out the monkeypox vaccine.
Last week, the US Food and Drug Administration authorized health providers to offer a fifth of the standard rabies vaccine, JYNNEOS.
But changing to smaller sizes isn’t easy, city Health Commissioner Cheryl Bettigole said in an interview Friday. Different needles and injection techniques are required; Record keeping is another challenge, she said, explaining why her agency has stopped dispensing small doses of the drug so far.
“We’re trying to move very quickly,” Bettigole said. We want both the vendors and the community to be involved in whatever we decide.
She expects to announce how the Philadelphia Department of Public Health will handle the new guidelines next week.
About 24,000 doses of vaccine are needed to provide the recommended two-shot series for each high-risk group, which includes men over age 18 who have recently had multiple or informal sex with other men. Some transgender and non-binary people as well Sex workers It can also be at high risk. The city has been allocated more than a third of that money by the federal Department of Health and Human Services, Betigole said, and this week’s expected delivery could be the last in 2022.
» Read more: Philly sex workers finally get a monkeypox vaccine
Until now, the city has been prioritizing people who are at risk of monkeypox, but health experts say that anyone can be exposed to the virus.
The FDA’s decision to allow smaller doses came as the United States reported more than 10,000 cases of the virus nationwide. Philadelphia reported 128 cases Monday, the most recent data available, about half of the cases reported in Pennsylvania, where demand for vaccines outstrips supply.
The FDA says the smaller size provides the same protection as the full size, instead of the fat layer beneath the skin.
“If we could take that number and multiply it fivefold, it could completely change the landscape of this,” said Dusty Latimer, a nurse practitioner at the Mazzoni Center, an LGBTQ-focused Philadelphia health clinic.
Although the FDA cites small-scale research as evidence that it protects people, Bettigole said other studies in Germany have boosted confidence in the approach.
“It’s the best thing we have right now,” she said of the vaccine, which was approved in 2019. “At least it’s safe.
Not only is the city short of supplies, it also lacks special needles for skin injections. Health department staff are determining how quickly they can get needles. The city waits with hope. But he doesn’t know how much federal funding will be available for the monkeypox response.
Intradermal injections require more precision – and therefore training – from the type of syringes used to administer a full monkeypox or Covid-19 vaccine.
“It’s been a minute since most people in medicine have done an intravenous injection,” Latimer said.
A clear blister on the skin at the injection site indicates that the shot was injected correctly. Among the unanswered questions, Betigole said, is what to do if one of those shots is mistakenly administered. If the small dose is injected too deeply, it won’t trigger the necessary immune response, she says.
Intradermal injections are more likely to leave a permanent scar, especially in people prone to developing thick keloid scars. If patients don’t have a choice about which type of injection to get, some may avoid the shots altogether rather than expose the scars that can create stigma, she says.
Some patients may have other skin conditions that make the larger size a better option, Latimer said.
However, giving patients a vaccine option creates additional complexity for providers, as it is yet another layer of enrollment.
Providers face questions from patients who doubt that smaller doses can be as effective as larger doses, Latimer said. It’s an “expected and now I’m not too excited to do it regularly” conversation.
He said clear guidelines from the city about who is or isn’t giving deep and high-dose vaccinations will help providers.
A survey of providers and community leaders on how to best handle vaccine distribution will be completed Monday, the commissioner said, with an announcement expected to be made within days.
“We want input from vaccine providers, community leaders, community members about how they feel about this,” Betigole said.