Anyone who plans to have “multiple sex partners” is now eligible for the monkeypox vaccine in Michigan, state health officials announced Tuesday, in the biggest expansion of eligibility for this vaccine so far.
Also newly eligible: sex workers, people whose sexual partners engage in “higher-risk sexual activities,” close contacts of people who’ve been exposed to the monkeypox virus (MPV) or “engaged in higher-risk activities,” people who plan to have close contact at a “high-risk event,” and anyone living with HIV or taking HIV pre-exposure prophylaxis, often called PreP.
“We need to keep expanding eligibility for vaccines in order to really get ahead of this disease,” said Dr. Natasha Bagdasarian, the state’s chief medical executive, on Tuesday. “We're really now making vaccines available in a lot more circumstances … and we're also making sure that this is not just focused on the MSM, or men who have sex with men, community, that we've broadened it to really account for transmission occurring outside of that group.”
That state-level expansion came the same day the FDA issued an emergency use authorization for the Jynneos monkeypox virus vaccine to be injected intradermally (meaning into the skin layer) as opposed to subcutaneously (meaning into the fat layer beneath the skin). Intradermal injections require only a fraction of the dose needed for subcutaneous shots. “This will increase the total number of doses available for use by up to five-fold,” the FDA announced Wednesday.
“In recent weeks the monkeypox virus has continued to spread at a rate that has made it clear our current vaccine supply will not meet the current demand,” FDA Commissioner Robert M. Califf said in the statement. “By increasing the number of available doses, more individuals who want to be vaccinated against monkeypox will now have the opportunity to do so.”
That could mean that the roughly 6,400 vaccine doses the state currently has on hand could be stretched to vaccinate some 32,000 people.
“We will be adjusting our strategy accordingly, but need to receive interim clinical guidance from CDC to know all of the details,” a spokesperson for the Michigan Department of Health and Human Services said via email. “But in practice, yes, it should greatly increase the number of doses.”
The FDA cited a 2015 study showing a two-dose series of the vaccine given via intradermal injection “produced a similar immune response to subcutaneous administration, meaning individuals in both groups responded to vaccination in a similar way.”
Still, the strategy has risks. Research into the effectiveness of intradermal MPV vaccine injection is limited, and the method has little margin for error and requires additional training.
While the FDA's emergency authorization also allows for people under 18 to be vaccinated for MPV, it says for that age group, the vaccine should still be administered by the original subcutaneous route.
As of Monday, Michigan had 72 confirmed cases of MPV, primarily in the Detroit area and surrounding counties, as well as Kent County. But limited testing means the real count is likely higher. So far, just over 1,000 doses of the vaccine have been administered in the state, with roughly 6,400 left in the state’s supply, according to MDHHS.
But until Tuesday, eligibility had primarily been for those with direct exposure to a confirmed or probable MPV case, as well as household members of people who tested positive for the virus, and those in who may have been exposed, as Bagdasarian said in July, “to outbreak settings, or who may be in networks where transmission has been ongoing.”
Another 3,000 doses are expected to arrive in in Michigan mid-August, with another 3,000 coming at a later unknown date. “In total, Michigan will be receiving around 14,500 total doses of JYNNEOS through the first 3 phases of pre-deployment,” an MDHHS spokesperson said last week.
“As more vaccines are available, we want to make sure that those vaccines are getting into arms,” Bagdasarian said Tuesday. She said the hope is containment of the virus. "Rather than playing catch up with this transmission, rather than looking only for those who have been exposed and vaccinating them, we really want to get ahead of the virus and offer vaccine to individuals who are at higher risk of being exposed, even if we don't have a documented exposure.”
If you’re interested in getting vaccinated for MPV, or want to talk to a healthcare provider about whether you should be vaccinated, contact your local health department.
