As monkeypox cases surge in South Florida, demand for vaccines intensifies
Fever. Shooting pain. Pimple-like bumps.
Victor Infante has been in quarantine for days, recovering from monkeypox, a virus normally not found in the United States but that has been surging in New York, California, Illinois and Florida, primarily impacting gay and bisexual men. As of Friday, Florida had recorded 260 cases, up from one presumed case at the end of May.
At times, the pain from Infante’s pimple-like blisters spikes, waking him up in the early morning. He no longer has a fever though he still gets chills. Parts of his body feel swollen, making it uncomfortable to lie down too long.
And he keeps noticing new pimples — on his hands, back, feet. They have a dark spot in the middle. So far, none have appeared on his face. But some have started to burst — “It’s horrible pain,” he told the Herald in Spanish.
Infante, of Hollywood, is one of nearly 200 people who’ve had either a suspected or confirmed monkeypox case in Broward and Miami-Dade counties. Broward, with 124 confirmed and suspected cases as of Thursday, is the state’s epicenter, followed by Miami-Dade with 65 confirmed and suspected cases. The rare disease is in the same family as smallpox, and while both viruses share similar symptoms, monkeypox is usually milder and is rarely fatal, according to the Centers for Disease Control and Prevention. It also is not as contagious as COVID-19.
The surge in monkeypox cases is coming at the same time Florida has been battling an outbreak of meningococcal disease, which is caused by bacteria. The two most common meningococcal infections are meningitis — an infection of the brain and spinal cord lining — and a bloodstream infection. The infections quickly can become deadly.
READ MORE: ‘Florida is in midst of a meningococcal outbreak.’ What to know now about meningitis
Meningococcal disease, too, is spreading among gay and bisexual men. In fact, the CDC has called Florida’s outbreak — with 48 cases since the start of year, about twice the levels for an entire year — “one of the worst outbreaks of meningococcal disease among gay and bisexual men in U.S. history.”
Public health experts are much more concerned with meningococcal disease, than monkeypox, due to its deadliness. Of the 48 Florida cases, 12 people have died, or 1 in 4. No one has died from the U.S. monkeypox cases, although five deaths have been reported in Africa.
“Meningococcal disease, to some degree, concerns me more given the severity of the disease,” said Dr. Ulyee Choe, statewide medical director for the Florida Department of Health, at a Wednesday press conference.
How quickly meningococcal disease can develop into a serious health issue led Duane Rinde to get vaccinated Wednesday at Latinos Salud, a Wilton Manors clinic in Broward County. He had just seen a photograph of a friend who lives in Texas lying in a hospital bed, hands and feet wrapped in bandages. The meningococcal infection had cost his friend his hands and feet.
“After seeing him, I just had to get a shot,” said Rinde, who also got a monkeypox vaccine at the clinic.
READ MORE: What meningococcal disease can do to a body
When they started, how they spread
The meningococcal disease outbreak in Florida began at the end of 2021, accelerating in 2022. By contrast, monkeypox cases started showing up in May in Florida.
READ MORE: As monkeypox spreads in South Florida, experts have advice on prevention, risk, vaccines
Both can spread through close contact over a period of time, or direct contact such as kissing, hugging, sex or sharing food and drinks. In the case of monkeypox, a person can get infected through contact with the infectious rash, pimples and scabs or touching the bedding, towels or clothing of an infected person, according to the CDC.
“Sitting next to someone does not necessarily mean that you’re going to basically catch the virus,” said Dr. John Esin, medical director of emergency medicine at Jackson Memorial Hospital, discussing monkeypox. “As long as there’s no contact, and you’re not sharing something — a clothing item, or rubbing against an individual that may have a lesion, or kissing or hugging someone with an exposed lesion.”
For Infante, it’s a mystery how he contracted the virus. The 35-year-old hotel worker said he hasn’t traveled, hasn’t gone to parties, festivals or even to a bar recently. He doesn’t have a partner at the moment. And he hasn’t been sexually active, he said.
When his doctor asked him about it, he couldn’t pinpoint anything unusual.
Concerns over stigmatization
Monkeypox typically occurs in the tropical rain forests of Central and West Africa, according to the World Health Organization, which, on Saturday, declared the global outbreak of monkeypox “a public health emergency of international concern.”
This year, however, the outbreak has been heavily concentrated in Europe. As of Wednesday, there were 16,538 cases in 243 countries, according to the CDC.
While anyone can get monkeypox, many of the infections in the U.S. and Europe have happened in men who have sex with men. Doctors and members of South Florida’s LGBTQ community are concerned that this could lead to stigmatization of gay men similar to what happened with the HIV/AIDS epidemic in the 1980s and early ‘90s.
“A lot of education needs to be done. Early data may suggest that gay, bisexual and other men having sex with men, they make up a high number of cases. The problem with that data is that it tends to stereotype a particular group of people, which takes us back to the early days of HIV,” said Esin, the Jackson Memorial medical director.
“As far as transmission is concerned, anyone in close contact with someone who has monkeypox is at risk. We have to make that very well known before we fall in that trap of thinking that it’s a certain group of people that have this,” Esin said.
Think of monkeypox transmission like a “social network,” said Mary Jo Trepka, an infectious disease epidemiologist at Florida International University.
Esin said Jackson hospital has seen a “sharp rise” in the past week alone of patients who have come in to be evaluated for monkeypox. In the past month, he’s seen at least 20 confirmed or suspected cases of monkeypox.
‘Frustrating’ shortage of vaccines
There are two vaccines approved by the U.S. Food and Drug Administration that can help prevent monkeypox in people who were exposed or at higher risk of being exposed to the disease. This includes certain healthcare workers, people who have had multiple sexual partners in the past two weeks in areas known to have monkeypox cases, and anyone who learns that their sexual partner in the past two weeks has been diagnosed with monkeypox.
CDC Director Dr. Rochelle Walensky told reporters on July 15 that the country is facing a “frustrating” shortage of the Jynneos monkeypox vaccine at a moment of overwhelming demand. Over 2,800 U.S. cases have been confirmed as of Friday — 20 times the number of U.S. cases just a month ago.
Walensky said the agency is working to increase demand for the Danish-produced two-dose vaccine, called Jynneos (also known as Imvamune or Imvanex ). The Department of Health and Human Services has ordered 2.5 million additional doses of Jynneos that will arrive throughout the year. A second order of 2.5 million more doses won’t arrive until 2023.
“We don’t yet have all the vaccine that we would like in this moment,” Walensky said.
READ MORE: Here’s where you can get a vaccine or test for meningitis or monkeypox
Dr. Peter Marks, director of the Center for Biologics Evaluation and Research at the Food and Drug Administration, said the regulatory agency is inspecting a production facility for Jynneos to decide whether to authorize the use of an additional 780,000 doses. If the FDA approves the facility, those could be available starting at the end of the month.
Another vaccine, ACAM2000, which was designed to prevent smallpox but has proven to work against monkeypox, can have severe side effects and is not meant to be given to people with certain health conditions, including pregnancy and people who are living with HIV.
Like with COVID, vaccination, testing and contact tracing will play a key role in controlling the spread of monkeypox, said Trepka, the FIU infectious disease epidemiologist.
Getting the vaccine shortly after exposure
Vaccination will be particularly important for people exposed to monkeypox, she said. The CDC recommends getting the vaccine within four days from exposure for the best chance to prevent the disease. Getting the vaccine within four to 14 days after exposure could help reduce symptoms, but might not prevent you from falling ill.
Example: “You have sex with somebody that is later diagnosed with monkeypox within the last couple of weeks. You can get the vaccine, which could help prevent you from getting the disease or prevent severe illness,” Trepka explained.
Finding tests, vaccine not easy
But finding a shot amid a nationwide shortage can be difficult. Monkeypox testing has also been hard to find.
Infante, the Hollywood man who has monkeypox, had tried to get the monkeypox vaccine as a “precaution.” But appointments were full. A week after he began searching for the vaccine, he developed a fever and noticed a small pimple in the groin area.
“I was shocked,” Infante said.
He grew worried. Was it an STD or monkeypox?
His STD tests came back negative. But he couldn’t find a monkeypox test site.
“It was horrible,” Infante said. “Where the hell am I going to go?”
Infante said he called the CDC, Florida’s health department and several clinics, but no one could tell him where to get tested. Broward Health couldn’t help him. He went to Jackson’s urgent care center in Miami Gardens, where he finally got tested on Tuesday.
The doctor suspects Infante has monkeypox, but they’re still waiting for the results.
“What’s affected me the most is the lack of attention. As a human being, you want support from a doctor to tell you don’t worry, it’s going to be OK,” Infante said.
Miami-Dade’s health department, in an email to the Miami Herald, said that the county is “seeing the same demand for vaccination as in other parts of the country. Unfortunately, the demand for the vaccine is far greater than the amount available from the federal government.”
The health department also noted that it’s working with providers to coordinate and provide vaccination outreach activities for people who meet the vaccination criteria. It also recommends that people who need a monkeypox test speak with their provider. The department said providers can send the tests to commercial labs such as LabCorp and Quest.
As for vaccines, other then Miami-Dade and Broward’s health departments, which are scheduling vaccine appointments online based on availability, monkeypox vaccination sites are scarce in South Florida. Retail pharmacies such as CVS and Walgreens do not have the monkeypox vaccine, at least for now. There also isn’t any online locator people can use to find a vaccine or test site.
Pride Center seeing big demand for vaccines
One of the places that received doses from the health department is the Pride Center at Equality Park, 2040 N. Dixie Hwy. in Wilton Manors. On Monday, within three hours, it booked more than 800 appointments for the week, said Robert Boo, the center’s chief executive officer. The site can vaccinate 192 people a day by appointment, depending on its vaccine availability.
Elias Taravay, 49, was one of several dozen men waiting to get vaccinated at the clinic. He said he has been trying to get the shot for the last month and a half.
The Miami resident wanted to get inoculated before his trip to Spain, during which he will stay in a gay hotel. He had even considered flying to New York to get a vaccine — until a friend sent him a link to the Pride Center site.
Matt Gantenbein, 33, received his shot at the center a day after he joined the wait list.
The Oakland Park resident said he’s one of the first in his friend group to get the monkeypox vaccine. Many have told him they want to get vaccinated but haven’t been able to secure an appointment.
Another Wilton Manors site offering vaccines is Latinos Salud, 1401 NE 26th St., which began administering monkeypox vaccines Wednesday. Stephen Fallon, the clinic’s executive director, said he hopes other Latinos Salud locations, including some in Miami-Dade, will offer the vaccine in the coming weeks.
Monkeypox awareness
Fallon said the clinic has encountered anxiety about monkeypox more than actual cases. Only two patients have fallen ill to monkeypox, and one contracted it while in Europe, he said.
However, vaccinations have been a challenge due to limited supply, nurse practitioner Joel Ramos said. The clinic is prioritizing gay and bisexual men, people with multiple sexual partners and those who have illnesses like HIV and diabetes, which can suppress the immune system.
Esin and Trepka, the Jackson doctor and FIU epidemiologist, also noted that the type of monkeypox that is spreading is a bit “atypical” in appearance.
Both experts noted that more rashes are occurring in the genital area during this outbreak than what has been seen in the past, making it harder to distinguish if a person has a sexually transmitted disease or monkeypox. (Regardless, Trepka says you should seek medical care if you get a fever and rash.)
“The other thing that has raised a lot of the eyebrows, as far as the clinical world, is that some of the [monkeypox] presentations mimic standard sexually transmitted infections, which basically tells you that if you’re not thinking about monkeypox, this can be easily missed,” said Erin.
As soon as the CDC identified Florida as a hot spot, Latinos Salud’s staff began educating patients on preventing the illness. Prevention methods recommended by the CDC include frequent hand washing, not having intimate contact like kissing or sex with an infected person, avoiding touching their rash or scabs and not sharing eating utensils, cups or touching their bedding, towels or clothing.
Education is also on the mind of Boo, the CEO of Pride Center.
“This is really not just an LGBTQ concern; it is an entire community concern,” said Boo. “And so by raising awareness and trying to de-stigmatize this so it’s much more of a kitchen table conversation — people can be informed and then, based upon their own actions or what’s going on in their life, they can make better informed decisions.”
McClatchy DC Bureau staff writer Michael Wilner contributed to this report.
This story was originally published July 24, 2022 at 7:00 AM.
