What the North Jersey mother and daughter did for the symptoms

Monkeypox was the last thing on Erica’s mind recently when her brother called to say he had tested positive for the virus after spending a week at his South Orange home.

After raising a toddler during the COVID-19 pandemic, she thought she was done learning about unknown infectious diseases. Now she had to fear again for her 3-year-old daughter, Cate.

“I was really worried about her and what monkeypox meant to a child,” said Erica, who asked that the family’s last name not be used. His concern grew when quick research revealed that the vaccine used to prevent monkeypox in patients with exposure was only approved for adults 18 or older.

“Now I’m freaking out,” she recalled.

But a vaccine held in reserve for a possible terrorist attack using smallpox, and the coordinated efforts of a private medical practice and state and federal officials, prevented the worst from happening.

Monkeypox, a viral disease of animal origin and which was once present in only a few African countries, has spread worldwide in recent months. The World Health Organization has reported more than 3,400 cases in 50 countries. In the USA, 2,108 cases had been confirmed as of Tuesday – an unprecedented outbreak that experts say is likely a huge undercount.

New York has become an epicentre: So far 639 people have tested positive for orthopox — the family of viruses that includes smallpox, cowpox and monkeypox — and are presumed to have monkeypox. New Jersey had 45 confirmed or probable cases as of Tuesday, mostly in North Jersey, the state health department said.

These numbers are expected to increase.

Symptoms usually take three weeks after exposure to develop. Testing has increased over the past two weeks as several commercial labs have added the ability to analyze skin lesion swabs. “We expect cases to increase” through the remainder of July and August, Dr. Rochelle Walensky, director of the Federal Centers for Disease Control and Prevention, said Friday.

With long lines for testing and appointments unavailable for vaccines in New York, critics said the mistakes of the early response to COVID-19 have been repeated since monkeypox arrived in the United States. United in mid-May. With too little testing, it has been impossible to measure the extent and location of the spread of the virus. Tests and treatments have been rare, and the criteria for obtaining one or the other have been strict. Now, some warn, the virus will be impossible to contain.

The vast majority of cases in the current outbreak have been reported in men who have sex with men, but the virus can infect anyone. The main route of transmission is by skin-to-skin contact with the lesions, which appear as a blistering rash – small pimples with bubble tops. Towels or bedding that have touched the lesions can transmit the infection, as can close face-to-face contact, such as kissing.

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In South Orange, 3-year-old Cate has definitely been exposed, her mother said. She was so happy to see her uncle when he visited in June that she ran to her bed every morning when she woke up. She loved to cuddle. The whole family had been in close contact with the visitor, but Erica was worried about her daughter in particular, she said as she recounted their experience and pointed to the talkative child in a summer dress and shoes with rainbows on them.

Little is known about monkeypox in children. Of the 700 confirmed cases in the United States during the current outbreak for which demographic information is known, none were under the age of 18, a CDC official said Friday. Almost all were male, and only eight were identified as female at birth.

For those exposed, there is a vaccine that can prevent or lessen the severity of monkeypox symptoms. Demand in some places, like New York, has far exceeded supply. The New York City Health Department website for vaccination appointments has crashed twice and currently has no appointments available.

But Erica and her daughter were lucky.

A summit doctor administers the Monkeypox vaccine

Dr. Ashish Parikh, Quality Manager for Health Summit, where Erica turned for her care, explained that the vaccine, if given within the first four days of exposure, greatly reduces the risk of contracting the disease. “If you take it a few days beyond that,” he said, “you could still get the disease, but that reduces the risk of it being very serious.” They had more than four days of exposure, but the benefits of vaccination justified the effort to get it, he said.

The JYNNEOS vaccine, developed to prevent smallpox, has been stored as part of the federal government’s national strategic stockpile in case this once eradicated virus is released. The vaccine is also known to be effective against monkeypox, a related virus in the orthopox family, although its effectiveness in this outbreak is unknown. It is given twice, 28 days apart, as a 0.5 milliliter injection, said Laura Balsamini, pharmacy services manager at Summit Health.

New Jersey has been assigned 2,700 doses, including 2,400 in the past few days, according to the state health department. Twenty-four doses had been used on Monday. Erica and Cate each received two.

As supplies are limited, the vaccine was only used for people who had been exposed to someone who tested positive for monkeypox.

But on Tuesday, Gov. Phil Murphy announced a policy change to include “residents of New Jersey who are at high risk of having been exposed to the virus within the past 14 days.” The vaccine is currently available through three community partners, by appointment, the health ministry said. They are:

  • Hyacinth AIDS Foundation/Living Out Loud! Project, Jersey City: 201-706-3480
  • The Prevention Resource Network, a program of the Visiting Nurse Association of Central Jersey, Asbury Park: 732-502-5100
  • North Jersey Community Research Initiative (NJCRI), Newark: 973-483-3444, ext. 200
Cate 3 with Dr. Ashish Parikh after receiving the second dose of the Monkeypox vaccine given to him and his mother Erica at the Summit Health Urgent Care Center in Florham Park, NJ on July 15, 2022.

“As the state obtains additional supply, the department will continue to expand access to the vaccine,” Health Commissioner Judy Persichilli said Tuesday. At this time, in addition to those with known exposure, other people eligible for the vaccine include people who have attended an event where known exposure to monkeypox has occurred, and people who “Iidentify as gay, bisexual, or a man who has sex with men and/or transgender, gender non-conforming or non-binary and have a history of multiple or anonymous sexual partners in the past 14 days,” said the Ministry of Health. Tuesday.

For Erica, it was an easy call: she had known exposure to someone who tested positive. A New York City Health Department contact tracer alerted New Jersey health officials that Erica and Cate had been exposed. She was eligible.

Cate’s case was different. Due to Cate’s age, her doctor needed special permission from the Food and Drug Administration to give her the vaccine. The pediatrician applied for an “investigational new single patient drug” license, which was approved as quickly as possible, said FDA spokeswoman Abby Capobianco. Many similar apps have also been approved, Capobianco said.

Balsamini, director of pharmacy at Summit Health, was at a Paul McCartney concert when a deputy commissioner from the state health department texted her. He said a federal government courier would drive a cooler with the four vaccine vials to the medical group’s offices in Florham Park the next morning, the June 16 federal holiday. Balsamini met the courier and put the vials away in the pharmacy freezer.

Erica received her first shot that day and Cate received hers the next day, after the FDA granted approval.

Both felt fine afterwards, with some minor pain or itching at the injection site, they said. Last Friday, they each received a second shot.

Neither of them developed monkeypox.

If they had developed the telltale rash or flu-like symptoms, a treatment developed for smallpox is available. Critics of the federal response said that too was hard to come by. The New Jersey Health Department has doses of the treatment, known as TPOXX. It is provided to doctors who request it, with monitoring of its use, a spokeswoman said.

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