Even before the World Health Organization declared monkeypox a global health emergencyIndiana officials were determining how best to respond to a possible outbreak of monkeypox.
The virus, which is a cousin of smallpox, has been spreading around the world since May. It has been identified in 78 countries and 46 states, including Indiana.
“We have already started a lot of the same things that we implemented at the start of COVID,” Dr. Lindsay Weaver, Indiana Department of Health (IDOH) Chief Medical Officer, told WTIU/WFIU News. “[Ensuring] our suppliers across the state know what’s available when it comes to vaccines, antivirals, treatment – [we’re] making sure it’s on their radar.
As of Friday morning, the state was reporting 45 confirmed cases case monkeypox.
The current outbreak is unique because the virus is spreading to places where it has not typically been found before. In previous years, monkeypox has been reported in several African countries, with occasional cases in other countries linked to travel from Nigeria. Today, the disease is spreading in Europe, the Americas and elsewhere.
The virus is spread through liquids, contact with an infected area, or prolonged face-to-face contact. Those infected may experience fever and muscle aches before developing an itchy rash with lesions that eventually whiten and burst.
“It’s not like COVID where, ‘OK, I was in a big room and maybe somebody had it there,'” Weaver said. “It’s really those kinds of close contact situations.”
Indiana first case was reported in Lake County in June. Health officials have speculated that the virus traveled to Gary from nearby Chicago. Illinois has the third highest number of monkeypox cases, behind New York and California, according to data from the United States Centers for Disease Control and Prevention.
Since the first case was confirmed in Lake County, at least 12 other counties have reported cases, according to a July 22 report. Indiana Department of Health briefing addressed to healthcare providers.
“It’s actually prevalent across the state and in every corner,” Weaver said.
But the July 22 IDOH briefing showed the virus could take a different route in Indiana.
As of the end of last week, cases of monkeypox had been identified in a handful of Hoosier women, representing 20% of the approximately 30 confirmed confirmed cases in Indiana at that time. This contrasts with global and national data: around 98% of cases worldwide are in men, and 99% of those cases are in men who have sex with men, according to the World Health Organization.
Most of Hoosier’s cases were in gay and bisexual men, Weaver said, but the spread of the virus here, which includes women and children, shows it’s not limited to a certain population.
“It is important that we use the networks, whether it is social media, word of mouth, working with partners, to ensure that they are aware [and] to protect themselves,” she said.
There are similarities between the HIV epidemic in the 1980s and the current monkeypox epidemic, particularly in media coverage, said bill yarber, senior fellow at IU’s Kinsey Institute for Sexuality, Gender and Reproduction. In the 1980s, Yarber was commissioned to write the country’s first school curriculum on HIV.
“There may not have been an intention to marginalize or stigmatize, but we have to be careful not to point fingers or blame [people],” he said.
For Yarber, the spread of monkeypox to women and children shows the importance of treating monkeypox like any other communicable disease – not a sexual disease. Monkeypox is not inherently sexual, and there is currently no evidence that it is spread through semen or vaginal secretions.
“The words we use are really important, very important. Because we can inadvertently make that person feel like we’re pointing at them,” Yarber said. “These people may not seek treatment or diagnosis as quickly because of the stigma. And then they can’t tell anybody else or their family or anything.
The Department of Health has taken careful steps not to label monkeypox as a sexually transmitted infection, Weaver said. The agency is now focusing on outreach which emphasizes reducing the risk of transmission.
There are two vaccines cleared by the United States Food and Drug Administration to prevent monkeypox: JYNNEOS, also known as Imvamune or Imvanex, and ACAM2000. But supplies are limited. These vaccines can protect people against monkeypox when received before or after recent exposure, according to the CDC, although data are not yet available on the effectiveness of vaccines in the current outbreak.
Efforts to increase access to vaccines are underway, U.S. Department of Health and Human Services Secretary Xavier Becerra said Thursday during a press briefing. HHS has obtained more than 1.1 million doses of the JYNNEOS vaccine to distribute to state and local health departments across the country in the coming days and weeks.
The goal is to both stay ahead of the virus and end the outbreak. HHS is working to provide vaccines, as well as supplies for testing and treatment, prioritizing areas that need them the most.
“We’re going to do whatever we have to do,” Becerra said.
But ultimately, he said, it’s up to state and local health departments to determine how to use the resources: “We don’t have the power to tell them what to do. We need them to work with us.
The state currently has enough vaccine doses for 1,500 people, Weaver said, and they don’t know when more will arrive.
Weaver said the health department is following CDC guidelines and, unlike COVID-19, is focused on vaccinating people after potential exposure.
“If you get this vaccine within four days of your exposure, it can actually prevent you from getting monkeypox,” she said. “And if we give the vaccine between 4 and 14 days after exposure, it can significantly reduce your symptoms.”
Weaver said they are starting to expand vaccines to people at high risk of exposure and severe disease. Then they hope to open up to high-risk people. They will have to balance current needs with the potential for a future epidemic.
“If we hear from the CDC [about] timeline, about when we’re going to get this next allocation [of vaccines]it will help us feel safer to push the vaccine for pre-exposure.
Of the 21,000 cases worldwide, only 5 people died. In the United States, no one has died from monkeypox, but officials say preparing the state’s health infrastructure will be key to keeping it that way.
Farah Yousry and Christine Herman of Side Effects Public Media contributed reporting.