In Tennessee, monkeypox vaccine is limited and appointments booked for months
‘It’s like COVID all over again,’ health organization leader says
Dr. Joanna Shaw-KaiKai, infectious disease specialist at Metro Nashville Health Department. (Photo: John Partipilo)
Drew, a Nashville businessman, went to bed early one Sunday night in July, assuming his busy weekend with family and friends had left him exhausted.
But the next morning, he woke up with COVID-like symptoms, and — despite a negative home test — off he went to a walk-in clinic. The doctor on duty tested him for COVID and strep throat, and after both proved negative, he asked Drew: “Are you aware of monkeypox?”
“We heard it was something in New York and Chicago,” said Drew, who asked that his full name be withheld to protect his privacy. “There was zero awareness: I wasn’t aware I needed to take precautions.”
Since the first reported case of monkeypox in the U.S. in May, cases have multiplied and continue to rise, with Davidson County accounting for half of all cases in Tennessee. Vaccine supplies are limited, and appointments to receive one are booked out for weeks.
“It’s going to get worse before it gets better. It’s like COVID all over again,” said Lisa Binkley, spokesperson for the AIDS-prevention organization, Nashville CARES.
On Aug. 4, the Biden administration declared the monkeypox outbreak a public health emergency. There are currently more than 19,900 confirmed monkeypox cases nationwide, according to the Centers for Disease Control and Prevention. About 1 one in 10 cases can be fatal, and the disease is thought to be more severe in children.
In Tennessee, monkeypox cases have steadily increased since July, leading to a total of 192 cases as of Sept. 2, according to the CDC. By demographics, men make up 95% of the total confirmed cases, and Black Tennesseans accounted for 52% of cases, according to the Tennessee Department of Health. White Tennesseans accounted for 32%.
- Appointments in Davidson County are currently filled through the end of September and may be scheduled by calling (615) 340-5632.
- In Shelby County, health providers who suspect monkeypox in patients can request a diagnostic test through the Shelby County Health Department to obtain prior approval before sending a specimen. Specimens are sent to the Tennessee State Public Health Laboratory and confirmed by the CDC.
- Eligible patients can make an appointment online for the vaccine through the SCHD while supplies last.
- At the Williamson County Health Department, no appointment is needed and vaccines are available Monday through Friday at the Franklin Clinic.
- In Knox County, where there have been three cases of monkeypox, 450 doses of the vaccine have been administered. The Knox County Health Department is now making plans for future distribution by engaging with partners and the TDH. Vaccines are by appointment only.
- Testing is also available at commercial laboratories and does not require prior approval.
While more than than half of all monkeypox cases come from Davidson County, Shelby County has 20% and the Mid-Cumberland region – Williamson, Dickson, Montgomery, Robertson, Rutherford, Steward and Wilson counties – accounting for 10% of all cases.
With monkeypox vaccines and testing only available through local health departments, Nashville CARES, the Music City PrEP Clinic and other community clinics have shifted to screening, spreading awareness and sending potential cases to the Nashville health department for confirmation.
Because Nashville CARES and Music City PrEP provide comprehensive services for those at-risk for or living with sexually transmitted diseases, both are collaborating with the Metro Nashville Public Health Department to reach vulnerable populations, such as the LGBTQ community and HIV-positive patients.
At Music City PrEP, the staff works to prevent the spread of HIV in Middle Tennessee by offering free prescriptions for medication to protect against HIV. Since monkeypox outbreaks appeared in Nashville, the clinic is helping to screen potential cases before sending them to the health department.
“What Music City PrEP is kind of position (sic) ourselves with the health department to kind of work on providing education to all of our patients who may come in or who may give us a call, and we answer questions based on what we know so far,” said Steve Ogooue, spokesperson for the Music City PrEP Clinic .
Initially doctors reported monkeypox spread through sexual intercourse, but the CDC now reports that the disease is spread through other skin-to-skin contact as well. This includes direct contact with rashes, body fluids and surfaces touched by an infected individual. Vulnerable populations include the the LGBTQ community, those diagnosed with a sexually transmitted diseases and receive treatment of HIV and those who have had multiple partners in the past 90 days.
“‘Anyone can get it,’ is the message we should be delivering,” said Ogooue.
After initial infection, a person may carry the virus for 14 days before presenting with symptoms, which include flu-like ailments, lymph nodes becoming swollen and blister-like rashes appearing anywhere on the body. Once potential cases are screened by community clinics, patients are sent to their local health departments for further testing. For a case to even be considered for testing, patients must have the tell-tale signs of rashes and pustules.
“A lot of people describe it like having chickenpox,” said Dr. Joanna Shaw-KaiKai, infectious disease specialist at Metro Health.
“They might have a couple (lesions) on the face, but not like other pictures where people have so many,” said Shaw-KaiKai. “We have had two or three with a whole lot of lesions, but a lot of the lesions tend to be on the extremities and the private area.”
Once a client develops potential monkeypox symptoms, most patients will recover without medication. Other more severe cases may require antiviral medications and possible hospitalization.
“It can be terrible for some people,” she said.
Once monkeypox is confirmed, patients take an average of two to four weeks before symptoms subside, or for skin to heal, for them to be considered no longer contagious.
The Metro Nashville Health Department’s contact tracing team is still using infrastructure left over from COVID-19 policies to find potential cases and provide temporary housing for those needing isolation. Those with close contact to a verified monkeypox case can receive the vaccine. Patients with light symptoms are also able to receive the vaccine.
Drew said his experience with monkeypox showed him healthcare systems haven’t kept pace even after the COVID pandemic.
“My doctor said, ‘there’s nothing I can do, the Metro Health Department is in control,’” Drew said of his experience. “I called the Vanderbilt (Health) Infectious Disease: They said they weren’t treating it.”
By the time his monkeypox test was confirmed with the Metro Department of Health, his symptoms were fading.
To date, the TDH has received 5,762 vials from the U.S. Department of Health and Human Services, and most local health departments are requiring appointments for the vaccine and testing.
“As our supply increases and we are able to offer vaccines to more people, we will be relying on our ongoing work with community partners to make sure our message reaches those who need to know it,” said NMHD spokesperson Matthew Peters, adding that patients can receive the vaccine even if presenting symptoms.
Because of the limited supply, vulnerable groups have priority to receive the vaccine. This includes those who have been in close contact with a confirmed case and members of the LGBTQ community.
But despite being limited, local health officials can use one dose to vaccinate five people. Some shots are required to be injected past several layers of skin, and therefore, a higher dosage is needed for the vaccine to be effective. On the other hand, the monkeypox vaccine only needs to be injected between layers of the skin, which requires only one-fifth of the dosage to vaccinate one person.
“With that method, a fairly small amount of the vaccine is needed. So only a fifth of the amount that was previously being used is needed for the intradermal injection,” said Ogooue.
Drew said information was in short supply when he was diagnosed in late July and hopes doctors are up to speed now.
“I was lucky (the doctor at the walk-in clinic) had seen a case and had done his own research,” he said.
Holly McCall contributed to this story.
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