Survey shows high intent to get the monkeypox vaccine but problems self-diagnosing

Intradermal injection
Intradermal injection

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A study today in Eurosurveillance shows 70% of surveyed men who have sex with men (MSM) in the Netherlands said they intended to vaccinate against monkeypox, and 44% showed high intention for self-isolation after diagnosis.

The online survey, however, showed the challenges of self-diagnosis, with only 52.3% of participants able to correctly identify a picture of monkeypox lesions on the face. Participants were asked to view images of monkeypox, Staphylococcus infection, stage 2 syphilis infections, or eczema.

Only eczema was correctly identified as not being monkeypox more often than not.

In US news, federal officials will make 1.8 million more Jynneos vaccine doses available next week.

High intent to vaccinate but low intent to isolate

The new survey is one of the first to gauge how European MSM are viewing the outbreak, and adds to the evidence that monkeypox vaccine are in high demand in countries seeing major outbreaks.

Of the 394 MSM surveyed, 43% (171) were below the age of 45, 6% (22) were living with HIV, and 66% (241) were using HIV pre-exposure prophylaxis (PrEP)

Overall, 70% of participants were "extremely likely" to receive the vaccine and 44% showed high intention for self-isolation after diagnosis until all lesions are gone, usually for up to 21 days. Among the 178 respondents using PrEP, 73.9% were very likely to get the vaccine, versus 71.3% of those not using PreP.

For the lesion self-identification portion, the researchers displayed four images of facial lesions and asked respondents to indicate what condition it could be. Eczema was diagnosed correctly most often (67%), while monkeypox and staphylococcal photos received some correct answers but many false self-diagnoses (up to 48% and 58%, respectively).

Stage 2 syphilis was most commonly misdiagnosed as monkeypox (52%).

"The findings from a survey including 394 MSM in the Netherlands showed that only about half of them were able to self-diagnose monkeypox from other skin lesions which shows that self-diagnosis in particular of novel diseases, can be challenging," the authors wrote.

 "Based on our findings public health policy makers and services should in addition to focussing on vaccinations in their communication, aim to increase MSM's intentions to self-isolate and their ability to accurately self-diagnose."

High yield with lesion swabs

In a second study in Eurosurveillance, Spanish investigators looked at 140 clinical specimens to gauge which yielded the highest positivity rates. The highest positivity rates (97%) were from skin lesions of any part of the body, followed by plasma, pharyngeal and anal swabs, they found.

Anal swabs produced positive results 93.8% of the time, followed by plasma (91.9%), and oropharyngeal swabs (88%).

Testing from multiple sites on a patient also reduced the number of false-negatives, the authors reported.

Europe remains an epicenter of the monkeypox outbreak, with a total of 19,429 cases from 43 countries, according to an update from the European Centre for Disease Prevention and Control (ECDC). The ECDC report said 505 patients in Europe were hospitalized (5.8%), with three intensive care unit admissions. Two people have died from the virus.

HHS makes 1.8 million more Jynneos doses available

Today the US federal government monkeypox response team said jurisdictions that are adopting the intradermal administration of the Jynneos vaccine and have used 90% of their supply of vaccine will be able to order additional doses, as 1.8 million doses will be available at the beginning of next week.

The Department of Health and Human Services (HHS) also announced today a new pilot program that will set aside 50,000 doses of vaccine from the Strategic National Stockpile to be used in jurisdictions that are hosting large events that attract MSM in the coming weeks and months, such as PRIDE events. Two events over Labor Day, the Black Pride in Atlanta and Southern Decadence in New Orleans, were cited as future sites of the vaccine pop-ups.

"This is important; it's innovative—the way that we will bolster local efforts to meet people where they are and mitigate the spread of monkeypox," said response coordinator Robert Fenton during a press briefing.

Rochelle Walensky, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), said US officials have confirmed 13,500 monkeypox cases in 49 states, as well as in Washington, DC, and Puerto Rico. 

Walensky said 98% of US patients are in men, with 93% of cases among MSM. The mediate age of case-patients is 35.

In other US news, Los Angeles County said today it would begin offering second doses of Jynneos to those who had received a first dose. An estimated 8,000 people in that county are waiting for a second dose.

Los Angeles County and Fulton County, Georgia, home of Atlanta, were both cited today by White House officials as places where intradermal injections of Jynneos have become the standard of care.

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