Monkeypox Arrives in Hawaii, Update on COVID-19 and Recommendation for New Bivalent Booster Vaccines

by Edwin Quinabo

The latest emerging infectious disease outbreak of global importance is monkeypox. The contagious disease has spread to all continents. As of September 8, there are 56,609 reported cases of monkeypox globally, 21,274 cases in the U.S., according to the CDC.

In Hawaii, the State of Hawaii Department of Health (DOH) reports there have been 28 cases as of September 8, with most of them (21) located in Oahu.

“While the risk to most Hawaiʻi residents remains low, local transmission of monkeypox is occurring,” said Deputy State Epidemiologist Dr. Nathan Tan. “The growing number of cases in Hawaiʻi underscores the importance of vaccination—if you are eligible, please take this step to protect yourself and our community.”

DOH continues to conduct contact tracing and follow-up with all reported cases.

What is Monkeypox?
Monkeypox is caused by the monkeypox virus, the same family of viruses as variola virus, the virus that causes smallpox. Monkeypox are rarely fatal, but rash that typically accompany monkeypox can be painful and people can experience severe outcomes, health experts say.

Monkeypox will typically last 2-4 weeks – at which time the infected person is contagious – and would require usually home recovery with minimum contact. While most who have been infected recover on their own in their homes, some have been hospitalized.

Monkeypox has been recognized as an endemic disease in central and western Africa since 1970. In an average year, a few thousand cases occur in Africa. But cases outside Africa have previously been limited to only a handful of cases, until now.

This global (outside of Africa) 2022 outbreak of monkeypox is a first. The first cluster of cases was found in the United Kingdom in May 2022 and linked to an individual who traveled to Nigeria. It spread through Europe initially.

On July 23, 2022 the Director-General of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus declared the outbreak a public health emergency of international concern (PHEIC).

Symptoms of monkeypox
Symptoms of monkeypox can include any or all of the following:

– Fever
– Headache
– Muscle aches and backache
– Swollen lymph nodes
– Chills
– Respiratory symptoms (e.g. sore throat, nasal congestion, or cough)

A rash that can look like pimples or blisters appears on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. The rash goes through different stages before healing completely.

Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash.

Who should get vaccinated?
At the moment, the CDC does not recommend widespread vaccination against monkeypox. But the monkeypox situation is being monitored and evolving quickly and could be subject to change.

DOH says vaccine supplies are currently limited. DOH’s current eligibility taken from their website are as follows:

Hawaii residents ages 18 years and older and fall into one of the following categories:

– Had close contact in the last 14 days with a person with known or suspected monkeypox infection

– Gay, bisexual, and other men who have sex with men (MSM) and transgender individuals who have multiple or anonymous sex partners (e.g., such as through dating apps)

– People who are severely immunocompromised (e.g., advanced or poorly controlled HIV infection [CD4 ≤200 cells/mm3, persistent HIV viral load >200 copies/mL, or a recent HIV-related illness], active cancer treatment, high-dose steroids) or have certain skin conditions, such as eczema, and who have a household member or sex partner at high risk for monkeypox

– People in certain occupational risk group. People at risk for occupational exposure to orthopoxviruses include research laboratory workers performing diagnostic testing for monkeypox virus and members of health care response teams designated by appropriate public health and antiterror authorities.

Nikka Aquino APRN-Rx; Aiea, Hawaii, said if the CDC eventually recommends monkeypox vaccination to the general population, she would schedule an appointment to get a shot.

“Prevention is better than cure. Not only are we protecting ourselves from the possibility of getting infected but also our loved ones and those around us. Prevention is key! It is significant for us to be careful when coming into close contact with those who may have symptoms. If we feel sick, stay home and avoid others for the time being. Proper and frequent hand-hygiene can also play a crucial role in the prevention of monkeypox,” Aquino said.

James Pagdilao, Hilo Hawaii, also said he would get the monkeypox vaccination if recommended by the CDC. “I would definitely get vaccinated as a duty to not only myself, but to the rest of the public population.”

He said, “monkeypox is to be taken seriously, as contrary to popular belief, it can be spread through other means than the typical contact. Monkeypox, like any other infectious disease, should be treated like any other infectious disease that requires a Quarantine/Isolation period and careful precautions to avoid further spread.”

Franciso (last name withheld), 58, Honolulu, said the outbreak of the monkeypox reminds him of when AIDS broke out. “I was living in San Francisco at the time and many of my friends died. I eventually contracted HIV many years later when the HIV-AIDS cocktail drugs came out which have extended the lives of many living with this disease. Right now monkeypox is mostly affecting the gay men population like AIDS used to be. I hope it can be contained before it becomes more widespread.

“I know many in the LGBT community are upset that the Biden administration did not take on the monkeypox virus more aggressively in the earlier days. That window of opportunity closed and the virus is already spreading all over,” Francisco said.

How is monkeypox spread? Prevention
Anyone in close personal contact with a person with monkeypox can get it. The virus could spread by direct contact of infectious rash, scab or body fluids. It also can be spread by respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex.

The virus can also be contracted from materials (like bed sheets or a door knob) contaminated with the virus.

Monkeypox is increasingly becoming known as a sexual contact disease. Health experts say while it could be “sexually transmissible” – sex is only one of the ways that monkeypox can be spread. Experts emphasize that any close, sustained skin-to-skin contact (even non-sexually) with someone who has monkeypox can spread the virus.

Preventative steps include: 1) avoiding close contact with someone infected with monkeypox as well as touching the objects and materials the person has used; 2) Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom; 3) postpone having new casual sex partners and avoid events where you have close bodily contact with others

Because of the similarities between smallpox and monkeypox, antiviral drugs used to treat smallpox is being used to treat monkeypox infections.

The U.S. government has two stockpiled vaccines—JYNNEOS and ACAM2000—that can prevent monkeypox in people who are exposed to the virus.

The DOH ordered its full allocation of the JYNNEOS vaccine from the federal government.

JYNNEOS is FDA-approved for safe and effective monkeypox prevention in adults. JYNNEOS reduces one’s chances of getting monkeypox and may reduce symptoms after becoming infected.

Monkeypox Vaccine Clinics in Hawaii

Oahu resident options:
– Waianae Coast Comprehensive Health Center (in Waianae and Kapolei) at 808-427-0442

– Hawaiʻi Health & Harm Reduction Center (in Honolulu) at 808-521-2437

– Kaiser Permanente, Mapunapuna Medical Office (in Honolulu) at 808-432-2000 and prompt #1 (for members and non-members)

Limited appointments are also available through DOH by calling our monkeypox hotline at 808-586-4462 or requesting an appointment online.

Kauai residents can contact Malama Pono Health Services (in Lihue) at 808-246-9577 and the Kauai District Health Office by calling 808-241-3495.

Maui residents can contact Malama I Ke Ola Health Center (in Wailuku) at 808-871-7772.

Hawai’i Island residents can contact Hamakua-Kohala Health (in Honoka’a) at 808-930-2751.

For other sites, call DOH’s monkeypox hotline at 808-586-4462.

It’s recommended that if you believe you’ve contracted monkeypox, to contact your personal physician. Treatment for monkeypox is available but must be coordinated through DOH and a physician.

COVID-19 UPDATE in Hawaii
The DOH recommends the use of the first bivalent booster vaccines designed specifically to protect against original COVID-19 and the most common forms of COVID-19 in Hawai‘i, the BA.4 and BA.5 Omicron subvariants.

The BA.5 subvariant accounts for an estimated 91% of the COVID-19 cases in Hawai‘i. The BA.4 subvariant accounts for an additional 4% of the cases in Hawai‘i.

“The COVID-19 boosters we have been using do a good job of protecting us against severe illness. The new bivalent boosters are an upgrade because they take into account mutations of the COVID-19 virus to specifically address Omicron subvariants,” said State Health Director Dr. Elizabeth Char, FACEP.

The new booster not only protects from severe illness and hospitalization, but also help to minimize even getting infected or getting reinfected.

The U.S. Food and Drug Administration issued Emergency Use Authorization for the bivalent COVID-19 boosters late last month.

Char said the new booster is available for people 12 years and older. The vaccine is expected to be available for people 12 years and older, which would cover a wider range of the state’s population than the second Covid booster that’s only available for people older than 50 years and immunocompromised.

The Hawaii Department of Health has ordered about 38,000 doses of the bivalent Covid-19 booster. The new vaccine is administered by Pfizer and Moderna. The bivalent Covid-19 booster could start arriving this month.

The new bivalent vaccines are to be administered as a single booster dose to those who previously completed a primary series of COVID-19 vaccines and those who have had one or two booster doses. Bivalent boosters can only be administered if it has been at least two months since a person’s most recent vaccination.

Aquino received her booster shot in September 2021. “I plan to get the fourth shot. The bivalent vaccine targets both the original strains of SARS-CoV2 and the subvariants of Omicron BA.4 and BA.5.

“COVID-19 is here to stay. For more than 2 years, people have faced the economic consequences of the pandemic. But is the pandemic ‘over’? I think when we say that the pandemic is over, it does not mean that the virus has been eradicated rather the horrific stage of intense transmission and consequent illness is better controlled. With the constant changes in strains, persons can still get the virus. Some may say that COVID-19 is now similar to just a regular seasonal flu. However, I think that because of the long COVID complication of post-illness, we must all continue to be careful not to spread or catch the virus,” Aquino said.

Pagdilao, who says he is moderately immunocompromised, said he got the 4th Bivalent Booster shot. “COVID-19 today is still just as serious of an issue than it first started, but due to vaccinations, social distancing, and new studies on the spread of COVID-19, it has become a part of daily life to live with the normalcy of COVID infections.

“As opposed to early on in the Pandemic, the majority of the population is vaccinated, resulting in less hospitalizations and less severe infections, so overall COVID is generally like the flu in which we should get updated boosters when available to keep not only ourselves protected, but to protect the rest of our vulnerable populations such as the elderly, those with significant comorbidities, and our keiki,” Pagdilao said.

COVID-19 is still very much active and around
The DOH Summary Metrics as of Sept. 7, 2022 reports there have been 1,215 news cases of COVID-19 statewide in the last week. Eleven new deaths were reported, bringing the statewide cumulative death toll to 1,655.

Completed vaccination is 77.3% statewide with Honolulu having the highest at 80%.

Aquino, who did catch COVID-19 in February 2022, said “I think people should still acknowledge that COVID is still around. Although vaccines and medications are available for us to help prevent the debilitating complications, we can still contract the virus if we are not mindful of it. Each one should be responsible in taking his or her part in controlling the spread of the virus through proper hand hygiene, avoiding extremely crowded areas, and wearing masks or avoiding contact when sick.”

Pagdilao who caught COVID-19 in May this year, said “I just hope and pray that we can keep up to date with boosters and obtaining the so-called herd immunity.”

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