News Track: Monkeypox cases drop off in Iowa

Background

CEDAR RAPIDS — In August, after a wave of novel monkeypox infections spread through high-risk communities across the coasts and large Midwestern cities, cases started to trickle into Iowa.

With a limited number of vaccine doses available, Linn County Public Health and Johnson County Public Health quickly and quietly established two monkeypox vaccination clinics to help contain what the Biden administration declared a public health emergency. Relying on word-of-mouth, the agencies worked together to vaccinate 200 people at local LGBTQ bars like Basix in Cedar Rapids and Eden Lounge Nightclub in Iowa City.

Linn County, as one of four counties in the state to receive an allocation of the JYNNEOS smallpox vaccine now used to fight monkeypox, shared another 80 doses with public health officials in Black Hawk County. The vaccine is 85 percent effective against monkeypox, which is rarely fatal but can cause a rash of painful and infectious blisters that last weeks and require quarantining.

Local public health officials didn’t know when vaccine patients would be able to receive their second dose of the vaccine series, but started distributing shots to start a protective immune response in vulnerable populations.

What’s happened since

Three months after the initial clinics held at the bars, Eastern Iowa has seen very few new cases of the virus. Iowa has fared remarkably well compared with all but one neighboring state, even when adjusting for population.

Iowa has the 10th lowest count of monkeypox cases in the country with 27 cases, according to the U.S. Centers for Disease Control and Prevention. The only neighboring state with fewer cases is South Dakota.

With two of Iowa’s most populous counties, the East region of Iowa had only four of Iowa’s cases. The last case in the region was identified Sept. 9.

“We saw it was out of control with numbers nationwide. We were trying to prepare for it as much as we could with limited resources,” said Heather Meador, clinical branch supervisor for Linn County Public Health, who helped organize the first vaccine clinics. “We were able to start planning, knowing it would most likely show up here at some point.”

With the advantage of time, rural population density and collaboration between state and local health departments, local departments were able to provide a “targeted, unified approach,” she said.

“The difference between this and COVID is we knew about this infection. It’s been around for a while. So we had tools in the toolbox we could draw from,” said Meador.

Illinois has had 1,397 cases. Minnesota and Missouri have case counts of 233 and 167, respectively. Wisconsin stands at 87, Nebraska at 31 and South Dakota at three.

Iowa’s central region had the most cases with 13. Rural regions around Iowa had one to five cases each. The entire state has identified only two cases in the last month.

Over 3,200 doses of the vaccine have been administered in Iowa, and over 1,200 people have been fully vaccinated with two doses, according to the state. Several hundred doses were distributed in Linn and Johnson counties alone.

Sam Jarvis, community health division manager for Johnson County Public Health, said the partnerships with departments like Linn County Public Health helped share resources, information and practices to benefit from lessons in distribution and community engagement. Since the first two vaccination clinics launched in August, Johnson County has administered 380 vaccinations through various venues including University of Iowa colleges and the Free Medical Clinic.

“We are not an island and utilizing everyone’s ability, skill and effort makes response to disease outbreaks and addressing health issues far easier,” he said.

Linn County, which has not done any more clinics at bars, has evolved its strategy for vaccination as demand declines. It now relies on those who indicate interest for vaccination via an online survey and has moved from word-of-mouth to targeted advertising on dating apps to find those at highest risk for the virus.

While doses remain limited, their reach has expanded to new populations eligible for the vaccine, according to new CDC criteria. Now, people living with HIV and sexual partners of those at high risk are eligible. Though people of any sexual orientation or gender identity can contract monkeypox, public health officials emphasize that the risk to the general population for contracting it remains low.

Since August, Linn County Public Health transitioned from giving subcutaneous shots in the deltoid muscle of the shoulder to giving shots intradermally in between layers of skin on the forearm.

“Studies show it was just as effective to give intradermally as subcutaneously, but with intradermal doses using a smaller amount and vaccinating more,” Meador said. “That approach helped blunt the surge we were seeing nationally.”

While they continue to look for those at higher risk, a public health crisis on the heels of COVID-19 seems to have been successfully contained in the Corridor, for now.

“With monkeypox, we’re very hopeful in what we’re seeing and hoping it continues to improve,” Meador said.

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