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St. Louis health officials answer your questions about the monkeypox outbreak

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Since June, two dozen cases of monkeypox have been reported in Missouri, with about one-third of those cases in St. Louis. While the state’s case count is much lower than in Illinois, New York and other states with higher populations, health officials in Missouri are trying to keep the virus from spreading through education and prevention.

The state Department of Health and Senior Services this week raised the threat level for the contagious virus, which causes fever, aches and a telltale rash of spots, usually on extremities or genitals. The state now defines monkeypox as a reportable disease, which means health providers or officials must report positive cases to state or local health departments within one day of detection.

During a virtual town hall meeting Tuesday, the St. Louis and St. Louis County health directors told residents there’s still not enough vaccine to meet demand, and frustrated departments hope the federal government will send more soon.

Health officials say here's what people in the region need to know.

Who can get monkeypox?

Anyone of any sexual orientation or gender can contract monkeypox. Right now, it’s mainly spreading in people who have sex with men who have sex with men. That includes gay men and people who identify as transgender, bisexual and other queer identities.

“No. 1 was just making sure that we were very clear and fighting that stigma,” said Tyrell Manning, a program specialist at the St. Louis Department of Health. “[We’re] pushing the understanding that everyone is in the position to get monkeypox.”

How is monkeypox spread?

Monkeypox is spread through close physical contact with the trademark lesions of the virus. It can also be spread through respiratory secretions during prolonged face-to-face contact or during physical contact. That includes kissing, cuddling or sex.

The more close contact with skin and respiratory droplets with an infected person, the more likely one is to catch the virus. That means transmission is more likely in places where people are wearing minimal clothing close together, including raves or dance parties. It can also be spread through sharing towels, sheets and other objects with an infected person.

It’s rare that the disease is spread by people who don’t have symptoms, said Nebu Kolenchery, St. Louis County director of communicable diseases, during Tuesday’s meeting.

“Asymptomatic transmission is highly unlikely because of the way this thing is transmitted,” Kolenchery said, but may be possible shortly before symptoms occur.

How can you protect yourself from contracting or spreading monkeypox?

Getting vaccinated against the virus is one of the best ways to avoid contracting the disease. However, in Missouri, the vaccine supply is extremely limited. Until more is available, there are ways to lower one’s risk by limiting risky behaviors. Limiting sexual partners and staying away from crowded areas with minimal clothing including raves, parties and clubs can reduce one’s risk. You can also avoid sharing clothes, towels and other objects with others before cleaning them thoroughly.

“Again, this disease is spread through skin-to-skin contact with lesions and respiratory illness,” Kolenchery said. “If you mask and you cover your lesions with your clothes, it's that much less likely for you to transmit the disease.”

Who can get the vaccine in Missouri?

Monkeypox vaccine is given in two doses, four weeks apart. St. Louis County is distributing the vaccine in eastern Missouri. The health department has received 1,900 doses, but that supply is dwindling, said Dr. Mati Hlatshwayo Davis, St. Louis health director.

That means the vaccine is only being given to people who have been in contact with a person who has tested positive, usually household contacts or sexual partners. Recipients have to meet eligibility requirements. Men who have sex with men have been most affected during this outbreak, and the region is prioritizing them in their vaccine rollout.

“It is highly frustrating for you and for us — in ways you cannot even fathom how frustrating it is for us — that we are having to make these sorts of decisions around a smaller pool of vaccines than we would like,” Hlatshwayo Davis said Tuesday.

Those who want to be vaccinated can fill out a survey on the St. Louis and St. Louis County health department websites, and if there’s a dose available, health officials will contact those deemed eligible.

Why is there so little vaccine? Is more coming?

The federal government is distributing doses to states based on how many cases there are and how many people are at high risk, he said. That combination means Missouri and St. Louis are getting a lower allocation than Los Angeles or Atlanta might.

“I do want to say that the supply of vaccine that we have is far outpaced by the demand that we're seeing for the vaccine,” Kolenchery said. “And I know it's frustrating.”

The Biden administration announced this week that it would make more than 400,000 vaccine doses available to states.

“So already, they have just released just under half a million doses through an accelerated course,” Hlathswayo Davis said. “So we're hoping that we'll see a lot more vaccines come out. But we can assure you that the proportions that they're using right now for different states won't be the same. And that again, you'll see a lot more in New York and San Francisco and in Chicago as compared to here in Missouri.”

Kolenchery said scientists at St. Louis University recently discovered the vaccine can be effective when administered in the upper skin layer. That could stretch doses much further because less vaccine needs to be used.

Where can I get tested for monkeypox?

Primary care physicians, commercial labs, federally qualified community health centers and urgent care clinics can all test for the monkeypox virus. Because most commercial labs are able to test for the virus, almost any provider is able to collect a sample for testing.

Health officials said that those who don’t have insurance should call the county health department, which will be able to connect people to testing. 

What should I do if I’ve been exposed?

Unlike with COVID-19, people who have been exposed don’t need to quarantine. Health officials said those who have been exposed should seek out the vaccine and monitor their bodies for fever, rash, swollen lymph nodes and other signs of the virus. The time between exposure and symptoms can be long — up to three weeks — so health officials recommend staying vigilant in checking.

Those who test positive or have likely symptoms should isolate until their symptoms go away. There isn’t a set number of days recommended for isolation, but doctors say it’s until the lesions of the rash scab over and new skin forms.

Follow Sarah on Twitter: @petit_smudge

Sarah is the health reporter at St. Louis Public Radio.

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