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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

Boone County confirms first monkeypox case as Missouri plans for more potential cases

Bureau of Communicable Disease Control and Prevention
Missouri Department of Health & Senior Services

According to the Centers for Disease Control and Prevention, Missouri now has more than 40 diagnosed cases of monkeypox– and Boone County reported its first confirmed case yesterday.

Now, while the case count and the community risk still remain fairly low – KBIA’s Rebecca Smith spoke with Nathan Koffarnus, the Assistant Bureau Chief of the Bureau of Communicable Disease Control and Prevention with the Missouri Department of Health and Senior Services.

They spoke about how the disease presents, how prepared we are as a state and what people can do to keep themselves and their communities safe.

"It is a relatively mild illness from the severe outcome standpoint – most people aren't going to need to be hospitalized for this. Deaths are very rare, but it is frequently reported via an extremely painful disease."
Nathan Koffarnus

Rebecca Smith: Okay, so how does this disease present? You know, what are the things that people should be worried about that would make people, hopefully, want to go to a physician and get checked out?

Nathan Koffarnus: Yeah, it is a relatively mild illness from the severe outcome standpoint. Most people aren't going to need to be hospitalized for this. Deaths are very rare, but it is frequently reported via an extremely painful disease.

So that's one of the things that separate these lesions from different rash illnesses is that people say, you know, just how painful they are. So, it's definitely not something you want to acquire.

The symptoms can really be kind of divided into two parts: basically any symptom you get before the onset of the rash, which is the main part of the disease. So, that could be things like fever and fatigue, just generally not feeling well, things like that. So, nothing that can really tell you that this is potentially monkey pox brewing.

So, when we can really diagnose it, and when we can really get to the bottom of it, is more when the rash onsets, or the “pox,” you know, onsets. What’s really kind of challenging is depending on what stage the illness is in, because people can have, you know, these sores or rashes or whatever, however, you want to describe them. for anywhere between two to four weeks.

"It has picked up a little bit lately... Now, that's still pretty low compared to a lot of other states. So, that's some good news, but I think we also expect that it'll continue to grow."
Nathan Koffarnus

Smith: So, when it comes to testing of the disease, is it really just the state labs? Or do we have facilities throughout the state that are capable of testing and confirming for monkeypox?

Koffarnus: Sure. So, it's more limited than your run of the mill virus or something like that, but we actually have way more capacity in the United States right now to test than we're using. So, we do test at the state public health lab.

You know, if a member of the public called us and wanted to be tested, the first thing we're going to tell them is you really need to go get checked out by a provider first.

The CDC has said we're only using 10% of our capacity right now to test in the United States.

Smith: Before I ask about [vaccine] doses, can you just, you know, give us kind of an anecdotal look at how many cases we currently have in Missouri, and where we're seeing that, you know, geographically?

Koffarnus: You know, it has picked up a little bit lately. So, you know, it's – I wouldn't say every single day we're adding cases, but it's coming a bit more frequently. Now, that's still pretty low compared to a lot of other states.So, that's some good news, but I think we also expect that it'll continue to grow.

As far as where cases are located, we've been a little cautious with that just because the counts are so low. I think it's safe to say that the majority of cases are in the St. Louis area.

But the one thing I would note is that most — not all — but most of our cases still to this point, are reporting either some international or out of state travel. But because of that, it can pop up anywhere. So, just because you haven't had a case in your home community yet, doesn't mean that somebody couldn't go on vacation and bring it back with them. So really, we're still being vigilant throughout the whole state.

Smith: So, you know, you mentioned the St. Louis area, and the [vaccine] doses are going to be targeted to the Kansas City, St. Louis and Jefferson County areas, and it looks like we have 1,900 vials?

Koffarnus: So, the 1,900 vials, that was specifically for the St. Louis County. Their allotment. There's a similar amount that went to Kansas City, and then some smaller allotments that went to Boone County and Springfield/Green, and Butler County in Southeastern Missouri. So, we have more as a state that was just that one location.

So, with the new dosing regimen, we should get five times as many doses out of each vial, but it's also important to remember that the CDC is still recommending a two-dose series. So, you divide that number by half, ultimately, because people have to come back for a second shot four weeks later.

And so, for St. Louis, right now, I did some math earlier, it was around 4,500, 4,700, doses, something like that – or individuals rather – that they would be able to vaccinate.

"We're in this standpoint, where we got what we got, and it was a relatively small number [of vaccine doses]. We would have loved to have more, but we still have a lot less vaccine than we need, and it'll really be 2023 before we get a large quantity."
Nathan Koffarnus

Smith: And so, you know, we don't know how many cases we're going to end up having in the state of Missouri, obviously, but we do keep hearing about limited number of doses, and that's why we're targeting specific populations.

And so could you talk to just the limited number we have? If we're seeing other companies ramp up that production? And you know, what are some of those limiting factors when it comes to having a vaccine for monkeypox?

Koffarnus: Yeah. So going into this situation, the United States had 1.1 million doses in kind of a strategic national stockpile, and so, we had it on hand and that's what they've been sending out to states. It's just strictly what's in the stockpile. Now, all of that 1.1 million doses has been promised.

That's what was already on hand, and then they're trying actively to get more from the manufacturer, and the problem is, of course, there's international need right now. So we're kind of, you know, all competing for the same vaccine, and there's just one supplier.

They did announce —I believe it was 175,000 more doses for the United States coming in December, but that's not going to go very far. We've already distributed 1.1 million, and we didn't get very much of that. So, 175,000 divided by 50 states isn't that much.

So, you know, we're in this standpoint, where we got what we got, and it was a relatively small number. We would have loved to have more, but we still have a lot less vaccine than we need, and it'll really be 2023 before we get a large quantity.

I think they said the United States has put in an order for 5.5 million more doses. So, it's coming. It's just gonna be a while.

Smith: Yeah. So, what would you say to communities that are concerned, you know, whether it's people around large congregate places like campuses, or you know, who are in, you know, St. Louis or Kansas City or areas with lots of high-risk population? What would be your advice to those who are, you know, worried right now?

Koffarnus: Yeah, so I think, you know, caution is definitely warranted because for one thing: until the vaccine supply gets up, we are going to be limited on what we can provide to people who are just generally concerned.

So, right now college campuses haven't been, you know, a big area of transmission, but it is the summer. So, you know, would it be completely believable, if you told me two months from now that we had a big outbreak on a university campus? Absolutely, the conditions are there for it to happen, and, you know, we'll probably have some tools to use after it happens. And the shame is that we'd love to do that in advance, and the supply is just too low.

So, in the meantime, you know, the recommendations are to take what precautions you can, you know, the CDC has been pretty out there – they’re kind of cautious, but basically encouraging people to, you know, limit their exposure.

So, you know, not sharing linens, you know, not sleeping in somebody else's bed or sharing towels or things like that… clubs and parties and situations where people are having either, you know, kinds of casual sexual relations, or they're having just maybe non-sexual, but skin-to-skin contact. So, people are dancing shirtless, and things like that.

So, those would be the types of venues that I think you'd have to really, you know, question, is this a great idea right now?

For additional information about monkeypox and how it spreads, visit https://www.cdc.gov/poxvirus/monkeypox/if-sick/transmission.html

Rebecca Smith is an award-winning reporter and producer for the KBIA Health & Wealth Desk. Born and raised outside of Rolla, Missouri, she has a passion for diving into often overlooked issues that affect the rural populations of her state – especially stories that broaden people’s perception of “rural” life.
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