▶ Watch Video: Hundreds line up for monkeypox vaccine in NYC

New York City announced Thursday it had become the first jurisdiction in the country to roll out monkeypox vaccinations to a wider group of people at risk of the illness. The city is offering shots to any “gay, bisexual, and other men who have sex with men” who are 18 or over and have had “multiple or anonymous sex partners in the last 14 days.”

That mirrors decisions from health authorities abroad, including in the United Kingdom and Canada, which have also broadened monkeypox vaccinations. While most of the cases identified in the recent global outbreak have been in men who have sex with men, authorities caution that anyone can catch the disease through close physical contact with an infected person. At least five women are among the U.S. cases so far.

Hundreds of people lined up for shots Thursday, CBS New York reported, and there was such high demand that the city had to close its vaccination clinic to walk-ins. (Appointments can be made at nyc.gov/health/monkeypox.)

Just 1,000 doses of the Jynneos vaccine were in the city’s supply, though local officials say they are working with the Centers for Disease Control and Prevention to request more from the national stockpile.

The CDC is now working with several state and local health departments around the country to broaden eligibility for monkeypox vaccinations, federal health officials said Thursday, amid a growing number of cases in the U.S. that cannot be traced back to a source. 

The move marks the latest escalation in the Biden administration’s response to the growing global outbreak of cases, which now numbers more than 3,000 confirmed patients worldwide. The CDC’s latest domestic tally counts 173 monkeypox cases nationwide across 24 states and the District of Columbia.

“We are aware that there are jurisdictions with a larger number of cases that are reporting high percentages of contacts that cannot be identified. And there are several considering, planning, and even implementing expanded vaccination programs at this time,” the CDC’s Brett Petersen  told the agency’s Advisory Committee on Immunization Practices on Thursday.  

Petersen said the CDC has been working with the panel and other partners to develop a new national strategy for the monkeypox vaccine doses in the U.S. stockpile. Current federal recommendations for Jynneos had been limited largely to health care workers who had come into high-risk exposures with patients.

“There are some supply limitations that we’re working to address and make sure that this medical countermeasure, in particular, is being provided and used in an optimal fashion, but also in an equitable fashion,” Petersen said. 

There are 36,000 courses of the Jynneos vaccine in the government’s warehouses which are “available for immediate release,” and can be shipped in less than two days. More than 4,000 courses of the two-dose vaccine have been distributed to 28 states and territories.

An additional 150,000 courses of Jynneos are expected to be delivered from its manufacturer, Bavarian Nordic, in the coming weeks, on top of the 500,000 more doses the Biden administration has asked the company to fill into vials from its own reserves.

For decades, the federal government has poured millions into developing Bavarian Nordic’s vaccine in preparation for any potential outbreak. The company could fill up to another 7.9 million doses of Jynneos into vials for the U.S. if needed, officials have said.

The CDC has also shipped tests for orthopoxvirus — the family of viruses that includes both monkeypox and smallpox — to several commercial labs.

Those labs could begin testing suspected monkeypox cases “by early July” to supplant the network of public health labs that have been fielding cases so far. 

The CDC, which can conduct tests that can differentiate between monkeypox and smallpox, is still asking for positive samples at commercial labs to be forwarded to them for “characterization testing.” 

“As we have continued to say, healthcare providers can and should act on positive orthopoxvirus results before CDC monkeypox-specific testing is performed,” Kristen Nordlund, a CDC spokesperson, said in a statement.

No deaths have been reported in the U.S. so far from the disease, which causes painful and itchy rashes and sores that can last for weeks until they finish scabbing over. Virtually all cases so far are believed to have been infected through either intimate skin-to-skin contact or through shared fabrics, like towels and bedding.

The CDC is also planning to study whether monkeypox has been spreading through semen, given the majority of cases have been linked to sexual contact.

Patients with known infections range in age from 20 to 76 years old, and are mostly in men but include a handful of women. No health care personnel have so far tested positive for the disease after treating a patient.

“We are looking at several clusters across the country, and it is sounding to us similar to what the international community, scientific communities have established, in that most of these cases are occurring in men who have sex with men,” the CDC’s Agam Rao told the panel.

A growing number of recent infections are believed to have been acquired through “local transmission” or cannot be linked to another known case, Rao added.

The accelerating U.S. response to monkeypox comes as federal officials have been participating in the World Health Organization’s emergency meeting to decide whether to declare the outbreak an international public health emergency of international concern, or PHEIC.

“If a PHEIC is declared, and the United States follows suit and declares a public health emergency as well, that could change some of the regulatory mechanisms in terms of these medical countermeasures, opening up the possibility that they may be used under an emergency use authorization or under emergency use instructions,” Petersen said.

For example, the CDC is pursuing the Food and Drug Administration’s permission to expand use of the vaccine in more children who may be exposed. At least one dose of vaccine had to be administered to a child who was exposed to monkeypox so far, Petersen said. 

Molly Howell, a representative for the Association of Immunization Managers, had also told the committee that many health departments have been consumed with curbing the COVID-19 pandemic. Local vaccination programs would need time to prepare for a large-scale monkeypox immunization effort, Howell said, and might need more resources. 

“A lot of our COVID vaccine funding is very specific to COVID vaccine and cannot be used for any rollout of a monkeypox vaccine initiative,” said Howell.