Cases, reactions to the vaccine rising

A growing number of South Floridians are reporting a painful red lump the size of an egg at their Jynneos vaccine injection site.

The side effect of the monkeypox shot, which for some is lasting up to two weeks, comes as the federal government tries to stretch the limited supply of the vaccine by giving smaller doses using a different method of injection.

Instead of giving a full dose of the vaccine plunged into the arm tissue, the new method injects a fifth of the original dose between layers of skin.

“The inflammation is incredibly itchy but tolerable. The area is raised and firm to the touch,” one social media user wrote, displaying his red lump.

“It was the size of half a golf ball earlier today about 24 hours after my second shot,” wrote another.

Dr. Stephen Fallon at Latino Salud, which operates four clinics in South Florida, said some gay and Latino community members have been hearing about “bad side effects” and are now scared to get their second shot or even to begin vaccination.

Jynneous is given as a two-shot series 28 days apart. Those locally who got their shots earlier in the summer received their first dose using the original method into their arm muscle.

But as of last month, the U.S. Food and Drug Administration authorized the intradermal method as part of a dose-stretching strategy.

“Some of our patients are seeing an angry red rash, and if they also have fever or fatigue they are blaming the shot,” Fallon said. “I’m not sure if there’s a higher incidence of a reaction now, but there’s a perception of a higher incidence.”

Health care providers say they are reassuring Jynneos recipients that this common reaction is expected with the change in how the vaccine is administered.

“The skin is more sensitive to injections than the muscle, so there is more of a chance of getting a reaction,” said Dr. Margaret Gorensek, an infectious disease specialist at Holy Cross Hospital in Fort Lauderdale. “Your body’s immune system is making a response. It’s worth the protection you will get.”

Nurses giving out the shots are recommending patients take Tylenol or Motrin to ease inflammation, and they suggest avoiding any medication directly on the injection site.

Kristofer Fegenbush of Wilton Manors received his second monkeypox vaccine on Wednesday and had been warned about the redness and swelling that followed. “It’s not debilitating; I am avoiding touching it,” he said Thursday.

According to the FDA packaging insert for Jynneos, the side effects related to the vaccine include pain, redness and swelling at the injection site, muscle pain, headache, fatigue, nausea, and chills.

The original Jynneos vaccine studies in 2015 reported some degree of local swelling in over half of the people who received the vaccine.

“About 20% did not show up for the second shot because they had a big reaction to the first,” said Dr. Scott Burstin, interim national director of infectious disease for the Aids Healthcare Foundation. “This is being done on an emergency basis and the calculations were done by smart people who determined that giving vaccine outweighs any pain in the arm.”

Reynier Tapanex, a nurse practitioner with Latino Salud in Miami, said he has had a few patients with swelling that resembled cellulitis, along with pain so severe they couldn’t move their arms.

Still, he said, “For almost everyone, by the third day the redness is coming down.”

Monkeypox mainly spreads through close physical contact, including sexual contact, and has been circulating mostly in the men-who-have-sex-withmen community. People with monkeypox often experience flu-like symptoms and get rashes or lesions, including near their genitals. They are supposed to isolate until the lesions are gone, which could take up to four weeks.

Michael Nicotera was among the first in Broward County to get the Jynneos vaccine in June. Nicotera said he received both shots using the original method and had no reaction. Regardless, he said the reactions now being reported wouldn’t scare him: “I would rather have cellulitis on the arm than monkeypox on my thing.”

Nicotera said the red rash from the shot has become a badge of honor of sorts in the gay community. “Some guy who was helping me with something the other day pointed to the welt on his arm and said “Yeah, monkeypox.”

As of Thursday, Florida is reporting 2,158 confirmed or probable cases of monkeypox, an increase of more than 300 cases in the last two weeks. However, the rapid rate of rise seen during the summer appears to have slowed.

“The numbers are starting to plateau and go down,” Gorensek at Holy Cross Hospital said. “We are not as many new cases as we did a few weeks ago. I think it’s both the vaccine and awareness.”

Dr. Zachary Henry at Medical Director of the AHF Healthcare Center in Fort Lauderdale said the initial demand for the Jynneos vaccine demand is declining, too. His clinic is holding a mass vaccination event this weekend in hopes of giving out more shots. He encourages patients to look past the reactions and get vaccinated: “If your arm is red and swollen, that means your immune system is working for you.”