Here's Who Needs a Monkeypox Vaccine, and What We Know About It

Here's Who Needs a Monkeypox Vaccine, and What We Know About It

What's happening

The monkeypox vaccine is available to people at higher risk of getting the disease, but supply has been limited. To stretch out more doses, the US is starting to administer the vaccine in a slightly different way that requires a smaller dose.

Why it matters

Vaccination is an important tool to slow the monkeypox outbreak happening in the US and other countries. Access to vaccines is crucial for people most at risk.

What it means for you

Some men who have sex with men are eligible for the vaccine, as are other people who may've been exposed to monkeypox.

The vaccine Jynneos is being given out a little differently now in some places. If you're eligible for a monkeypox vaccine, you might be getting a shot under a top layer of skin, instead of deeper into your arm. That's because the US Food and Drug Administration authorized intradermal injection for the monkeypox vaccine this month, which is an effort to increase the US supply of vaccine up to five times since intradermal injection requires a much smaller dose than one given subcutaneously.

Also called "dose-sparing," intradermal types of injections aren't new to health care. But the change in medical guidance on how the monkeypox vaccine can be administered reflects a shortage of Jynneos that's plagued the vaccine rollout since it began. Health officials have touted a national stockpile of vaccines that work against monkeypox as well as smallpox, but getting them out to states and into the arms of people who need them has been a challenge. 

According to a report from The New York Times, a hurdle in the monkeypox vaccine rollout (besides limited supply of Jynneos) is that the federal system being used to move vaccines to states and cities is different from the system local health officials are used to, which is run by the US Centers for Disease Control and Prevention and is already linked to state databases. The current system states are using for the monkeypox vaccine is made for mass vaccine rollouts where every person would need a vaccine (like a smallpox bioterrorism event), and it's been difficult in some states for local health officials to track their orders or get to the site where the doses have been delivered, the Times reports.

But federal health officials are confident in the new intradermal vaccination method, which they say gives an immune response similar to that of the traditional method. But it still requires two doses, about 28 days apart. One-dose priority policies for the vaccine, which could potentially delay a second dose, have been put in place in cities like San Francisco and New York City, which make up a large portion of the country's monkeypox cases. 

Here's what we know about monkeypox vaccination.

Read more:  Monkeypox: What to Know About Variants, Symptoms and More

Who can get a monkeypox vaccine? 

Exact criteria for who should get a monkeypox vaccine depend on the city or state people live in and how widespread the outbreak is there, but men who have sex with men and who have had multiple or anonymous sexual partners in the last two weeks are eligible in cities like New York. That's because gay and bisexual men are currently at higher risk in the outbreak, though anyone with close contact to monkeypox can get the disease. You may also be eligible if you were recently exposed to someone with monkeypox.  

According to the CDC, you meet the criteria for a monkeypox vaccine if: 

• You're a contact of someone who has monkeypox or you were identified as possibly exposed via contact tracing. 
  
• You had a sexual partner within the last two weeks who has monkeypox.
• You've had multiple sexual partners in the last two weeks in an area with a high number of monkeypox cases.
• You are a lab or health care worker who's around orthopox viruses, including in animals. 

If you think you qualify for a vaccine or were exposed to monkeypox, contact your local health department or doctor's office to find an appointment in your area. You can also book an appointment for the vaccine online, a process that'll walk you through the eligibility criteria. Here is New York City's vaccine appointment website. You can make an appointment and find a vaccine in San Francisco by calling one of the city's clinics or visiting its drop-in location. 

Colematt/Getty Images

What is intradermal vaccination? 

Intradermal vaccination is a method that injects the vaccine under a more shallow layer of skin, typically on the inner side of the forearm. This should produce a "noticeable pale elevation of the skin," according to the US Centers for Disease Control and Prevention. Counties including Los Angeles county and Fulton county in Georgia (where Atlanta is) have already transitioned to intradermal injections, according to the White House.

Most vaccines we get these days go either into the muscle in our arm (intramuscular injection) or into the fatty tissue under our skin (subcutaneous injection), like Jynneos has been given so far. Subcutaneous injection of Jynneos is the only authorized method of vaccination for people younger than 18. If you get the monkeypox vaccine intradermally, you'll still need two doses.

When the FDA authorized the new vaccine method, the agency referenced a study published in 2015 that found that a smallpox vaccine given intradermally gave a similar immune response in people compared to the vaccine given subcutaneously. 

What are the monkeypox vaccines? 

The US has two vaccines in its national stockpile that work against monkeypox. Jynneos is currently being given out to people before an exposure, as well as after an exposure, as it's a newer vaccine that's safe for most people. 

Jynneos (made by Bavarian Nordic) is a new-generation vaccine approved by the US Food and Drug Administration in 2019 for monkeypox and smallpox. It's a two-dose vaccine, with each shot given about four weeks apart. It uses a weakened virus and is approved for adults 18 and older who are at high risk of getting monkeypox or smallpox.

Because of limited supply, it's likely you'll only be able to book an appointment for the first dose for the time being. In New York City, for example, health officials say you'll be contacted if you received a first dose about the second dose in the coming weeks. 

Side effects of Jynneos may include typical temporary vaccine side effects, including headache, chills and fatigue. There can also be some pain and swelling around the injection site, which can result in what some are reporting as a temporary swollen lump around the injection site. 

ACAM2000 is a second-generation smallpox vaccine that also works against monkeypox. According to the CDC, ACAM2000 is a derivative of Dryvax, which helped eradicate smallpox. (The two diseases are closely related and both caused by orthopoxviruses, which makes this possible.) If necessary, the US Department of Health and Human Services said it's also prepared to ship out the ACAM2000 vaccine, which is in greater supply than Jynneos but remains a second choice in the monkeypox response because it has a side effect profile that isn't safe for certain people.

ACAM2000 is administered differently than the typical vaccine shot we're used to, including intradermal injection. It's given by dipping a needle into a vaccine solution which will then be "pricked" several times on the upper arm. It will cause a localized infection (a "pox"), prompting an immune response. 

While ACAM2000 doesn't cause smallpox, it contains live vaccina virus, which isn't suitable for everyone. It could be unsafe for immunocompromised people, pregnant folks and those with certain heart or skin diseases, like eczema.

Smallpox was declared eliminated from the world in 1980. The US stopped routine vaccination against it in 1972, though some health care workers or people who work in labs may have had the vaccine. Historically, according to the CDC, smallpox vaccines were 95% effective against infection and protect you for about three to five years, and after that protection starts to wane. 

Because of this, it's possible people born before the early 1970s who got the smallpox vaccine might have some cross-protective immunity against monkeypox, according to the WHO, but there is "little immunity" to younger people living in non-endemic countries because they've had no exposure to a similar virus.

Read more: Monkeypox: What Gay and Bisexual Men Need to Know

A smallpox vaccine scar. People born before the mid-1970s might have such a scar. Jynneos, a newer-generation monkeypox and smallpox vaccine, is not the same type of vaccine as the one used to eradicate smallpox and doesn't leave a scar. 

Picture Alliance/Getty Images

How effective are the vaccines against monkeypox? How long do they take to work? 

Giving Jynneos within four days of a monkeypox exposure is the best option for stopping the onset of the disease, according to the CDC. If it's given four to 14 days after an exposure, the CDC says, Jynneos may not prevent monkeypox but will likely reduce the severity of symptoms. However, this information was published when Jynneos was given only the "standard" way (subcutaneous injection). 

The CDC says that the Jynneos vaccine takes two weeks (14 days) after the second dose for immunity to build, and that ACAM2000 takes four weeks for maximum immunity. Though many people are receiving only the first dose of Jynneos at this time, early research suggests that one dose will still offer some protection, at least for a shorter period of time. 

Because the US outbreak of monkeypox is so new, there's no data yet on exactly how effective the vaccines will be in the current situation, according to the CDC. 

You should still self-isolate if you develop symptoms of monkeypox after getting vaccinated, such as a rash. 

A computer image of a monkeypox virus.

Uma Shankar Sharma/Getty Images

Why does the US have a stockpile of monkeypox vaccines? 

The US has a stockpile of Jynneos and ACAM2000 on hand not because the country was worried about an outbreak of monkeypox (which has been endemic in some African countries for years), but in case smallpox becomes a public threat again. Smallpox was declared eliminated in the 1980s, and the last natural outbreak in the US happened in 1949. But smallpox is usually much more severe than monkeypox, and officials worry it could be used as biological warfare. 

"The stockpile was created in the event of a biological weapons attack on the United States with smallpox," Dr. Amesh Adalja, an infectious-disease expert and senior scholar at the Johns Hopkins Center for Health Security said. In this event, health officials would not be rationing vaccines or using only the newer-generation vaccine, according to Adalja. 

"If there was a smallpox attack, we would be using whatever vaccines we have to be able to deal with it," he added. 

Why is there a monkeypox vaccine supply issue? 

The supply of Jynneos, the newer vaccine specifically approved to prevent monkeypox, has been in particularly short supply.

Officials who spoke to The New York Times said the supply issue is partly because the government waited too long to ask Bavarian Nordic, which makes Jynneos, to bottle and fill the vaccine order the US had already purchased. 

Another report by the Times alleges that the US national stockpile of monkeypox and smallpox vaccines dwindled because the government never replaced the expired doses and instead put money into technology that would extend their shelf life. Part of the reason for this was that the government created the stockpile not for monkeypox but for smallpox, which is a more contagious and often more serious disease officials fear could be used in biological warfare against the US. 

The US Department of Health and Human Services didn't respond to a request for comment on the reports.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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GoPro HD Hero2 review: GoPro HD Hero2

GoPro HD Hero2 review: GoPro HD Hero2

I've had a bit of a love-hate relationship with the GoPro HD Hero that we've used during the recording of the Car Tech Live podcast for the last year or so. On the one hand, the Hero takes phenomenal wide-angle video, is ridiculously durable thanks to its polycarbonate shell, and (when you get the settings right) relatively easy to use. However, that last bit is also my biggest point of contention with the first few generations of the GoPro Hero cameras; I'm a self-proclaimed techie who's recorded hours of footage using the HD Hero and I still have to break out the poorly written instruction sheet to change any of the settings. More often than not, I just leave the settings where I left them and just point and shoot.

So, when the new generation GoPro HD Hero2 landed on my desk boasting an improved interface, I decided to challenge myself to full-test the device without cracking the spine on its (also improved) 90-page user manual.

Old design with a twist
Looking at the GoPro HD Hero2 side by side with the original HD Hero (hereafter referred to as the HD Hero1), reveals remarkably little change in the unit's form factor. Both units are dimensionally identical and feature the same lens, power button, shutter button, and LCD screen placement. This means that any waterproof cases or lens covers purchased for the HD Hero1 will still work with the HD Hero2, which is a good thing for GoPro devotees. Likewise, both units feature the same rear hook and connection port for GoPro's line of removable BacPacs, which we'll discuss later.

Closer inspection reveals that there's more than the addition of the number 2 to distinguish the new model from the old. For starters, the Hero2 features a new glass lens that should be sharper and more durable than the old lens. Where the Hero1 featured only one red recording indicator LED, the Hero2 features four (one enlarged indicator on the front of the unit and smaller lights on its top, back, and bottom edges). On the right edge (when viewed from the front) are the connections for the proprietary video output, the Mini-USB port for charging, and a 2.5mm microphone input. Thankfully, these three connections are actually labeled this go-round. On the left edge are the full-size SD card slot and a new HDMI video output. Onboard microphones are now located on the top and bottom edges of the unit. Finally, the rear panel is where you'll find the battery door that covers the user-replaceable 1,100mAh lithium ion battery.

I mentioned that the HD Hero2 ships with the same waterproof housing as the Hero1. For those unfamiliar with this housing, it's a clear, polycarbonate shell that holds the Hero camera to whatever mounting option you chose to use. Spring-loaded waterproof buttons give users access to the selection and shutter buttons and a clear lens bubble protects the HD Hero2's lens from scratches. In the event that this bubble is damaged, a replacement can be ordered and affixed with a small screwdriver. At the back of the shell is door that locks shut with a plastic latching clamp. (The plastic latch on our HD Hero1 busted after only a few weeks of use, so this bit worries me. Fortunately, it's a relatively simple fix.) Users are given the choice between two easily swappable doors that ship with the HD Hero2. The first is a sealed waterproof door that keeps the camera dry, even when submerged to a depth of 197 feet. The second door is a "skeleton door" with openings that sacrifice waterproofing f or increased sound quality.

The mounting options included in the box will depend on which HD Hero2 kit you pick up. The Motorsports Edition, for example, ships with a suction cup mount on an articulated arm and five adhesive mounts. The Surf Edition packs a pair of surfboard mounts and a special "Floaty" back door that will keep your camera from sinking to the bottom of the ocean in the event of a detachment. Finally, the Outdoor Edition includes a helmet strap, a head strap, and a selection of adhesive mounts. Additionally, additional mounts for handlebars, roll bars, chest straps, etc. are available from the manufacturer for additional cost.

Same screen, new interface
Of all of the changes to the HD Hero, the most drastic is the overhauled interface present on the tiny monochromatic LCD. For starters the HD Hero2 uses larger, bolder icons for identifying the current recording mode. So tapping the selection button on the front of the unit fills the screen momentarily with a large icon for the newly selected mode that is easier to read with goggles on or at an arm's length. When the moment is passed, the screen returns to its default state with a smaller icon indicating the mode and a new text-based setting identifier. So rather than memorizing that "R7" is 1080p video at 30 fps, the unit simply displays "1080-30," which is much easier to decode. Likewise, photo modes are clearly identified with, for example, "5 MP 0.5 sec" which can easily be identified as "take a 5 megapixel shot every half second."

Likewise, the menu system has also been made clearer, with more easily identified icons for each setting that leads to a drop-down menu where the different options can be viewed clearly. Navigating the GoPro's many options with just the select and shutter buttons is still an exercise in patience. For example, setting the date to 11:11am on 11/11/11 can take as many as 60 or more button presses. (Fortunately, the date is something you should only really have to set once.) That's an extreme example, but even simpler tasks (such as changing the video or still-photo resolution) can take as many as 10 button presses.

On the bright side, the fact that the GoPro HD Hero2 even offers granular access to all of its settings right on the camera is an advantage that it holds over simpler camera systems, such as Contour's.

There are still a few icons that don't make much sense. (I doubt many can tell me what this icon means without first checking the manual.) However, the important bits--changing the resolution of photos and video, setting time-lapse intervals--and the options that you're likely to find yourself wanting to fiddle with before bombing down that double-black-diamond slope are extremely easy to understand.

I started the review with the intention of never cracking open the GoPro HD Hero2's instruction manual and I'm pleased to state that I didn't need to use it. (Although, I did flip through the manual and found that it is both more thoroughly written and better organized than the old sheet. So if you do find yourself needing help, it's a great resource.)

Recording modes
So, we've discussed the chassis and we've explained that it's easy to use, but what sort of video and photos can you expect to get out of this camera?

Like the Hero1, the HD Hero2 features a wide range of video and photo modes to chose from. Where moving images are concerned, the HD Hero2's highest recording resolution is 1,920x1,080 pixels (1080p for short) Full HD video at 30 frames per second (fps) with a wide-screen 16:9 aspect ratio. Users can also select a 1,280x720-pixel (720p) wide-screen mode with options to capture at 30 or 60 fps. There's also 1,280x960-pixel Tall HD mode that records at a 4:3 aspect ratio with options to capture at either 30 or 48 fps. Finally, there are the 800×480-pixel (480p or WVGA) modes that capture relatively low-resolution video but at high 60 or 120 fps speeds, which can be slowed down using software to create slow-motion video.

Most video modes capture at the lens' full 170-degree wide-angle field of view (FOV), but users can choose to step down to medium 128-degree or narrow 90-degree FOVs. To my eye, 1080p video captured at these narrower FOVs appears to be grainier with visible pixelation, which leads me to believe that GoPro is using some sort of digital zoom technology to compensate for the lens' fixed focal length. This likely won't bother many, particularly at the medium FOV, but I couldn't unsee the image degradations once I'd noticed them and stuck with the full wide FOV for most videos captured after the official testing had concluded.

Still photos are captured at a maximum of 11MP with space-saving 8MP and 5 MP modes also available. Like the video mode, still photos take advantage of the full 170-degree FOV, but can be set to capture at a medium 128-degree FOV. (The narrow FOV is unavailable for still photos, presumably because the digital zoom artifacts would be too visible in a still shot, but that's just speculation.) Photos taken outdoors at the full resolution with full FOV are sharp and pleasing. The wide angle makes framing shots easy, but without the aid of the optional LCD BacPac, shot composition is a bit of a guess-and-check affair.

When shooting still photos, there are a few trigger modes to choose from. The first is a single shot. Press the button, capture a photo. It's the simplest of the available modes. Next is a self-time mode that captures a single shot after a 10-second delay. The next mode is one of my favorites: Time-lapse mode continuously captures a still photo at timed 60s, 30s, 10s, 5s, 2s, 1s, and 0.5s intervals. (Note: The fastest interval of 0.5s requires a high-speed Class 10 SD card to keep up.) Users can then stitch those photos together into a cool time-lapse video that compresses hours of actions into minutes of video.

Finally, the HD Hero2 gains a new trick made possible by its new faster digital image processor called Photo Burst Mode. In this mode, the camera can capture 10 full-resolution 11MP photos within the span of a single second. Personally, I found timing the Burst to be tricky, particularly because there's a few seconds of lag after a burst is captured while the HD Hero2 writes the contents of its buffer to the SD card. However, with practice this could be another cool tool in your GoPro toolbox.

In sum
About the only think that I didn't like about the previous-generation GoPro HD Hero was that maddeningly difficult interface. And while in my opinion GoPro still hasn't perfected its menu structure and usability, it's gotten pretty damn close within its self-imposed constraints (two-button interface, maintaining compatibility with older hardware). GoPro also states that its low-light image quality has been improved between the two generations, which you can see yourself by comparing the indoor photos below. There's no question in my mind that this is the best GoPro camera yet.

But is it the best HD sports camera? To figure that out, we have to compare it to its most fierce competitors from Contour's lineup, particularly the ContourGPS. (Contour's top tier Contour+ is significantly more expensive, so we're leaving it out of the running for now, but many of the same points I'm about to make will still apply.)

Ease of use is a tie. Both camera systems excel here in different ways. The Contour camera's supersimple slide-and-record interface and laser-pointer aiming makes it easier for first-time users to pick up and shoot with. However, the GoPro HD Hero2 excels where on-device flexibility is concerned. If you're, for example, trackside with the Hero2 and you want to switch capture modes, every still and video setting is available right there on the device itself. The ContourGPS features two user presets that can be selected with the flip of a switch, but if neither of those is what you need at the moment, then you'll need to fire up the Contour smartphone app or bust out your laptop to pick a new preset. Additionally, the Contour cameras give no visual indication of what mode they're in, where the GoPro always displays its capture mode on a display. Trust me, there's nothing worse than getting back from a full day of recording with an SD card full of photos when you wanted videos. To the p oint, users who enjoy constantly fiddling with settings on the fly will prefer the GoPro, but if you're the kind of person who sets up the camera once and never changes modes, perhaps the Contour cameras are a better fit.

One place where Contour has the GoPro system beaten is where applications are concerned. Contour's included desktop editing and uploading software makes it easy to cut the good part out of a long video. Conversely, GoPro's experience is a B.Y.O.-software affair. Contour's top-tier models also capture GPS position, speed, and elevation data that can then be displayed alongside an uploaded video. GoPro does not, but if you don't mind spending a few extra bucks, the GoPro system can be upgraded with longer battery life, an LCD display, or the ability to capture 3D video thanks to its BacPac system.

The GoPro has the Contour cameras flatly beat on ruggedness. The Contour+ and ContourGPS require an additional purchase of a waterproof housing to match the GoPro in the wet. The entry-level ContourRoam is waterproof out of the box, but not nearly to the same depth as the GoPro. And if the HD Hero2 and the ContourGPS fell off of the same car at speed, the GoPro camera would definitely fare better. When you're talking about action cameras, durability is a top-tier attribute.

Deciding which camera system is best is truly a tough decision, and depending on your particular needs, you may disagree with me. At $299, the GoPro HD Hero2 is a slightly better buy than the ContourGPS, which is the same price--provided that the collection of GPS metadata isn't one of your top priorities. The learning curve is slightly steeper (and only just barely thanks to the upgraded interface), but once you're over it, the GoPro HD Hero2 is a much more flexible and durable device.

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