Update 2022-08-12: The Hamilton County Health Department now has a page about monkeypox with symptoms and isolation guidance, as well as options for vaccination, testing, and treatment–look for “complete our monkeypox vaccine registration”. The Cincinnati Health Department is also offering vaccines for high-risk groups. People in Hamilton County without a primary care physician who have symptoms can also call call 513-357-7320 for the Cincinnati city health clinic.

If you’re a gregarious gay man like me you’ve probably heard about monkeypox. Monkeypox is an orthopoxvirus which causes, in addition to systemic symptoms, lesions on the skin and mucosa. It’s transmitted primarily through skin-to-skin contact, though close-range droplet and fomite transfer are also possible. The current outbreak in industrialized nations is almost entirely among gay, bisexual, and other men who have sex with men (GBMSM); likely via sexual networks. In the UK, for example, 99% of cases are male and 97% are among GBMSM. Ontario reports 99% of cases are in men. In New York 99% of cases are in men who have sex with men. For a good overview of what monkeypox looks like, how it’s spread, and ways we can reduce transmission, check out San Francisco Leathermen’s Discussion Group’s presentation by MPH Frank Strona.

Earlier outbreaks of monkeypox have been generally self-limiting, but that does not appear to be the case with the current outbreak; perhaps because it’s spreading among men who enjoy lots of skin-to-skin contact with lots of people, and often travel to do just that. We saw cases come out of Darklands, IML, and Daddyland; they’re also rising quickly in major cities across the US. Cases haven’t taken off in Ohio yet, but for those of us who travel to large gay events it’s an increasing risk. Two of my friends tested positive last week; one landed in the ER. We’ve known for a while about symptoms and risk reduction tactics, so I won’t cover those here, but I do want to talk about vaccines and testing.

There is a vaccine (in the US, JYNNEOS) for monkeypox, but but we have nowhere near enough doses. Some cities like SF, New York, and Chicago have pop-up mass vaccination sites. The Ohio Department of Health, on the other hand, has been basically silent on the outbreak: two months in there’s no public messaging about risk factors, prevention, testing, or treatment. Only ten doses have been distributed in the state. Many of my friends here have no idea how to get vaccinated.

Through an incredible stroke of luck and a truly fantastic doctor, I got my first dose yesterday. I followed up by chatting with our county’s (super nice!) head epidemiologist, and asking what advice I can give to the local queer leather community. Here’s the scoop:

Getting Vaccinated in Ohio

Because of the limited supply of vaccine doses, we’re currently focusing vaccination on those at high risk. Ohio’s current high-risk category includes:

  • Anyone who has had close intimate contact (sex, cuddling, making out, etc.) with a known monkeypox case
  • Exposure to respiratory droplets (e.g. dancing close, kissing) with a known case

The problem is that many of us don’t know we’ve been in contact with monkeypox cases: of the people I know who have tested positive, none knew where they got it from. You might dance, make out with, or fuck dozens of people at an event weekend. So (our epidemiologist advised me) your participation in events where people have lots of sex or skin-to-skin contact can also be considered a risk factor. In other states having multiple or anonymous partners in a two-week span is a qualifying criterion; that might be worth a shot here too.

There are no public vaccination sites in Ohio yet, as far as I know. Doses are distributed to individuals through their primary care physician (which poses a problem if you don’t have one, oof). You should start by talking to your doctor about your risk factors: for me that was “I have two friends who tested positive, I just did bear week in ptown, I play regularly, and I’m going to be participating in a large leather run in a few weeks.” If your doctor concurs you’re at high risk, they should get in touch with their usual contact at the county or city department of health. The department of health gathers information about risk factors and contact information, and then gets in touch with the Ohio department of health, which requisitions doses from the CDC and ships them to your doctor. For me it took three days from “talking to my doctor” to “first dose in arm”.

The JYNNEOS shot is fairly easy: it’s a single sub-cutaneous injection with a thin needle into the fat on your arm–much better than the old orthopoxvirus vaccines. I barely felt it. The usual vaccine side effects apply: you might have some redness, swelling, or pain at the injection site; other common side effects include low-grade muscle pain, headache, and fatigue. I’ve noticed some redness and a little bit of pain, but it’s been super mild. You need to come back for a second dose four weeks later, and protection is maximized two weeks after the second dose.

When you get vaccinated, there’s a 21-day observation period where you need to report monkeypox-related symptoms via phone, text, or email to the health department–they’ll get in touch with you about this.

Getting Tested in Ohio

There’s no dedicated testing system in place yet, and I know friends have had really mixed luck getting tested through their primaries, urgent care, and even some hospitals. That said, our county epidemiologist says that both the state lab and some private labs–notably LabCorp–can test for monkeypox. Theoretically any primary care provider, urgent care, or emergency room should be able to do the test: they take a swab of your lesions and ship it off to the lab for analysis. In Cincinnati, Equitas Health (2805 Gilbert Ave, Cincinnati, OH 45206; 513-815-4475) should be able to test–call ahead and check before showing up though.

When you get tested, you should isolate until you get results back. If your results are negative, talk to your primary doctor about what to do: it may be some other kind of illness. If the test is positive, you’ll have to isolate until no longer contagious, which means the lesions need to scab over and heal–you should see new skin underneath. Your contacts do not need to isolate unless they show symptoms, but the county will start contact tracing, and just in case, I think it’d be a good idea for you to reach out to intimate contacts personally.

Mileage May Vary

Right now I’m the only person I know who’s gotten vaccinated here, and I haven’t needed to look for testing, so I don’t know what’s going to happen when other people start trying to access care. A friend just told me that his doctor didn’t think there was a vaccine: if this happens to you, try showing them the CDC’s MMWR report on JYNNEOS. If they can’t get you JYNNEOS, ACAM2000 is also available–it involves worse side effects and may not be a good fit if you have a weakened immune system, but for many people it should still offer significant protection against monkeypox. If your doctor still doesn’t get it, ask them to contact the local health dept anyway.

In Dayton, one friend’s primary doctor states the only way to get vaccinated is at the ER following a possible exposure. In NE Ohio, another reader’s primary said to contact the health dept directly; they’ve tried, but so far no response.

If you’re still having trouble getting tested or vaccinated–your doctor doesn’t understand, or they can’t find the right contact at the health department–and we’re friends locally, get in touch. I’m aphyr+monkeypox@aphyr.com. I may be able to put you in touch with a doctor and/or health department staff who can help.

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