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The Biden administration has decided to stretch out its limited supply of monkeypox vaccine by allowing a different method of injection that uses one-fifth as much per shot, according to people familiar with the discussions. In order for the Food and Drug Administration to authorize so-called intradermal injection, which would involve injecting one-fifth of the current dose into the skin instead of a full dose into underlying fat, the Department of Health and Human Services will need to issue a new emergency declaration allowing regulators to invoke the F.D.A.’s emergency use powers. That declaration is expected as early as Tuesday afternoon. (LaFraniere and Weiland, 8/8)

“It really means, basically, sticking the needle within the skin and creating a little pocket there into which the vaccine goes,” Food and Drug Administration Commissioner Robert Califf said, comparing it to tests for tuberculosis and other injections performed by health-care workers. “This is really nothing highly unusual.” (Diamond, 8/8)

New data published in Morbidity and Mortality Weekly Report and gathered by the Centers for Disease Control and Prevention (CDC) shows 99% of monkeypox cases in the United States are in males, and 94% of cases report recent male-to-male sexual or intimate contact. (Soucheray, 8/8)

Most patients in New York City, an epicenter of the outbreak, are recovering at home with outpatient supportive care, said Jason Zucker, MD, an infectious diseases specialist at NewYork-Presbyterian/Columbia University Irving Medical Center in New York City, during an Aug. 5 call with reporters. They're experiencing some symptoms that present with many other viral illnesses, such as fever, chills and swollen lymph nodes, in addition to a rash that develops a few days after the other symptoms. He said there's been a "small number" of patients whose symptoms were severe enough to require hospitalization.  (Carbajal, 8/8)

With 472 cases — 36% of the state’s 1,310 cases — city public health officials believe San Francisco has the nation’s highest per-capita rate. At first, the practice of tracing people exposed to a fast-spreading disease, then isolating or treating them, seemed like a good idea. Health officials relied on it in the early days of the COVID-19 pandemic as cases climbed. (Asimov, 8/8)

Sparrow Health System is testing for the monkeypox virus through its own in-house system that started Thursday, the same day U.S. health officials declared the monkeypox outbreak a public health emergency. Two patients had been tested by noon Friday, with the main lab in Lansing having the capability of testing up to 200 patients per day, said Dr. Paul Entler, the health system’s chief clinical officer. (Hall, 8/8)

KHN: Covid Sewage Surveillance Labs Join The Hunt For Monkeypox 

The same wastewater surveillance techniques that have emerged as a critical tool in early detection of covid-19 outbreaks are being adapted for use in monitoring the startling spread of monkeypox across the San Francisco Bay Area and some other U.S. communities. Before the covid pandemic, wastewater sludge was thought to hold promise as an early indicator of community health threats, in part because people can excrete genetic evidence of infectious diseases in their feces, often before they develop symptoms of illness. Israel has for decades monitored wastewater for polio. But before covid, such risk monitoring in the U.S. was limited largely to academic pursuits. (Kreidler, 8/9)

The Biden administration declared monkeypox a public health emergency on Aug. 4, but leading national and international health organizations haven’t made sweeping changes to the way they classify the virus and illness, despite alarming claims made by an image circulating online. An image shared in a Facebook post on Aug. 3 suggested that the Centers for Disease Control and Prevention and the World Health Organization made major changes to their available monkeypox guidance and information. (Czopek, 8/8)

The only drug available to treat monkeypox is so difficult to access that just a fraction of the nearly 7,000 patients in the United States have been given it. Health officials have designated tecovirimat, also called Tpoxx, an “investigational drug,” which they say means it cannot be released from the strategic national stockpile without a series of convoluted bureaucratic steps. But most doctors do not have the time or resources to fill out the required 27-page application or to provide the detailed patient information. (Mandavilli, 8/6)