Florida college students are back on campus just as monkeypox is spreading quickly in the state, including among young adults.
But while universities are posting information and offering flyers about the disease, few are prepared for a campus outbreak. They have yet to announce how they plan to isolate students with the virus and help them keep up with classes, and few have acquired the Jynneos vaccine being used for people at high risk of monkeypox.
Monkeypox most commonly spreads through skin-on-skin contact of any kind with a rash. It can also spread through contaminated surfaces. The virus can start with flu-like symptoms, painful muscle aches, swollen lymph nodes and a pox-like rash, though during the current outbreak, it has often presented with just a rash, according to CDC officials. There have been no deaths in the U.S. linked to this outbreak.
So far, most of the more than 1,700 cases in Florida are in men who have sex with men. Already, about 100 of them are young people between 15 and 24.
There’s nothing inherent in the disease that makes this gay male population more at risk, and experts fear the disease could spread more widely in the coming months — especially on college campuses where students tend to have multiple sexual partners, or may have skin contact with strangers at parties or other activities.
“College campuses are inherently a risky environment in terms of transmission,” said Dr. Joshua Lenchus, medical director of Broward Health. “I would tell college students to assess your risk tolerance for certain behavior, look at the person who you are with. If that person has these lesions, it may not be the best idea to be with that person.”
Epidemiologists at the Centers for Disease Control and Prevention told college administrators Wednesday during a briefing that while monkeypox is “not COVID” because it is not airborne, colleges should still take some precautions.
They should train their health center staff to identify a rash as monkeypox should a student show signs, test for the virus, provide treatment if necessary, and figure out how to isolate to keep monkeypox from spreading to the student.
“The risk level in institutions of higher education is extremely low,” said Dr. Demetre Daskalakis, White House Monkeypox Response deputy coordinator. “With that said, we recommend that colleges and college students are mindful of signs and symptoms of monkeypox and are very aware of the populations that are overrepresented in this current outbreak, because those populations are part of your campuses.”
American Public Health Association Executive Director Georges C. Benjamin said it’s inevitable monkeypox will surface on college campuses this fall.
“There’s nothing to say they’ll have big outbreaks, but all schools should assume that they’re going to have somebody on their campus that has monkeypox. The outbreak is just too widespread for that not to be the case,” he told the Florida Phoenix.
Joseph A. Puccio, executive and medical director of Student Health Services at Tampa’s University of South Florida — known for its well-regarded public health school — is also anticipating monkeypox on campus this semester.
“At some point, we’re going to get a student who gets infected with monkeypox. Is it going to be an overwhelming number of students? I do not think so,” Puccio said.
Focus on prevention
With the new school year underway, Florida colleges are focused on informing students and families about how the virus spreads, what groups are at risk, and what to look out for.
“Our message right now is: we know what the risk factors are. We know how it’s transmitted. And we’re trying to teach prevention,” said Dr. Jonathan Appelbaum, a practicing physician and chair of the Department of Clinical Sciences at Florida State University.
The University of Central Florida — the largest university in the state — is located in Orange County, which has over 120 cases of monkeypox. The university made a page that shares information about what monkeypox looks like as well as how it spreads and refers students to the Florida Department of Health Orange County for vaccines.
Spokesperson Heather Lovett said people who think they have monkeypox should contact their primary health care provider, which in many cases would be student health services.
University of Florida’s awareness campaign also started with a brief on its website providing information on the disease, symptoms and behaviors that would put a student at risk. Cynthia Roldan Hernandez, a spokeswoman for the University of Florida, said the health center also is increasing the promotion of health hygiene and safe sex messaging.
Appelbaum said that Florida State University’s campaign includes offering printable fliers, adding information to its website about monkeypox, and hosting a campuswide information session about monkeypox next week.
University of South Florida also has printable flyers and information about who is at risk on its website. Puccio said the university plans to do more outreach in the future and plans to create forms for students to ask questions about monkeypox anonymously.
Florida International University in Miami-Dade — the county with the most monkeypox cases in the state, at over 630 — shared information about monkeypox symptoms and transmission in an email to students and faculty. The information came directly from the CDC website and directed students with concerns to Student Health Services.
Florida Atlantic University in Boca Raton used its FAU Owls Care website and its social media channels to put out information on monkeypox to its students. The university also has links to testing and vaccine locators on its public health page.
Scrambling to respond
Education is just one aspect of planning for monkeypox, however. If county-level spread in Florida is an indicator, infections on campuses will need to be managed swiftly and competently to keep cases from multiplying.
While state universities are all creating some form of communication, few have shared plans for what will happen if a case actually pops up. When asked about their response plans, not one was able to commit to having isolation space available to students on campus.
University of Florida’s Roldan Hernandez said her school does not have vaccines but can conduct testing at its hospitals and student health care center, adding, “if a case is identified, the Florida Department of Health in Alachua County would be contacted.”
Representatives for several public universities say they have ordered monkeypox tests for their student health centers, such as the University of Florida, Florida State University, University of South Florida and Florida A&M University.
Accessing the antiviral drug Tpoxx that federal officials are using to treat severe monkeypox cases and shorten the illness’ duration for an individual will require requesting the drug from federal authorities and completing a labor-intensive process of paperwork. Few universities have done so.
Several universities are in the process of trying to procure the Jynneos monkeypox vaccine from their local health department, said Puccio of Tampa’s University of South Florida. USF is one of the few universities, along with FAMU, that is administering the vaccine to students in its health center at this time.
Florida State University is “working with Leon County DOH regarding vaccination options,” spokesperson Amy Farnum-Patronis said.
University of Florida’s Nicole Iovine also said while the vaccine and antiviral treatment are available only from the CDC via local health departments, “we are working to enable access through our Student Health Care Center in the coming weeks.”
The universities that offer the vaccines on campus are limited to their county health department’s vaccination criteria. Many counties are currently in phase 3 of vaccine distribution, which means the vaccines are given to men who have sex with men, close contacts of people with monkeypox, and laboratory personnel and select health care personnel at high risk for monkeypox, as well as other high-risk groups.
“Right now vaccines are in short supply and they are earmarked for high-risk populations,” Lenchus of Broward Health Medical Center said. “We are not at the point where we can have mass inoculations on college campuses.”
Ulyee Choe, director of the Florida Department of Health in Pinellas County, said during an Aug. 16 news conference that his department has worked with local universities’ student health centers to provide education and resources.
“We do have robust surveillance units throughout the state, so we will continue to monitor and adapt our strategies if things were to shift,” Choe said.
The Florida Department of Health did not respond when asked to expand on how it is helping state universities prepare for monkeypox.
No isolation plans
Because monkeypox lesions can last two to four weeks, CDC guidelines say anyone infected should isolate until the rash has resolved, the scabs have fallen off, and a fresh layer of intact skin has formed.
Ideally, students should be in a room with a door that shuts and a private bathroom, said Dr. Martha Montgomery, a CDC epidemiologist, in a Wednesday news conference. If they need to leave that space, they should wear clothing covering their sores and a mask, she said.
“Having that isolation space available is really important,” Montgomery said.
But most Florida universities haven’t communicated how they’ll help students isolate or keep up with their classes during the time when they are contagious, and some have shrugged it off as not being their responsibility.
Puccio says the University of South Florida is still developing its strategy.
“Our university is working on a definitive plan,” he said. “We have a few options that are being explored by the university. And we are working to finalize that plan hopefully in the near future.”
FSU is asking students diagnosed with monkeypox to isolate at home.
Florida Gulf Coast University in Fort Myers and University of North Florida in Jacksonville say on their websites they will not provide isolation spaces.
Florida Gulf Coast University notes in “extenuating circumstances” a student may isolate in their room, but the burden is on the student to arrange that.
“Residential students who isolate in their room are responsible for securing wrap-around services to address their personal needs, such as food, laundry and medical services,” it notes.
FGCU’s website advises students to create an off-campus isolation plan with their parents before the semester begins.
South Florida Sun Sentinel staff writer Cindy Goodman can be reached at cgoodman@sunsentinel.com. Orlando Sentinel staff writer Caroline Catherman can be reached at ccatherman@orlandosentinel.com
