Sporadic clade II mpox cases continue to be reported to the Virginia Department of Health. This serves as a reminder for providers to continue to keep mpox in mind when evaluating patients and recommend JYNNEOS vaccine for people at risk. Please check the VDH website for the most up-to-date data.
Clade I mpox has historically caused more severe illness and deaths than clade II mpox, which is the cause of the 2022 global outbreak. However, recent data indicate that infections from clade I mpox in the current outbreak may not be as clinically severe as in previous outbreaks.
Clade I mpox continues to spread in Central and Eastern Africa, with spread to other countries. On November 16, 2024, the first case of clade I mpox was reported in the U.S. For the latest updates on clade I mpox, visit CDC’s webpage and CDC’s updates for clinicians.
CDC assessed the risk to the U.S. posed by the clade I mpox outbreak. Currently:
-
- The risk to the U.S. overall population remains low.
- The risk to men who have sex with men (MSM) and people who have sex with MSM, regardless of gender (via sexual transmission) is low to moderate.
Other resources
Information and resources for HIV, STIs, and viral hepatitis
Learn the basics about mpox and how to protect yourself and loved ones
Find information on mpox vaccines, vaccine locations, and more
Find mpox case data
-
- Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox. Ask about travel history.
- Test all suspected cases for mpox, even if the person has been vaccinated or had mpox in the past.
- Contact your local health department if a patient with suspected mpox has traveled or had contact with someone with mpox symptoms who traveled to Central or Eastern Africa in the 21 days before symptom onset so that clade-specific testing can be performed through the state lab, the Division of Consolidated Laboratory Services (DCLS).
- Discuss mpox prevention and risk reduction strategies with all travelers to countries with ongoing human-to-human transmission of clade I mpox.
- Recommend vaccination to people who are eligible for mpox vaccine, including those who may have recent mpox exposure. Vaccines are expected to be effective for both clade I and clade II infections.
- For more information, please see CDC’s HAN Advisory.
General Resources
Mpox screening, prevention, and treatment should be incorporated into routine sexual health and HIV services to ensure all patients are screened for mpox, assessed for risk factors, counseled on prevention measures, and evaluated for testing and treatment, if indicated.
Clinical Guidance
Mpox Testing
VDH encourages providers to use commercial laboratories for mpox testing, but this testing is not free. The laboratories will bill private insurance, Medicaid, or Medicare for all testing performed. Providers may find the relevant CPT code for mpox virus testing on each commercial laboratory’s website. Providers who encounter any issues while trying to order testing should contact the laboratory’s client services.
Public health testing through the Division of Consolidated Laboratory Services (DCLS) continues to be available at no cost for patients who meet clinical and epidemiologic criteria, which includes clade-specific testing to distinguish clade I and clade II MPXV. Providers should consult with their LHD about clade specific testing.
Mpox Treatment
Supportive care for mpox includes pain management, skin and wound care, maintenance of fluid balance, and treatment of co-occurring sexually transmitted infections or bacterial superinfections. CDC's Clinical Considerations for Pain Management of Mpox has more details.
For most individuals with intact immune systems, supportive care and pain control will be sufficient for management. In some patients, supportive care and pain control may not be adequate and treatment should be considered. Tecovirimat or TPOXX is considered as first line treatment of mpox in people who have advanced or poorly controlled HIV or are otherwise immunocompromised, as they may be at high risk for severe disease. It is important to begin tecovirimat as early as possible in such patients.
Providers seeking oral tecovirimat must access it through CDC’s expanded access investigational new drug (EA-IND) protocol. The STOMP Trial, a trial evaluating the efficacy of tecovirmat is no longer enrolling.
Interim analysis from the STOMP trial found that tecovirimat did not reduce the time to lesion resolution or have an effect on pain among adults with mild to moderate clade II mpox and a low risk of developing severe disease. There were no safety concerns associated with tecovirimat.
If patients meet protocol eligibility criteria, they can receive tecovirimat under the EA-IND protocol. Tecovirimat is available orally or intravenously for certain patients with (or who are at high risk for) protracted or life-threatening illness, including severely immunocompromised patients, people with atopic dermatitis and other conditions affecting skin integrity, children and pregnant or breastfeeding adults.
If a provider at a local health department is requesting TPOXX through the EA-IND for a patient, they should contact VDH’s Division of Pharmacy Services (DPS) for assistance with fulfilling this request.
Private providers should contact their local health department to request TPOXX through the EA-IND. The local health department will then contact DPS to coordinate medication access.
Additional treatment details, including other therapeutics (e.g., cidofovir, brincidofovir, and VIGIV) are available on CDC’s Clinical Treatment of Mpox webpage.
-
- VDH: TPOXX Ordering Information for Virginia Providers and Local Health Departments (updated August 2025)
- CDC: Clinical Treatment Information
- CDC: MMWR Interim Clinical Treatment Considerations for Severe Manifestations of Mpox — United States, February 2023
- Mpox - Caring for the Skin (American Academy of Dermatology)
- Mpox - Treating Severe Lesions (American Academy of Dermatology)
Mpox Vaccination
Cases of mpox peaked in the U.S. in August 2022, but the outbreak is not over. CDC continues to receive reports of cases that reflect ongoing community transmission in the U.S. and internationally, including multiple jurisdictions in the U.S.
CDC and VDH are urging clinicians to be on the alert for new cases of mpox (even if someone has been partially or fully vaccinated for mpox) and to encourage vaccination for people at risk.
Although vaccine-induced immunity is not complete, vaccination continues to be one of the most important prevention measures. CDC expects some new cases among previously vaccinated people to occur, but a CDC MMWR reported that infections after vaccination have been estimated to have occurred in fewer than 1% of fully vaccinated people. In addition, people who have completed their two-dose JYNNEOS vaccine series and then developed mpox have less severe symptoms and are less likely to be hospitalized than those who have not been vaccinated.
Mpox vaccination, testing, and treatment should be incorporated into routine care, including sexual health and HIV care services. CDC also has guidance to help with planning and implementation of satellite, temporary, and off-site vaccination clinics by public and private vaccination organizations. Resources include:
JYNNEOS vaccine is used to prevent smallpox and mpox in people at high risk for infection. During the current mpox outbreak, JYNNEOS is the only vaccine being administered in the U.S. JYNNEOS (also known as Imvamune or Imvanex) is licensed (or approved) by the U.S. Food and Drug Administration (FDA) to prevent mpox in people aged 18 years and older. It is also available under an Emergency Use Authorization (EUA) for the subcutaneous administration in people under the age of 18 years old and the intradermal administration for people aged 18 years and older.
Provider Resources
Healthcare providers should be aware of the groups of people recommended for mpox vaccination and the currently available vaccine. Providers who serve individuals at higher risk for mpox exposure are encouraged to become mpox vaccination providers. If a provider is unable to vaccinate, they may refer those eligible for vaccination to their local health department or pharmacy for vaccination. People should call ahead to ensure they carry the mpox vaccine.
Mpox screening, prevention, and treatment should be incorporated into routine sexual health and HIV care services to ensure all patients are assessed for risk factors, counseled on prevention measures, and assessed for further negative outcomes before the virus spreads. VDH’s Integrating Mpox into Sexual Health and HIV Care resource has more information.
The mpox vaccine is not routinely recommended for the general public and is intended to be used in specific groups that have a higher risk for exposure.
Vaccine Ordering
As of August 1, 2024, JYNNEOS has fully transitioned to the commercial market. Providers seeking to administer JYNNEOS should order JYNNEOS through their typical vaccine wholesaler. Local health departments should continue to order JYNNEOS through WebVision. For questions, please email pharmacy@vdh.virginia.gov.
Insurance Coverage and Payment
Medicare and Medicaid beneficiaries are expected to have full coverage for ACIP recommendations, including JYNNEOS.
Private insurance beneficiaries are expected to have full coverage for ACIP recommendations. Private insurers have one year after ACIP recommendation to include coverage in plans.
Individuals without insurance should inquire with their local health department about low or no cost vaccine.
Following Mpox Vaccination
All vaccine providers in Virginia must record any doses administered into the Virginia Immunization Information System (VIIS).
All vaccine waste must be reported in HPOP. Local health departments that do not have access to HPOP must report vaccine waste through the Mpox Vaccine & Medication Wastage (virginia.gov) survey.
Providers should report any clinically significant adverse event following vaccination to VAERS.
For VAERS questions, email info@VAERS.org, or call 1-800-822-7967 from Monday through Friday between 9 a.m. to 5 p.m. ET.
Resources
In October 2023, CDC’s Advisory Committee on Immunization Practices (ACIP) unanimously recommended routine vaccination with the 2-dose JYNNEOS vaccine series for persons aged 18 years and older at risk for mpox. CDC has updated its immunization schedules.
Note: Persons living with HIV or other immunocompromising conditions may be at higher risk for severe outcomes of mpox and should be a high priority for vaccination.
Individuals may attest to meeting one or more of the eligibility criteria for vaccination, however, should not be required to attest to a specific criterion nor should they be asked details about their eligibility.
Given the ongoing clade I MPXV outbreak in Central and Eastern Africa, CDC issued a health alert in September 2024, with mpox prevention strategies for U.S. travelers to countries with ongoing Clade I MPXV spread. CDC recommends 2-dose JYNNEOS vaccination to any adult, regardless of gender identity or sexual orientation, if:
-
- They are traveling to a country where Clade I MPXV is spreading between people AND
- They anticipate any of the following:
- Sex with a new partner
- Sex at a commercial sex venue, like a sex club or bathhouse
- Sex in exchange for money, goods, drugs, or other trade
- Sex in association with a large public event, such as a rave, party, or festival
Currently, most clinicians and laboratorians in the United States are not advised to receive the mpox vaccine for prophylaxis (vaccination before exposure) unless sexual risk factors are present.
Following exposure to a confirmed mpox case, CDC recommends that the vaccine be given as soon as possible after exposure, preferably within four days.
-
- Vaccinating during days 0-4 after exposure can prevent onset of the disease. The sooner an exposed person gets the vaccine, the better.
- During days 4-14 after exposure, the vaccine has been shown to be effective and should be offered. After 14 days, clinicians should consider the benefits of receiving the vaccine on a case-by-case basis. Benefits may still outweigh risks when administering vaccine in some clinical situations (e.g., for a severely immunosuppressed person with a recent sex partner confirmed to have mpox).
Exclusions
-
- Vaccines should not be administered after symptoms begin. If a patient presents with symptoms consistent with mpox illness at the time of vaccination, the patient is no longer eligible to receive the vaccine, regardless of previous eligibility status. Vaccination given after the onset of signs or symptoms of mpox is not expected to provide benefit.
- If a patient has been diagnosed with mpox previously, they are not eligible for vaccination.
- If a patient develops mpox before receiving their second dose, they are no longer eligible to receive the second dose.
Provider Resources
-
- VDH: What Vaccines Do You Need? Infographic - intended for patients at risk of mpox and has information about mpox vaccine, as well as flu, COVID-19, and meningococcal vaccines.
Mpox cases in the United States continue to occur. They are less common than during the peak of the outbreak. Unvaccinated and under-vaccinated people who could benefit from vaccine may still be at risk. The best protection against mpox occurs two weeks after the second dose, so patients should plan before attending events where they may be at risk and use other strategies to prevent mpox.
-
- It’s never too late to get a second dose of JYNNEOS vaccine even if someone received their first dose several months or even a year or more prior.
- People who were already vaccinated with two doses or were previously infected with mpox do not need an additional dose of JYNNEOS vaccine unless they have ongoing risk because of their job.
Dosing
-
- Because JYNNEOS is licensed as a two-dose series, CDC continues to recommend two doses of JYNNEOS vaccine to prevent mpox, regardless of how or where it is administered. The two doses should be given 28 days apart.
- If the second dose is not administered during the recommended interval, it should be administered as soon as possible, based on ACIP’s general best practices. There is no need to restart the series or add additional doses to the series if there is an extended interval between doses.
- Peak immunity is expected 14 days after the second dose. The duration of immunity after one or two doses of JYNNEOS is currently unknown. However, recent data indicate that immunity is not waning in people who received both vaccine doses. Booster doses are not currently recommended.
- Two doses of JYNNEOS provide the best protection against mpox.
Route of administration
-
- The JYNNEOS vaccine may be administered using the standard FDA-approved regimen (subcutaneous route) OR the alternative EUA-authorized regimen (intradermal route).
- The subcutaneous route is preferred.
- People of any age with a history of developing keloid scars and individuals younger than 18 years of age should receive the vaccine via the subcutaneous route.
- For people aged 18 years or older, providers may discuss with patients to determine which route of administration each patient prefers.
- Patients with concerns about intradermal administration due to potential stigma or other personal reasons should be offered subcutaneous doses.
- Dosing regimens are interchangeable.
- The JYNNEOS vaccine may be administered using the standard FDA-approved regimen (subcutaneous route) OR the alternative EUA-authorized regimen (intradermal route).
Coadministration with Other Vaccines
-
- Generally, JYNNEOS may be administered without regard to timing of other vaccines.
- Mpox vaccination should not be delayed due to recent receipt of a COVID-19 vaccine; no minimum interval between COVID-19 vaccination and mpox vaccination is necessary.
- People (particularly adolescent and young adult males) who are recommended to receive both mpox and COVID-19 vaccines might consider waiting 4 weeks between vaccines. This is due to the observed risk for myocarditis and pericarditis after receipt of ACAM2000 orthopoxvirus vaccine and COVID-19 vaccines; and therefore, the hypothetical risk for myocarditis and pericarditis after JYNNEOS vaccine. However, if a patient’s risk for mpox or severe disease due to COVID-19 is increased, administration of mpox and COVID-19 vaccines should not be delayed.
Provider Resources
Recent studies indicate that JYNNEOS vaccination is safe and provides real-world protection against mpox. In these reports, vaccine effectiveness was 66–89% with two doses of JYNNEOS vaccine and 36–75% with one dose of JYNNEOS vaccine. Two doses of vaccine provide the best protection. While people who have been vaccinated can still get mpox, vaccination may make illness less severe. Visit CDC’s webpage for more information about vaccine effectiveness.
Provider Resources
It is important that communities most affected by mpox have access to timely, clear, and appropriate information and a safe and effective mpox vaccine to prevent future outbreaks. In the 2022 mpox outbreak, gay, bisexual, and other men who have sex with men (MSM) made up most of the cases. Within this population, mpox cases are disproportionately higher among Black and Hispanic or Latino MSM, and, in smaller numbers, Black and Hispanic or Latina women. Gender minorities, including transgender women and non-binary people, have also been disproportionately affected by mpox.
Racial and ethnic disparities in mpox vaccination have also been described. A CDC MMWR from April 2023 described higher unmet vaccination need among racial and ethnic minority groups, particularly among Black and Hispanic males.