Role of a Healthcare Provider in the Monkeypox Vaccination Response
Healthcare providers should be aware of the groups of people recommended for monkeypox vaccination and the currently available vaccines. Providers should refer those eligible for vaccination to their Local Health District for more information on how to receive a vaccination. Monkeypox vaccine is not routinely recommended for the general public, and is intended to be used in very specific groups that have a higher risk for exposure.
For more information, please visit CDC What Healthcare Professionals Should Know.
Currently Available Vaccines
Two vaccines may be used for the prevention of monkeypox virus infection:
- JYNNEOS (also known as Imvamune or Imvanex), licensed (or approved) by the U.S. Food and Drug Administration (FDA) for the prevention of monkeypox virus infection in adults 18 years and older. On August 9, 2022, the FDA issued an Emergency Use Authorization (EUA) for JYNNEOS for individuals under the age of 18 years old.
- ACAM2000, licensed (or approved) by FDA for use against Smallpox virus and made available for use against Monkeypox virus under an Expanded Access Investigational New Drug (IND) application.
- The effectiveness of the vaccines in this current monkeypox outbreak is not known. Initial licensure was supported by animal and clinical studies showing development of antibodies after vaccination, and researchers are studying this issue.
JYNNEOS is an attenuated live virus vaccine which has been approved or authorized for the prevention of monkeypox.
- For more information about JYNNEOS, please refer to the Package Insert, as well as CDC JYNNEOS Special Considerations.
- For more information and guidance on the EUA for JYNNEOS use for individuals under the age of 18 years old, please refer to the EUA HCP Fact Sheet and the CDC Interim Clinical Considerations for Monkeypox.
- Smallpox/Monkeypox Vaccine (JYNNEOS) Vaccine Information Statement
ACAM2000 contains a live replicating vaccinia virus, licensed by the FDA for immunization in people who are at high risk for smallpox infection. ACAM2000 may be used as an alternative to JYNNEOS vaccine.
Vaccination Strategies to Prevent Monkeypox
When properly administered before or after a recent exposure, vaccines can be effective tools at protecting people against monkeypox illness. Either JYNNEOS or ACAM2000 can be used for Post-Exposure Prophylaxis (PEP), Expanded PEP (i.e., PEP++), or Pre-Exposure Prophylaxis (PrEP), following risk-benefit discussions and a review of conditions that could increase risk for serious adverse events. At this time, JYNNEOS is the primary vaccine used in Virginia for prevention of monkeypox.
Please see the CDC Considerations for Monkeypox Vaccination Guidance for detailed information about these strategies.
- PEP: Vaccination after a known monkeypox exposure for those who meet certain risk criteria
- PEP++: Vaccination of people with certain risk factors (see below) who are more likely to have been recently exposed to monkeypox, but do not have a documented known exposure
- PrEP: Vaccination of those at high risk for coming in contact with monkeypox virus, such as laboratory workers performing monkeypox diagnostic testing
Post-Exposure Prophylaxis (PEP)
Following exposure of a confirmed monkeypox case, the CDC recommends that the vaccine be given as soon as possible after exposure, preferably within 4 days.
Consider vaccine for PEP in the following situations:
- During days 0-4 after exposure for intermediate- and high-risk contacts to prevent onset of disease. The sooner an exposed person gets the vaccine, the better.
- During days 4-14 after the exposure for high-risk contacts. Vaccination may reduce the symptoms of disease, but may not prevent the disease.
- During days 4-14 after the exposure for intermediate-risk contacts, informed decision making is recommended on an individual basis to determine whether benefits of PEP outweigh the risks.
Healthcare providers should work with their local health district to refer eligible patients for vaccination. Vaccine supply is currently limited, however, as additional vaccine supply becomes available, vaccines may become available directly to certain providers who work closely with high risk populations. Until that time, providers should work with their local health department to get their high-risk patients vaccinated.
Groups Recommended for Monkeypox Expanded PEP in Virginia:
Eligible recipients include:
- Any person, of any sexual orientation or gender, who has had anonymous or multiple (more than one) sexual partners in the last two weeks; or
- Sex workers of any sexual orientation or gender; or
- Staff, of any sexual orientation or gender, at establishments or events where sexual activity occurs.
- Any person, of any sexual orientation or gender, who is living with HIV/AIDS; or
- Any person, of any sexual orientation or gender, diagnosed with any sexually transmitted infection in the past three months.
When coupled with self-isolation and other prevention measures when symptoms first occur, Expanded PEP may help slow the spread of the disease in areas with large numbers of monkeypox cases.
Note: Persons living with HIV or other immune-compromising conditions may be at higher risk for severe outcomes and should be a high priority for vaccination, specifically JYNNEOS. For persons living with HIV, please refer to CDC Clinical Considerations for Treatment and Prophylaxis of Monkeypox Virus Infection in People with HIV.
Pre-Exposure Prophylaxis (PrEP)
At this time, most clinicians and laboratorians in the United States are not advised to receive monkeypox vaccine PrEP.. For additional information regarding PrEP, visit CDC Monkeypox and Smallpox Vaccine Guidance.
The VDH requires proof of Virginia residency to receive monkeypox vaccination. Exceptions may be made on a case-by-case basis.
For Healthcare Providers Administering Monkeypox Vaccines:
- All vaccine providers in Virginia must report any doses administered to the Virginia Immunization Information System (VIIS).
- Vaccine adverse events for monkeypox vaccines will be monitored through Vaccine Adverse Events Reporting System (VAERS) along with CDC vaccine surveillance systems: the Vaccine Safety Datalink (VSD) and the Clinical Immunization Safety Assessment (CISA) team. For more information, visit Vaccine Safety Monitoring | Vaccine Safety | CDC.
- Providers should report any clinically significant adverse event following vaccination to the 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.
- For more information visit CDC VAERS.
- CDC JYNNEOS Standing Order Template (for 18 years and older)
- CDC JYNNEOS Storage and Handling Summary
- Smallpox/Monkeypox Vaccine (JYNNEOS) Vaccine Information Statement
- Package Insert - JYNNEOS
- CDC Video on Administering JYNNEOS Intradermally ( 8/11/22)
- FDA Intradermal JYNNEOS Monkeypox Vaccine Fast Facts
- CDC Interim Recommendations for JYNNEOS Vaccine Administration Errors and Deviations
- AMA Smallpox & Monkeypox Immunization CPT Codes (8/2/22)
- Medical Guide for Vaccination with ACAM2000
- ACAM2000 Package Insert
- VDH Information and Schedule for Administering ACAM2000 Smallpox Vaccine Train-the-Trainer Trainings
- Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022
- CDC Interim Clinical Considerations for Use of JYNNEOS and ACAM2000 Vaccines during the 2022 U.S. Monkeypox Outbreak
- CDC Monkeypox and Smallpox Vaccine Guidance
- CDC Video: Seven Questions on Monkeypox Vaccines with Dr. Daskalakis
Page updated: September 26, 2022
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