Role of a Healthcare Provider in the Mpox Vaccination Response
Healthcare providers should be aware of the groups of people recommended for mpox vaccination and the currently available vaccines. Providers may refer those eligible for vaccination to their Local Health District for more information on how to receive a vaccination or they may enroll to become an mpox vaccination provider. Steps to take to enroll as an mpox vaccination provider are listed below. Mpox 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.
Steps to Enroll as Mpox Provider
If you wish to enroll as an mpox vaccination provider, please review this one page JYNNEOS Information Sheet and follow these steps :
- Review the HHS Provider Agreement to understand requirements of mpox vaccine providers and prepare to attest to these requirements.VERIP (Virginia Electronic Registration for Immunization Programs) Training Video
- Email the VaxMaX Help Desk at firstname.lastname@example.org to declare intent to order and administer the mpox vaccines in accordance with the HHS Provider Agreement requirements. VaXMaX will provide next steps for attestation.
- Review the following resources that may be adapted to fit your practice site:
- Vaccine Guide for Private Providers (VDH)
- CDC JYNNEOS Smallpox and Monkeypox Vaccine Preparation and Administration Summary (Intradermal)
- Mpox Vaccine Screening and Consent Form Template
- Video: How To Do an Intradermal Injection
- CDC JYNNEOS Vaccine Intradermal Administration
- Administering Intradermal Injections
Please note the JYNNEOS vaccine is intended to be administered intradermally (ID). Staff must be adequately trained on proper ID administration technique. It is recommended that hands-on training be conducted to ensure adequate technique. However, JYNNEOS may be administered subcutaneously to certain individuals (see JYNNEOS Route of Administration section for more information).
End of Public Health Emergency Declaration
The Public Health Emergency (PHE) declaration for mpox expired on January 31, 2023. The following CDC standing order templates for vaccination may be used:
- CDC Standing Order for Subcutaneous Administration
- CDC Standing Order for Intradermal Administration
Pharmacists may continue to order, dispense and administer the JYNNEOS vaccine under their individual National Provider Identifier in accordance with the Public Readiness and Emergency Preparedness (PREP) Act. Pharmacy technicians, pharmacy interns, registered nurses and licensed practical nurses may administer the JYNNEOS vaccine pursuant to an order from a prescriber.
PHE expiration does not affect the EUA for JYNNEOS. JYNNEOS can continue to be administered to people under the age of 18 through the subcutaneous route and to adults through the intradermal route (see Currently Available Vaccines section).
Providers may continue to order JYNNEOS as needed through VaxMax and monthly reporting requirements will continue to be required for all JYNNEOS vaccine providers.
For Healthcare Providers Administering Mpox Vaccines:
- All vaccine providers in Virginia must report any doses administered to the Virginia Immunization Information System (VIIS).
- As of March 21, v-safe is no longer accepting enrollments for mpox vaccinations
- Vaccine adverse events for mpox vaccines will continue to 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.
Two vaccines may be used for the prevention of mpox 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 mpox 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 mpox virus under an Expanded Access Investigational New Drug (IND) application.
- Research on vaccine effectiveness is ongoing, but evidence indicates that JYNNEOS vaccination provides protection against mpox. Initial licensure was supported by animal and clinical studies showing development of antibodies after vaccination.
- A CDC MMWR published in December 2022 reported among males in the U.S. aged 18–49 years eligible for vaccination, mpox incidence among unvaccinated persons was 9.6 times as high as that among persons who had received 2 vaccine doses and 7.4 times as high as that among persons who had received only the first dose ≥14 days earlier.
- This analysis also suggested no difference in vaccine performance between subcutaneous and intradermal administration.
- Another CDC MMWR from December 2022 supports JYNNEOS vaccine safety during the current outbreak.
- During May 22–October 21, 2022, nearly 1 million JYNNEOS doses were administered in the U.S. The vaccine safety profile was consistent with prelicensure studies. The most common adverse health events reported were non-serious and included injection site reactions. Serious adverse events were rare among adults, and no serious adverse events have been identified among persons aged <18 years.
JYNNEOS is an attenuated live virus vaccine which has been approved or authorized for the prevention of mpox.
- Visit CDC’s Get Ready and Healthy for Summer webpage to learn more about preparing for spring and summer events that celebrate the LGBTQ+ community. Mpox cases in the United States are becoming increasingly rare, but unvaccinated and under-vaccinated people who could benefit from vaccine may still be at risk. The best protection against mpox occurs 2 weeks after the second shot, so plan ahead and use other strategies to prevent mpox.
- It’s not too late to get a second dose of JYNNEOS vaccine even if someone received their first dose months prior.
- People who are already vaccinated do not need an additional dose of JYNNEOS vaccine, unless they have ongoing risk because of their job.
- Because JYNNEOS is licensed as a two-dose series, CDC continues to recommend two doses of JYNNEOS vaccine to prevent mpox disease, 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 or add 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.
- The level of protection provided by only one dose is not known.
- Route of administration:
- During this outbreak, the alternative regimen (intradermal route) is preferred, but the JYNNEOS vaccine may be administered subcutaneously using the standard regimen (subcutaneous route).
- 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.
- Patients with concerns about intradermal administration due to potential stigma or other personal reasons should be offered subcutaneous doses.
- CDC recommends that healthcare providers have both subcutaneous and intradermal vaccine administration options available on site so that those unable or unwilling to receive the intradermal regimen, can receive the subcutaneous regimen.
- As a reminder, vaccines should not be administered after the onset of illness. If a patient develops 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.
- For more information about JYNNEOS, please refer to the Package Insert, as well as CDC JYNNEOS Interim Clinical 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 .
- Smallpox/Mpox 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.
- For more information about ACAM2000, please refer to the ACAM2000 Package Insert, as well as CDC ACAM2000 Interim Clinical Considerations
- FDA Medication Guide for ACAM2000
Interchangeability of Dosing Regimens
Dosing regimens are interchangeable. For example, a person aged 18 years or older who received one JYNNEOS vaccine dose with the standard subcutaneous regimen may receive a second dose with the alternative intradermal regimen at the recommended interval (i.e., 28 days) to complete the vaccination series. Another example is a person who received the first dose intradermally, had a robust local reaction, and refuses a second dose unless given subcutaneously. In this situation, that second dose can be given subcutaneously.
Coadministration with Other Vaccines
Generally, JYNNEOS may be administered without regard to timing of other vaccines.
Orthopoxvirus vaccination should not be delayed due to recent receipt of a COVID-19 vaccine; no minimum interval between COVID-19 vaccination and orthopoxvirus vaccination is necessary.
People, particularly adolescent or young adult males, might consider waiting 4 weeks after orthopoxvirus vaccination (either JYNNEOS or ACAM2000) before receiving a COVID-19 vaccine, because of the observed risk for myocarditis and/or pericarditis after receipt of ACAM2000 orthopoxvirus vaccine and mRNA (i.e., Moderna and Pfizer-BioNTech) and Novavax COVID-19 vaccines and the unknown risk for myocarditis and/or pericarditis after JYNNEOS administration. For more information, please view CDC Interim Considerations.
Vaccination Strategies to Prevent Mpox
When properly administered before or after a recent exposure, vaccines can be effective tools at protecting people against mpox illness. Either JYNNEOS or ACAM2000 can be used for prophylaxis, 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 mpox.
VDH has adopted CDC mpox vaccination recommendations1,2
CDC has developed an mpox vaccine locator tool to help people find a vaccination site near them.
¹Individuals 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.
²At this time, most clinicians and laboratorians in the United States are not advised to receive the mpox vaccine for prophylaxis (vaccination prior to exposure). For additional information, visit CDC Mpox and Smallpox Vaccine Guidance and ASPR/HHS Vaccination Strategies.
Following exposure of a confirmed mpox case, the CDC recommends that the vaccine be given as soon as possible after exposure, preferably within 4 days.
- 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 prophylaxis outweigh the risks.
Note: Persons living with HIV or other immunocompromising conditions may be at higher risk for severe outcomes and should be a high priority for vaccination, specifically JYNNEOS. For persons living with HIV or other immunocompromising conditions, please refer to CDC Clinical Considerations for Treatment and Prophylaxis of Mpox Infection in People Who are Immunocompromised. CDC Clinical Considerations for Treatment and Prophylaxis of Mpox Infection in People Who are Immunocompromised
Equity in Vaccination
On September 15, 2022, CDC launched the Mpox Vaccine Equity Pilot Program (VEPP). This program was developed to support innovative ways to reach populations most affected by mpox that were experiencing mpox vaccination disparities, such as Black/African American and Hispanic/Latino gay, bisexual, and other men who have sex with men, as well as people who are transgender.
On February 15, 2023, CDC stopped accepting applications for VEPP due to the wide-spread availability and supply of the JYNNEOS vaccine, and the implementation of long-term vaccine equity efforts. CDC will continue to monitor the outbreak and vaccine equity and is ready to resume VEPP, if needed.
More information is available on the CDC Mpox Vaccine Equity Pilot Program website.
The VDH no longer requires proof of Virginia residency to receive mpox vaccination.
- AMA Smallpox & Mpox Immunization CPT Codes
- Interim Recommendations for JYNNEOS Vaccine Administration Errors and Deviations (CDC)
- Intradermal JYNNEOS Mpox Vaccine Fast Facts (FDA)
- Package Insert – JYNNEOS
- Smallpox/Mpox Vaccine (JYNNEOS) Vaccine Information Statement (CDC)
- Video on How to Administer Intradermal Vaccine in Forearm, Deltoid, and Scapula (CDC)
- HHS Mpox and HIV Resources
- Interim Clinical Considerations for Use of JYNNEOS and ACAM2000 Vaccines during the 2022 U.S. Mpox Outbreak (CDC)
- Seven Questions on Mpox Vaccines with Dr. Daskalakis
- Use of JYNNEOS (Smallpox and Mpox 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
Page updated: May 12, 2023
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