www.cdc.gov/mpox

Mpox Vaccine Implementation and Interim Considerations 

Rosalind Carter, PhDVaccine Task Force2022 Multinational Mpox ResponseCenters for Disease Control and PreventionAdvisory Committee on Immunization PracticesFebruary 22, 2023
Interim Clinical Considerations (ICC) is a li

document

• Continued emphasis on vaccination: Mpox vaccination should 

offered to people with the highest potential for exposure to mpox

• Updated guidance: People with HIV infection or other causes o

immunosuppression who have had recent or anticipate potential exposure should be vaccinated against mpox. 

• New emphasis on inclusion of adolescents: The principal ris

reworded as “Gay, bisexual, and other men who have sex with mtransgender or nonbinary people (including adolescents who fall aforementioned categories) ... “ 
Available Vaccines for Mpox 

• JYNNEOS

• Primary vaccine for mpox outbreak in U.S.• Licensed in the U.S. for subcutaneous administration in ind

years or older

• FDA Expanded Use Authorization (EUA) in Aug 2022

• Intradermal administration for individuals 18+• Subcutaneous administration for individuals <18 at high 

infection

• ACAM2000

• Available, but not used during current outbreak• Higher risk of serious adverse events, including myocarditis
U.S. National Mpox Vaccine Strategy

• U.S. National Mpox Vaccine 

Strategy – June 2022

 Vaccinate and protect people at risk Prioritize vaccine allocations based 

on reported case numbers

 Provide guidance to health officials 

for planning and response

• Multiple federal agencies 

coordinating to implement mpoxvaccine strategy 

 ASPR (SNS, BARDA), CDC, FDA
Vaccination Strategies

Strategy Defini
on Post-Exposure Prophylaxis (PEP) Vaccination after known or pre

to mpox 

Vaccination Prior to Exposure Vaccination before exposure to 
Post-Exposure Prophylaxis

• People who are known contacts to a person with mpox, and iden

health authorities as a “contact” (for example, from case investigtracing, or risk exposure assessment); or

• People who are aware that a recent (within the past 14 days) se

diagnosed with mpox; or

• Gay, bisexual, other men who have sex with men, and transgend

people (includes adolescents) who have had any of the following 14 days:

 sex with multiple partners (or group sex); sex at a commercial sex venue; or sex in association with an event, venue, or defined geographic area where 

transmission is occurring
Vaccination prior to exposure to mpox 

Offered to people with highest potential for exposure or who anticipate potential exposure to m• Gay, bisexual, and other men who have sex with men, and transgender or nonbinary people (

who, within the past 6 months, have had:

 A new diagnosis of one or more sexually transmitted diseases (e.g., chlamydia, gonorrhea More than one sex partner.

• People who have had any of the following in the past 6 months:

 Sex at a commercial sex venue; or Sex in association with a large public event in a geographic area where mpox transmission 

• Sexual partners of people with the above risks.• People with HIV

† infection or other causes of immunosuppression who have had recent or an

mpox exposure

• People in certain occupational exposure risk groups (laboratory personnel working with ortho*People at risk for occupational exposure to orthopoxviruses include research laboratory personnel working with orthopoxviruses, clinical laboratory personnel performing and orthopoxvirus and health care worker response teams designated by appropriate public health and antiterror authorities. (see ACIP recommendations).†JYNNEOS is considered safe in persons with HIV infection, although effectiveness may be lower among severely immunocompromised individuals. ACAM2000 should not b

with advanced HIV disease or other causes of immunosuppression, who are pregnant, or who have certain heart conditions.
CDC Health Equity Considerations Utilized in Mp

National Vaccination Strategy

• Engage people from affected communities in planning and • Use non-stigmatizing, plain language• Reiterate privacy of information and how data will be used• Engage diverse partners already working with special popu• Bring vaccines to where people are: pop-up events, mobile • To improve accessibility, offer multiple opportunities and tim• Leverage clinical venues: STI clinics, LGBTQ+ health cente• Use multiple channels to advertise and book appointments• Minimize systems that are first-come, first-served

Mpox Vaccine Equity Toolkit | Mpox | Poxvirus | CDC
Total JYNNEOS Vaccine Doses Administer

Reported to CDC as of Feb 7, 2023

0

20,00040,00060,00080,000

100,000120,000

5/22-5/28

5/29-6/4

6/5-6/11

6/12-6/18

6/19-6/25

6/26-7/2

7/3-7/9

7/10-7/16

7/17-7/23

7/24-7/30

7/31-8/6

8/7-8/13

8/14-8/20

8/21-8/27

8/28-9/3

9/4-9/10

9/11-9/17

9/18-9/24

9/25-10/1

10/2-10/8

10/9-10/15

10/16-10/22

10/23-10/29

10/30-11/5

11/6-11/12

11/13-11/19

11/20-11/26

11/27-12/3

12/4-12/10

12/11-12/17

12/18-12/24

12/25-12/31

1/1-1/7

Doses administered

First dosesSecond doses

1,185,907 doses* administered and reported to CDC since May 20

EUA for intradermal administration introduced 
Vaccine First Doses Administered, by Race

NH=non-Hispanic, AI/AN=American Indian/Alaska Native, NH/OPI=Native Hawaiian/Other Pacific Islander. Weeks where n<30 are not shown. Does not include recipSource: CDC Immunization Data Lake. Data submitted as of January 31, 2023, 4:00 am ET.

51%

61% 62%

51% 51% 51% 51% 49% 

23%

16%

19%

23% 23% 22% 24% 24% 

12% 7%

7%

13% 13% 12% 12% 12% 

7% 9% 8% 8% 7% 7% 7% 7% 

0%

10%20%30%40%50%60%70%80%90%

100%

Overall

5/22-6/18

6/19-7/16

7/17-8/13

8/14-9/10

9/11-10/8

10/9-11/5

11/6-12/3

Percent of first doses

White NH Hispanic or Latino Black NH Asian NH Other NH Multiple NH AI/AN NH N

Data Reported to CDC as of January 31, 2023
Elements of Mpox Vaccine Implementation 

U.S. during this Outbreak

• Vaccine strategies and implementation plans were adapted by local jurisdicti

departments for their specific settings

• Vaccine eligibility criteria were modified as the epidemiology evolved and ne

findings emerged, and were adjusted for local context 

 Examples: Inclusion of sex workers; removing sexual orientation labels fro

criteria, reducing potential stigma by allowing participant to self-attest to 

• Recognition that mpox vaccination offered in context of broader prevention 

sexual health care may increase access and coverage

• Critical role of community organizations as trusted messengers, facilitating in

vaccination

• Need dedicated resources for reporting vaccine inventory and administration • Require vaccine status, date of vaccination on mpox case reporting or link ca

immunization inventory system to evaluate vaccine performance 

• Include race and ethnicity data on vaccination reports, including on reports s
Implementation challenges and soluti

• Limited vaccine supply at the peak of the outbreak in mid-July when d

highest

• EUA for intradermal route of administration increased vaccine su

• Limited ability to ship directly to providers 

• May to September, shipments limited to 5 per week; by mid Sept

shipments/week 

• Switch to intradermal administration required skills training and additi

• On average, jurisdictions began to implement within 2-3 weeks o

• Initially, health departments and public clinics were the primary vaccin

(>50% of all vaccinations)

• Increasing role of STI, HIV care providers, pharmacies