Who is eligible for the Monkeypox Vaccine? (...And more of your Monkeypox questions answered)


Last Saturday (July 23), The WHO designated the 2022 monkeypox virus outbreak as a “public health emergency of international concern” (PHEIC). This decision was made because the outbreak has spread around the world rapidly, has appeared in new places where the virus is not usually expected, and it has spread via new modes of transmission. Along with this PHEIC declaration also came increased chatter on social media about personal risk for monkeypox, numbers of cases, and vaccine eligibility.


Disease burden

Although the incidence of monkeypox has increased 77% globally over the last month, the risk for the general public is still believed to be low at this time (currently there are 18,095 cases globally, in 75 countries and 3,487 cases in the US, in 45 states). The cases, however, are almost certainly undercounted. The Biden administration has estimated that it will cost the US approximately $7 billion to scale up and respond to this increasing public health threat.


Current At-Risk Population

Most of the cases are in men who have sex with men (MSM) as the virus, while not technically an STI, has made its way into highly interconnected sexual networks in the MSM community. This is primarily because of the nature of close contact and not anything biological to do with being MSM, as anyone can develop monkeypox if they are in close contact with a case. There has been much stigma and confusion surrounding the MSM community being at high risk, and a lot of misinformation on social media. At the end of the day, there is a public health need to define the population at risk so that we can target resources and messaging where they are needed most. However, discussing at-risk populations can be done accurately and sensitively, and without stigmatizing language.


Transmission

Monkeypox spreads person-to-person by direct contact with the infectious rash, scabs or body fluids, via respiratory secretions during prolonged face to face contact or during intimate physical contact, or by touching items such as clothing or bed linens that previously touched the rash. It is not believed to spread as an airborne respiratory virus like the virus that causes COVID-19.


Vaccines

There are two vaccines licensed by the FDA for the prevention of Monkeypox: Jynneos and ACAM2000. ACAM2000 is contraindicated in people with some health conditions, such as a weakened immune system, skin conditions like atopic dermatitis/eczema, or pregnancy. As Jynneos can be used in more patient populations, it has been solely prioritized and deployed for use in this outbreak, but is in very short supply currently. Because of supply issues, and because the virus only spreads via very close contact, the Jynneos vaccine is currently only recommended for those at high risk of infection:


CDC only recommends the Jynneos vaccine to those who have been exposed to monkeypox and people who are at higher risk of being exposed to monkeypox, including:

  1. people who have been identified by public health officials as a contact of someone with monkeypox

  2. people who have been exposed to monkeypox:

  • are aware that one of their sexual partners in the past 2 weeks has been diagnosed with monkeypox,

  • people who had multiple sexual partners in the past 2 weeks in an area with known monkeypox.

3. People whose jobs may expose them to Monkeypox (lab workers, health care workers)


Local health departments can adapt the CDC vaccine recommendations to be applicable to the situation in their local populations. This is an example from Chicago Department of Public Health, which has one of the largest outbreaks in the US currently:


Strategies to deal with vaccine shortage

Jynneos is a 2-dose vaccine (administered a minimum of 28-days apart). Due to the shortage of vaccine, many cities are prioritizing first doses in as many at-risk people as possible, instead of reserving their second doses. It is believed that providing first doses to offer protection to more at-risk people more quickly is the best strategy until cities receive adequate vaccine supply.


Prevention measures for those who are ineligible for the vaccine

For those who are not high risk per the eligibility guidelines, prevention measures that can be used to prevent monkeypox are: avoiding close, skin-to-skin contact with people who have a rash that looks like monkeypox. Do not touch the rash or scabs of a person with monkeypox, check yourself and your partners skin for bumps, blisters, or rash, do not share bedding, towels and avoid skin to skin contact. Whenever possible, limit the number of sex partners. A tight or closed network of partners may help reduce your risk of infection. Avoid sex with partners whose MPV status is unknown. You can learn about how to have safer sex and social gatherings to prevent monkeypox also.


What to do if you think you have monkeypox

If you experience fever, swollen lymph nodes, and/or rash (which may or may not be painful), or otherwise think you have symptoms for monkeypox, isolate from others and go see a health care provider as soon as possible.


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