Monkeypox

Monkeypox Vaccine Update: Expanded Eligibility & Second Doses

Monkeypox Vaccine Update: Expanded Eligibility & Second Doses

There is now vaccine supply to begin administering a complete two-dose Jynneos vaccine series to each individual who is eligible for vaccine.

Updates

Eligibility for a first dose now includes:
• People of all ages. Subcutaneous administration continues to be required for those <18.
• People with a history of STI in the past 12 months, as well as individuals who plan to have multiple or anonymous sex partners, or those plan to meet new sexual partners via social media.

Eligibility for a second dose now includes:
• People who have received a first Jynneos vaccine dose through either intradermal or subcutaneous administration. This dose should be given intradermally to those 18 and older unless there is a contraindication.

Eligibility has also expanded to include those with a history of STI in the past 12 months (from 6 months previously) and to start offering preexposure prophylaxis to people at high risk for becoming infected. The interval between doses for both subcutaneous and intradermal injections is at minimum 28 days. Individuals who test positive for monkeypox after their first dose should not receive a second dose of vaccine. Individuals whose second doses have been delayed do not need to restart the two-dose vaccine series.

There is no age requirement for Jynneos vaccine eligibility, although those less than 18 years of age must receive the vaccine subcutaneously. Individuals 18 and older will be given intradermal vaccination, regardless of which method was used for the first vaccine, unless there is a contraindication.

Complete eligibility criteria include:

People who meet the following condition:

• Gay, bisexual, transgender, non-binary, and other men who have sex with men, transgender, or non-binary persons

AND meet ONE of the following criteria:

• Have had multiple or anonymous sex partners in the last 14 days
• Have had any newly diagnosed STI in the past 12 months, including gonorrhea, chlamydia, early syphilis, or HIV
• Have recently attended or plan to attend any venue where anonymous sex or sex with multiple partners will occur (e.g. saunas, bathhouses, sex clubs, sex parties) in the next 30 days
• Have met recent partners or plan to meet new partners in the next 30 days through social media platforms (such as Grindr, Tinder or Scruff), or at clubs, raves, sex parties, saunas

Additionally, the following people are eligible:

• Sex workers (of any sex or gender), and/or
• Anyone with known close contact (skin-to-skin) with someone with monkeypox in the past 14 days

When using an intradermal strategy, there may be unused doses in a single vial. All efforts should be made to give doses to the above eligible individuals. If there are doses that would go wasted, they may be given to other individuals not included in the above criteria. Healthcare workers directly involved in testing and examining those with possible monkeypox illness and staff involved in environmental cleaning and disinfection protocols should be prioritized.

Thank you for keeping Philadelphia safe and healthy! If you have any questions about these updates, please contact vaccines@phila.gov.

Monkeypox Testing, Treatment, and Vaccine Resources

Following PDPH’s information session on Wednesday, August 17, we have included the slides from our presentation and follow up resources on monkeypox testing and treatment.

Information for Healthcare Providers on Obtaining and Using TPOXX (Tecovirimat) for Treatment of Monkeypox

CDC, in partnership with FDA, has made it easier for healthcare providers to provide tecovirimat (TPOXX) treatment to patients with monkeypox under EA-IND. The streamlined process reduces the number of required forms and gives patients the option to see their doctor virtually. View the CDC’s full guidance.

If you are using CDC IRB: CDC IRB serves as the central IRB for review and approval. Facilities may elect to rely on the CDC IRB for centralized review and approval by submitting a request to the CDC’s Human Research Protection Office within 7 calendar days of tecovirimat treatment at your facility. CDC will promptly document an agreement in writing using the CDC IRB Authorization Agreement (Sample Template) [4 MB, 2 pages] which must be signed by both parties.For institutions that use EPIC, here is where the CDC TPOXX intake form (Form A) can be downloaded. When you open the file, you can copy it into an Epic smart phrase, and then just make sure the fields that are being pulled in with the smart phrases match the fields that we have in your version of EPIC. There were a couple of small discrepancies (e.g. our epic uses @DEPTPHN@ instead of @DEPTPHONE@ for the department phone numbers). We also had to make a few “Smart lists” by hand (like where the form had {tecovirimat reason:45613} we had to recreate that based off the CDC form). You can upload the outcome form into Epic and share it with any providers who might use it.

Monkeypox Update: Second Doses

PDPH is recommending that providers who are currently offering monkeypox vaccine to their patients and individuals at highest risk to begin offering second doses of the JYNNEOS vaccine to patients who have received their first dose intradermally. The second dose is recommended 28 days after the first dose.Currently, it is not recommended that patients who received their first dose subcutaneously be recalled for a second dose. Recommendations for when and at what interval subcutaneous doses should be administered will be shared soon.Patients should be reminded protection from monkeypox is not immediate with one dose. Two doses of the JYNNEOS vaccine are required for full protection and maximum immunity is reached 14 days after the second dose. One dose will provide some protection 14 days after vaccinations, but people should still continue to take precautions against monkeypox during this time.More information is available from PDPH at https://bit.ly/PHLMonkeypoxInfo.

Request more JYNNEOS vaccine here.

Providers will need to enter order requests by 5 pm on Mondays. If your request is approved, you can expect to receive MPX doses Wednesday or Thursday following your request date.

For further questions, email vaccines@phila.gov.

Monkeypox Inventory Update and Ordering Cadence

To facilitate the transition to intradermal (ID) administration of the Jynneos Monkeypox (MPX) vaccine, please:

Accept all Monkeypox inventory into your inventory location. Use this guide.
Complete an inventory reconciliation titled “SubQ to ID Transition,” so that we have an accurate count of the number of vials you have on hand. Use this guide.
Email vaccines@phila.gov when the reconciliation is complete so PDPH staff can update your inventory to reflect the number of ID doses you have on hand.

Beginning Monday 08/22, we are moving to a weekly ordering cadence for the MPX vaccine.Providers will need to enter orders by 5 pm on Mondays. If your request is approved, you can expect to receive MPX doses Wednesday or Thursday following your request date.Please remember for your request to be approved you must:

Upload your temperature logs to PhilaVax or email them to tempcheck@phila.gov.
Report wasted doses in PhilaVax. Because Jynneos is licensed for one dose per vial, wastage will be considered as any wastage of a full vial of vaccine for any reason. See wastage reporting instructions here and additional wastage guidance here.
Submit your reconciliation in PhilaVax. A reconciliation guide can be found here.
Find the order form here.

Additional Resources

Need a refresher on the Inventory Module in PhilaVax? Find a video guide here.
Use this dose tracker to track JYNNEOS administration at your practice.

If you have questions about accessing MPX vaccine, email vaccines@phila.gov.

Monkeypox Update: Switch to JYNNEOS Intradermal Strategy

Due to a shortage of doses, the PDPH recommends that providers switch to intradermal vaccination as soon as possible.

Intradermal administration involves injecting the vaccine superficially between the epidermis and the hypodermis layers of the skin, typically of the inner side of the forearm.

Intradermal JYNNEOS administration can be considered for most adults ages 18 years and older. Exceptions include people with a history of developing keloid scars. It is also recommended that clinicians observe patients after vaccination to monitor for the occurrence of immediate adverse reactions; 15 minutes is suggested for most patients, 30 minutes for persons with a history of anaphylaxis to gentamicin, ciprofloxacin, chicken, or egg protein.

Vaccine Schedule and Dosing Regimens

While JYNNEOS dose availability is currently limited, the recommendation is for providers to begin with a single shot. When there is enough vaccine to administer two shots (a complete dose), the recommended dosing interval between the first and second dose of JYNNEOS vaccine for both the standard (subcutaneous administration) and the alternative (intradermal administration) dosing regimens is 28 days for both.

For further questions, email vaccines@phila.gov.