A Clinician’s Handbook for Childhood & Adult Immunizations in Georgia

Monkey Pox

Pathophysiology

Spread through close, personal, often skin-to-skin contact, including direct contact with mpox rash, scab, or body fluids (any type of sex, kissing, hugging, or massage), touching items that have been used by someone with mpox, and through contact with respiratory secretions (saliva, mucus). The disease can be spread from the time symptoms start until the rash has healed (all scabs have fallen off and a fresh layer of skin has formed).

Vaccine Description

JYNNEOS™ (also known as Imvamune or Imvanex in other countries) is a live, replication deficient MVA vaccine. That means it does not produce infectious virus in humans, and therefore cannot cause clinical infections.

Indications for Use

JYNNEOS [ PDF – 11 Pages]: FDA approved this vaccine in 2019. It is approved for use in people ages 18 years and older and determined to be at high risk for smallpox or mpox infection.

Recommended For

  • For pre-exposure vaccination of people at risk for occupational exposure to orthopoxviruses (as an alternative to ACAM2000)
  • People aged 18 years and older at risk of mpox during an mpox outbreak.
  • For people 18 years and older with the following risks:
    • Gay, bisexual, and other men who have sex with men, transgender or nonbinary people who in the past 6 months have had one of the following:
    • A new diagnosis of ≥1 sexually transmitted disease
    • More than one sex partner
    • Sex at a commercial sex venue
    • Sex in association with a large public event in a geographic area where mpox transmission is occurring
    • Sexual partners of people with the risks described above
    • People who anticipate experiencing any of the above

 Risk factors for Mpox infection include:

  • Known or suspected exposure to someone with mpox
  • A sex partner in the past 2 weeks who was diagnosed with mpox
  • At risk for occupational exposure to orthopoxviruses (e.g., certain people who work in a laboratory or a healthcare facility).

Taken directly from CDC page updated 4/22/24

Dose & Route

People Less than 18 years of age:

Subcutaneous injection ONLY.

Administer two doses (0.5 mL each subcutaneously) of JYNNEOS 28 days (4 weeks) apart. For patients less than 6 months of age, Vaccinia Immune Globulin Intravenous (VIGIV) should be considered in lieu of JYNNEOS vaccine. Clinicians should first contact their jurisdictional health department (Jurisdictional Contacts). Jurisdictional health departments can facilitate consultation with CDC and Access to VIGIV.

People 18 years and older:

Subcutaneous injection or intradermal injection.

Administer two doses (0.1mL each intradermally) or (0.5 mL each subcutaneously) of JYNNEOS 28 days (4 weeks) apart. The providers and patient can discuss which method to use. There is currently adequate supply of JYNNEOS vaccine. Therefore, clinicians can preferentially administer JYNNEOS via the subcutaneous route (see CDC page). JYNNEOS is a suspension for injection. Each dose (0.5 mL) is supplied in a single-dose vial.       

Storage & Handling

Allow the vaccine to thaw and reach room temperature before use. Once thawed, the vaccine may be kept at +2°C to +8°C (+36°F to +46°F) for 4 weeks. Do not refreeze.

When thawed, JYNNEOS is a milky, light yellow to pale white colored suspension. Swirl the vial gently before use for at least 30 seconds. Withdraw a dose of 0.5 mL into a sterile syringe for injection.

Contraindications

JYNNEOS is contraindicated in patients with a severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.

Precautions

Moderate or severe acute illness, with or without fever

Special Situations

People who are pregnant and breastfeeding. Due to lack of safety data in pregnant persons, there is currently no ACIP recommendation for the use of JYNNEOS in pregnancy. Pregnant persons with any risk factors described may receive JYNNEOS. Details in pregnancy and breastfeeding.

Special Instructions

ACIP recommends the JYNNEOS booster vaccine after the 2-dose JYNNEOS primary series. ACIP recommended that the JYNNEOS booster dose be administered every 2 years to persons working with more virulent orthopoxviruses and every 10 years to persons working with less virulent orthopoxviruses. More.