A white graphic with black and orange text reading: Answering Moneypox Vaccination Questions.

With the support of partners and the public, we have made good progress in tackling monkeypox in the UK since the first outbreak was identified in May 2022.

The number of new cases per week peaked at 350 in July but has now dropped significantly to 13 per week as of October 17, with the majority of cases still among gays, bisexuals and other men who have sex with men. We are still seeing new cases in the UK and cases continue to be identified globally, particularly across Europe, North America and South America. Until this outbreak, monkeypox was considered a rare disease in these parts of the world.

A combination of factors contributed to this decline. These include increased awareness leading to more people seeking clinical advice and testing, changes in human behavior, and vaccines. While the reduction is certainly good news, we will continue to prioritize this work as we seek to stop the spread in the UK.

Vaccines and reducing exposure are our best defenses against monkeypox – here we explain how the vaccine works, who it’s given to, and the most important things to know about it.

Are any vaccinations being given?

Although there is no specific monkeypox vaccine, a smallpox vaccine (also known as MVA-BN, also known as Imvanex or Zynios) is given to some people at high risk of exposure to monkeypox and to some people who have been in contact with a confirmed case. It is used because monkeypox and smallpox viruses are part of the same virus family and this vaccine has been used successfully in previous monkeypox outbreaks.

Who is eligible?

The Joint Committee on Vaccination and Immunization (JCVI) has identified the following groups as eligible for the vaccine:

  • Health care workers who are caring for, or about to care for, a patient with monkeypox, including some sexual health clinic workers who evaluate suspected cases.
  • Gay, bisexual or other men who have sex with men who have multiple sex partners, participate in group sex, or participate in sex on premises (employees who work on these premises are also eligible).
  • Close contacts of confirmed cases of monkeypox are at highest risk of severe illness, including children under 5 years of age, immunosuppressed individuals, and pregnant women.

How is the vaccine being rolled out?

The vaccine is being rolled out to eligible groups in several ways:

  • Local sexual health services are leading the rollout of the vaccine for gay, bisexual and other men who have sex with men.
    • In agreement with the NHS and local partners, the vaccination strategy prioritizes those most at risk and ensuring that those who are not already familiar with or registered with sexual health services know where and how to access the vaccine.
    • Eligible individuals identified for sexual health services will be proactively contacted through the clinic as vaccines become available in the area.
  • A clinical decision on whether or not to vaccinate a close contact with a confirmed monkeypox case is made by health protection teams who conduct a detailed assessment of each case.
  • Health care workers will be given the vaccine by their employer if eligible.

More information is available from NHS.uk/monkeypox

How many doses are needed?

Although sexual health clinics will continue to prioritize giving the first dose to those at highest risk, some clinics have also begun giving the second dose to those at highest risk to provide long-term protection. A single dose is effective in reducing both the risk of getting monkeypox and the severity of symptoms, providing some protection to as many people as possible, as soon as possible.

How effective is the vaccine?

Evidence suggests that even a single dose reduces the risk of monkeypox. If someone is infected with monkeypox, one dose should reduce the severity of the symptoms. A dose prepares the immune system to respond more quickly to exposure to monkeypox.

Like most vaccines, the smallpox vaccine takes time to develop an immune response. Although some protection may begin after a few days, the vaccine provides maximum protection only after four weeks.

Even after getting the vaccine, a dose or two, it’s important to be aware of monkeypox symptoms. Anyone experiencing symptoms should stay home and call 111 or a sexual health clinic for advice.

Why is there a limited global supply?

There is only one global manufacturer of smallpox vaccine that, until this outbreak, only produced a small amount annually for national stockpiles. This outbreak has led to an unexpected and unprecedented increase in global demand.

Although the manufacturer is currently ramping up production capacity, it takes considerable time to produce new batches of the vaccine.

How many doses of UKHSA are there?

The UKHSA acted quickly at the start of the outbreak to secure doses to manage the current outbreak and has so far collected 150,000 vaccines. When administered intradermally, a single vial of vaccine can be made into at least 3 full doses, greatly increasing the number of people who can be vaccinated. More information on intradermal dosing is below.

The initial 50,000 vaccines – the largest amount available at the time – were distributed in July. They were launched by the NHS and most doses were given in mid-August.

What is the intradermal vaccine/fraction dose?

Most vaccines are given by injection under the skin (subcutaneous) or into the muscle (intramuscular) – almost all healthcare workers can do this. Some vaccines can also be injected into the top layer of the skin – this is known as intradermal vaccination. It requires specially trained personnel and is done in much smaller volumes using a small needle and syringe.

The injection may take a few seconds longer and should form a ‘bleb’ (a small blister) which disappears within a minute. This procedure is commonly used for skin testing and vaccination against tuberculosis (TB).

Although the dose given is small, intradermal vaccination provides the same level of vaccine protection as giving a full dose by other methods, while increasing the number of people who can be vaccinated.

When vaccines are injected into the skin instead of muscle, the important proteins in the vaccine are more accessible to the cells of your immune system. This means that your body can develop a better response to the vaccine, even with much smaller doses. This technique has been commonly used during outbreaks of other infections such as yellow fever.

Graphic explaining how intradermal vaccination works.  The text reads: There are three main methods of injection - intramuscular, subcutaneous and intradermal.  Injecting the vaccine into the upper layer of the skin is intradermal, and this makes it more accessible to the immune system.  This means the body responds well to it, even if it is a small dose.

Why is it being used for monkeypox?

This safe and clinically-approved method is commonly used in other global outbreaks when vaccine supplies are limited. Intradermal vaccination maximizes the number of doses without compromising protection, making a single dose of smallpox vaccine much larger.

After this smallpox vaccine was approved, a study in 2015 compared different doses and methods of giving the vaccine. Approximately 300 subjects were randomized to 0.5mL subcutaneously or 0.1mL intradermally. Peak antibody levels were similar after the second dose and the overall response rate was approximately 95% in both groups. Based on this evidence, the JCVI states that intradermal vaccination is considered equivalent to the standard route.

To maximize the number of people vaccinated, more clinics will offer the vaccine using intradermal administration. This method has been positively received by patients and staff where it has already been used.

Eligible individuals 18 years of age and older will receive a 0.1ml intradermal dose of smallpox vaccine instead of the usual 0.5ml dose. This would potentially significantly increase the number of people who could be vaccinated.

When you are called for your vaccine, it is important to show up, as missed appointments can result in missed appointments and missed opportunities to vaccinate others as vials cannot be kept for long once opened.

Are vaccines safe?

The vaccine was approved by the EU in 2013 for use against smallpox and has already been used successfully in outbreaks of small monkeypox. In the United States it was approved in 2019 to prevent smallpox and monkeypox. The vaccine contains a virus that has been modified so it cannot grow in the human body, does not contain smallpox or monkeypox virus, and cannot spread or spread smallpox or pox. Monkey pox

Like all vaccines, it can cause side effects, but most are mild and short-lived — and not everyone gets them. The vaccine has fewer side effects than conventional smallpox vaccines and does not cause scarring unlike conventional vaccines.

Although side effects may be more common in people who have previously received conventional live smallpox vaccine, this group only needs one dose of this vaccine to boost their existing protection.

What should I do while waiting for the vaccine?

Whether waiting for the vaccine or getting a dose or even two, everyone should be aware of the symptoms of monkeypox, especially those with new or multiple sexual partners. Although the vaccine will reduce the chance of getting monkeypox, no vaccine is 100% effective.

Symptoms of monkeypox can take up to 3 weeks to develop. Check yourself regularly after intimate contact. Common symptoms of monkeypox include fever, headache, muscle aches, fatigue, swollen lymph nodes, and a new rash. It may even be a single blister. People who suspect they may have monkeypox should take a break from sex, stay home and call 111 or their local sexual health clinic.

For more information about monkeypox, please visit: www.nhs.uk/conditions/monkeypox

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