Vaccines and immunization for monkeypox: Interim guidance, 16 November 2022

Overview

The goal of the global multi-country outbreak response for monkeypox is to stop human-to-human transmission of monkeypox, with a priority focus on communities at high risk of exposure which may differ according to context, and to effectively use strong public health measures to prevent onward spread of the disease. Judicious use of vaccines can support this response. This interim guidance, developed with the advice and support of the Strategic Advisory Group of Experts (SAGE) Working Group on smallpox and monkeypox vaccines and endorsed by SAGE, provides WHO recommendations on vaccines and immunization for monkeypox. Key points follow.

• Mass vaccination is not required nor recommended for monkeypox at this time;
• Primary preventive (pre-exposure) vaccination (PPV) is recommended for individuals at high-risk of exposure. Persons at highest risk of exposure in the current multi-country outbreak are gay, bisexual or other men who have sex with men (MSM) with multiple sexual partners. Others at risk may include individuals with multiple casual sexual partners; sex workers; health workers at risk of repeated exposure, laboratory personnel working with orthopoxviruses; clinical laboratory and health care personnel performing diagnostic testing for monkeypox; and outbreak response team members;
• The level of risk of exposure may vary between the groups and could be used in countries for prioritization in case of limited vaccine supply;
• Post-exposure preventive vaccination (PEPV) is recommended for contacts of cases ideally within four days of first exposure (and up to 14 days in the absence of symptoms);
• Vaccination programmes must be backed by thorough surveillance and contact-tracing, and accompanied by a strong information campaign, robust pharmacovigilance, ideally in the context of collaborative vaccine effectiveness studies with standardized protocols and data collection tools;
• Decisions on use of smallpox or monkeypox vaccines should be based on a full assessment of risks and benefits on a case-by-case basis.

Many interim recommendations provided here concern off-label use of vaccines. The guidance will be updated as more information becomes available.