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Information on Mpox vaccine acceptability and uptake from cross-
sectional surveys
Kevin P . Delaney, PhD, MPH
Community Engagement and Vaccine Policy and Implementation Task Force 2022 Multinational Mpox Response Centers for Disease Control and Prevention
Advisory Committee on Immunization Practices
February 22, 2023
www.cdc.gov/mpo
Information from US-based Clinicians
Sermo – online community of >1.3 million clinicians
Conducted a worldwide survey of physicians
July 31-August 1st; results reported 8/8/2022
• At that point (N=415 US-based clinicians)
• 69% said that the US did not have enough
mpox vaccine to handle the outbreak
Brief updated survey (N=62) on 9/12/2022
• 66% had treated at least one patient with monkeypox
• 76% knew where to send patients for JYNNEOS vaccination
• 86% wanted to be able to offer vaccine in their practice
More at https://app.sermo.com/barometer/unitedstates
Information from affected populations
Studies included
Study Timeframe Population Methods
Porter Novelli August –
Decemb
er 1 6 N= up to 371 LGBTQ+
Data weighted to matc h
census population Four KAP surveys in the general populatio n
includin g LGBTQ+
AMETHST : Ame rica n
Transformative HIV
Study Aug 9th –
November 15th
AMIS : America n
Men’s Internet
Survey N = 824 GBMSM Emory conducte d a one-time KAP survey of
2021 AMIS population .
Survey available
he
re
October 6 –
D
ecember 31 N=3041 GBMSM Ongoin g recruitment of the 2022 AMI S
survey summarized through 12/31
San Francisco study
amon g persons
experiencin g
homelessness (PEH) N= 2 73
57 with higher risk sexua l
activity
35 GBMSM N=8,551 5
0% Blac k and Latinx
GBMSM Mon t
hly cross-sectional surv ey to recruit
new cohorts of persons at risk for HIV .
Questions related to mpox added in 2022
Cross-sectional s urvey among PEH to
understand vaccine acceptabilit y and
coverage
A
ugust 5 –
A
ugust 15
Oct 2 3rd –
November 5th
AMETHST : Ame rican
Transformative HI V
Study Aug 9th –
November 15th N=8,551
50% Blac k and Latinx
GBMSM Monthly cross-sectional survey to recruit
new cohorts of persons at risk for HIV .
Questions related to mpox added in 2022
AMIS : America n
Men’s Internet
Survey
October 6 –
December 31 N=3041 GBMSM Ongoin g recruitment of the 2022 AMI S
survey summarized through 12/31
San Francisco stud y
amon g persons
experiencin g
homelessness (PEH) Oct 23rd –
November 5th N= 273
57 with higher risk sexua l
activity
35 GBMSM Cross-sectional survey among PEH t o
understand vaccine acceptabilit y an d
coverage Studies included
Timeframe Population Methods
Porter Novelli August –
D
ecember 16 N= up to 371 LGBTQ+
Data weighted to match
census population Four KAP surveys in the general populatio n
includin g LGBTQ+
August 5 –
August 15 N = 824 GBMSM Emory conducte d a one-time KAP survey of
2021 AMIS population .
Survey available here Study
Methods
Porter Novelli conducted 4 online general population surveys during fall
2022 on knowledge, attitudes, and beliefs of mpox-related topics
Data are weighted to match U.S. Census proportions
Survey includes a question about whether the individual “identifies as a
member of the LGBTQ+ community”
Most responses remained stable across the 4 months
In the December Survey we asked specific questions designed to more directly measure mpox vaccine acceptability and value
All results here are stratified by LGBTQ+ status
The population thinks that the vaccine is safe and
important
LGBTQ+ Status
Variable Overall, N =
1,3231 Part of LGBTQ+
Community, N
= 1471 Not part of
LGBTQ+
community, N
= 1,1761
The monkeypox vaccine is safe
Agree 36% (475) 51% (76) 34% (399)
Disagree 9.7% (128) 11% (16) 9.5% (112)
Don't Know
It is important for me to get the
monkeypox vaccine to protect myself against monkeypox 54% (721) 38% (56) 57% (665)
Agree 33% (440) 50% (74) 31% (366)
Disagree 30% (400) 18% (27) 32% (373)
Don't Know 37% (484) 32% (46) 37% (437)
1% (n)2Bolded numbers are significant p < .05, chi-squared test with Rao & Scott's second-order correction
Studies included
Study Timeframe Population Methods
Porter Novelli August –
December 16 N= up to 371 LGBTQ+
Data weighted to match
census population Four KAP surveys in the general population
including LGBTQ+
AMETHST :Ame rican
Transformative HIV
Study Aug 9th –
November 15th N=8,551 50% Black and Latinx
GBMSM Monthly cross-sectional survey to recruit
new cohorts of persons at risk for HIV.
Questions related to mpox added in 2022
AMIS :American
Men’s Internet
Survey August 5 –
August 15 N = 824 GBMSM Emory conducted a one-time KAP survey of 2021 AMIS population.
Survey available here
October 6 –
December 31 N=3041 GBMSM Ongoing recruitment of the 2022 AMIS
survey summarized through 12/31
San Francisco study among persons
experiencing
homelessness (PEH) Oct 23
rd –
November 5th N= 273 57 with higher risk sexual
activity
35 GBMSM Cross-sectional survey among PEH to understand vaccine acceptability and
coverage
AMETHST: American Transformative HIV Study
NIH funded study to build new cohorts of individuals at
risk for HIV
FY1-FY2 (2022-2024): Build cohort, enrolling at least 5000 people at increased risk for HIV infection; at least 50% people of color
• AMETHST cohort will focus on the mechanisms
through which meth use increases bio-behavioral vulnerability to HIV.
• Added questions re: Mpox knowledge, vaccine uptake and behavior change to their screening questionnaires
• 8551 participants surveyed through 11/15/2022
https://grants.nih.gov/grants/guide/rfa-files/RFA-AI-21-018.html
WORRY ABOUT MPOX OVER THE LAST 2 WEEKS
34.0% 40.6%
58.0%
66.4%
66% 59%
42%
34%
Aug Sept Oct Nov
Some or more than half of the days Never
While Mpox
concern has decreased over time, some concern remains
>85% of respondents remain interested in vaccination
Vaccine coverage nearly November
October
September
August
0% 20% 40% 60% 80% 100% doubled between August
and September
As o f November, 30.5%
received at least one dose
• ~90% overall and 88% of
the sample fro m
November either hav e
been vaccinated or
would like to be
vaccinated Vaccinated
Extremely likely to get vaccinated Li
kely to get vaccinated or unsure
Unlikely to get vaccinated
November
October Proportion that received at least one dose of vaccine
September
August
0 10 20 30 40 50 60 70 80 90 100
Other Latinx Black White
Vaccine uptake by Month and Race/Ethnicity,
AMETHST recruitment survey August-November 2022
In August, Black
participants had higher vaccine coverage than participants from other racial and ethnic groups
Vaccine uptake by Month and Race/Ethnicity,
AMETHST recruitment survey August-November 2022
In August, Black
participants had higher vaccine coverage than participants from other racial and ethnic groups
November
October Proportion that received at least one dose of vaccine
September
August
0 10 20 30 40 50 60 70 80 90 100
Other Latinx Black White
least one dose of vaccine
November
Vaccine uptake by Month and Race/Ethnicity,
AMETHST recruitment survey August-November 2022
In A ugust, Blac k
participants had higher
vaccine coverage than
participants from other
racial and ethnic groups
October
But b lack men did no t
see the “doubling” in
vaccine coverage tha t
we reported overall September
August Proportion that received at
0 10 20 30 40 50 60 70 80 90 100
Other Latinx Black White
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sssseeeexxxxuuuuaaaalll l oooorrrriiiieeeennnnttttaaaattttiiiioooonnnn,,, , AAAAuuuugggguuuusssstttt-- --NNNNoooovvvveeeemmmmbbbbeeeerrr r 2222000022222222
Had at least one dose of the MPV vaccine
No=5943 Yes=2608 Chi-sq p
n n Row %
Race or ethnicity 11.802 0.008
White 2907 1323 31.28%
Black 895 329 26.88%
Latinx 1419 625 30.58%
Other 659 331 33.43%
Age (M, SD) 35.65, 10.44 37.12, 10.74 35.098 0.000
Sex Identity 23.674 0.000
Cisgender male 5204 2364 31.24%
Transgender male 12 1 7.69%
Transgender female 138 30 17.86%
Non-binary, Other 589 213 26.56%
Sexual orientation 161.159 0.000
Gay, Queer 4378 2245 33.90%
Bisexual 1093 241 18.07%
Something else 472 122 20.54%
Studies included
Study Timeframe Population Methods
Porter Novelli August –
December 16 N= up to 371 LGBTQ+
Data weighted to matc h Four KAP surveys in the general population
including LGBTQ+
census population
AMETHST :Ame rican Aug 9th –
Transformative HIV 15th November
Study
AMIS :American N = 82 4 GBMSM Emory conducted a one-time KAP survey of
Men’s Internet 2021 AMIS population.
Survey Survey available here
October 6 –
De
cember 31 N=3041 GBMSM
N=8,551
50% Black and Latinx
GBMSM Monthly cross-sectional survey to recruit
new cohorts of persons at risk for HIV.
Questions related to mpox added in 2022
August 5 –
August 15
Ongoin g recruitment o f the 2022 AMI S
survey summarized through 12/31
San Fra
ncisco study
among p e
rsons
experi
encing
homelessness (PEH) Oct 23rd –
5th November N= 273
5
7 wi th higher risk sexual
activity
35 GBMSM Cros s-sectional survey among PEH to
unde rstand vaccine acceptability and
coverage
American Men’s Internet Survey (AMIS)
In August 2022, Emory University conducted a special one-time survey with
2021 AMIS participants to explore knowledge, attitudes and practices related to the US monkeypox outbreak.
• Also asked about behavior change and vaccination
• Survey conducted August 5-15, during the peak of the current outbreak
Survey is available here .
Questions ask about vaccine knowledge, access or availability, and trusted
sources of advice
824 men completed all questionnaire sections
• Overall, 53.1% reported concern about getting mpox
• 18.6% of the sample had received at least one dose of mpox vaccine
https://www.cdc.gov/mmwr/volumes/71/wr/mm7135e1.htm
AMIS survey results
Conducted August 5-15th2022
•18.2% of the sample had
received at least one dose ofMPOX vaccine“Equitable vaccine program implementation involve…, engaging
diverse partners already working with special populations,
delivering vaccines through mobile outreach and pop-up events, and diversifying times and locations for vaccine administration ”
“Expanding vaccine availability geographically, including diversifying vaccination locations to include nonurban areas, can help ensure that those who need vaccination have access to it .”
https://www.cdc.gov/mmwr/volumes/71/wr/mm7135e1.htm
https://www.whitehouse.gov/briefing-room/statements-releases/2022/08/30/fact-sheet-white-house-monkeypox-response-team-announces-new-plans-to-support-large-lgbtqi-events-and -
equity-interventions-to-reach-communities-at-highest-risk-of-contracting-the-virus/
Vaccine Equity Pilot Program
Created to:
• Support innovative ways to
15 address vaccination disparities Jurisdictions
• Encourage vaccination
coordination between health departments and community -
based organizations 28
Programs • Promote innovation to strengthen existing vaccination
infrastructure
~25k Doses
Studies included
Study Timeframe Population Methods
Four KAP surveys in the general population
includin g LGBTQ+
Emory conducte d a o ne-time KAP survey of
2021 AMIS population .
Survey available here
Ongoin g recruitment of the 2022 AMI S
survey summarized through 12/31
Cross-sectional survey among PEH t o
understand vaccine acceptabilit y an d
overage Port
er Novelli August –
December 16 N= up to 371 LGBTQ+
Data weighted to match
census population
Aug 9th –
15th November
AMIS :Ameri
can August 5 –
August 15 N = 824 GBMSM
Men’s Internet
Survey
October 6 – N=3041 GBMSM
December 31
San Francisco study
amon
g persons
exp
eriencing c
homelessness (PEH)
AMETH
ST:Ame rican
Transformative HIV
Study N=8,551
50% Blac k and Latinx
GBMSM Mo nthly cross-sectional survey to recruit
new cohorts of persons at risk for HIV .
Questions related to mpox added in 2022
Oct2
3rd –
5th November N= 273
5
7 wi th higher risk sexual
activity
35 GBMSM
Concern for mpox disease
AMIS 2022
This survey has been recruiting since
October 6th 2022
As of December 31, 2022
• 3041 cis-gender MSM have been enrolled
• 33.3% (n=1006) had received at least one
dose of mpox vaccine
Mpox vaccination associated with
• Mpox awareness,
• Mpox concern,
• STI risk,
• and engagement in sexual health and prevention services Variable Adjusted* OR (95% CI) P value
Any mpox vaccination
HIV+ 1.66 (1.30, 2.11) <.01
High Mpox awareness 4.69 (3.94, 5.59) <.01
High Mpox concern 3.52 (2.69, 4.62) <.01
STI testing 2.57 (2.12, 3.11) <.01
Recent CAS 1.76 (1.31, 2.37) <.01
PrEP use (ever)** 7.44 (6.07, 9.13) <.01
PrEP use (past year)** 2.80 (1.40, 5.61) <.01
* Adjusted models included age group (15-20, 21-24, 25-34, 35-44,
45-59, 60+) and race/ethnicity (Hispanic, Non-Hispanic white, Non-
Hispanic Black, Other)
** PrEP models considered for people at risk for HIV acquisition
(HIV-negative)
Studies included
Study Timeframe Population Methods
Porter Novelli August –
December 16 N= up to 371 LGBTQ+
Data weighted to match
census population Four KAP surveys in the general population
including LGBTQ+
AMETHST :Ame rican
Transformative HIV
Study Aug 9th –
November 15th N=8,551 50% Black and Latinx
GBMSM Monthly cross-sectional survey to recruit
new cohorts of persons at risk for HIV.
Questions related to mpox added in 2022
AMIS :American
Men’s Internet
Survey August 5 –
August 15 N = 824 GBMSM Emory conducted a one-time KAP survey of 2021 AMIS population.
Survey available here
October 6 –
December 31 N=3041 GBMSM Ongoing recruitment of the 2022 AMIS
survey summarized through 12/31
San Francisco study Oct 23rd – N= 273 Cross-sectional survey among PEH to
among persons November 5th 57 with higher risk sexual understand vaccine acceptability and
experiencing activity coverage
homelessness (PEH) 35 GBMSM
Overview of San Francisco Mpox Study
Dates: October 23 – November 5, 2022
Project Goals:
1
. Understand mpox vaccine
acceptability and coverage among people experiencing homelessness
2. Characterize orthopoxvirus seroprevalence among people experiencing homelessness
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Any higher risk
sexual activity (n=57)
GBMSM (n=35) Any higher risk
sexual activity (n=57), 56%
GBMSM (n=35), 74%
Vaccine acceptance by subgroups at higher risk for mpox
Would accept or had accepted vaccine Unsure Would decline or had declined vaccine
Acknowledgements
SERMO
• Joanna Molke (SERMO)
• Ma
nsi Das (CDC)
Porter Novelli
• Fred Fridinger
• Christine Prue
• Guila Earle-Richardson
• Christine Agnew-Brune
• Saskia Vos
• Ciara Nestor
• Gordon Mansergh
• Deborah Gelaude
AMIS (Emory University)
• Travis Sanchez
• Patrick Sullivan
• Marissa Hannah
• O. Winslow Edwards AMIS (Johns Hopkins University) AMETHST
• Stefan Baral
• Tom Carpino
• Kaitlyn Atkins
• Evan Eschliman
• Amrita Rao
• Sarah Murray
AMIS (CDC)
• Alexandra Oster
• Christine Agnew-Brune
• Winston Abara
• Neal Carnes
• Rachel Kachur
• Kaytlin Renfro
• Elizabeth DiNenno
• Amy Lansky
• Kathleen Ethier • Christian Grov
• Adam Carrico
• Denis Nash
• Drew Westmoreland
• Viraj Patel
• Tyler Bartholomew
• Jennifer Manuzak
• Dustin Duncan
• Kathryn McCollister
• Meredith Ray
• Matthew Stief
• Alexa D’ Angelo
• Chloe Mirzayi
• Michelle Dearolf
• Sarah Kulkarni
• Alyse Johnson
• Leah Davis Ewart
• Yan Guo
CDC 2022 Multinational Mpox
Outbreak Response Community Engagement Taskforce