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National Center for Emerging and Zoonotic Infectious Diseases
Mpox Vaccine Work Group
ACIP Meeting
June 23, 2023
Pablo Sanchez MD
The Ohio State University−Nationwide Children’s Hospital
Chair, ACIP Mpox Work Group
Mpox outbreaks
▪Before 2022, rare outside of Africa
▪In Africa, have involved 2 clades:
–Clade I (previously Congo Basin Clade)
–Clade II (previously West African Clade)
▪In United States, have involved Clade II
–Clade IIa: 2003 U.S. outbreak associated with pet prairie dogs
–Clade IIb: 2022/2023 global outbreak associated with male -to-male
sexual contact
▪Historically: Clade I believed to be associated with more severe disease
than Clade II
Severe manifestations observed in severely
immunocompromised persons during the 2022/2023 outbreak:
Clade IIb
Carrubba S, Geevarghese A, Solli E et al. Novel severe oculocutaneous manifestations of human
monkeypox virus infection and their historical analogues. Lancet Infect Dis. 2023 Jan 23:S1473-
3099(22)00869-6.
Menezes YR, Miranda AB. Severe disseminated clinical
presentation of monkeypox virus infection in an
immunosuppressed patient: first death report in Brazil. Rev Soc
Bras Med Trop. 2022 Aug 29;55:e0392.
ACIP recommendations
▪
▪
▪
–
–With global eradication of smallpox, routine vaccinations against
orthopoxviruses were no longer needed
Routine smallpox vaccinations stopped globally in 1980 (USA, 1972)
ACIP recommendations for persons at occupational risk for orthopoxvirus
infections since 1980
Largest proportion of people recommended to be vaccinated are
research laboratorians who work with orthopoxviruses (including
monkeypox virus [MPXV])
ACAM2000 and JYNNEOS are the vaccines recommended
Current ACIP recommendations for persons at risk for
occupational exposure: ACAM2000 and JYNNEOS
▪Since 2015, ACAM2000 recommended
▪In November 2021, JYNNEOS recommended as alternative to ACAM2000
ACAM2000 compared to JYNNEOS
Vaccine virus
AdministrationVia multiple percutaneous puncture
technique (single dose)Subcutaneously* via 2 vaccine doses,
28 days apartvirus
TakeInadvertent inoculation and
autoinoculation can occur via vaccine
site lesionNo risk of inadvertent inoculation
and autoinoculation with vaccinia
virus
*During the 2022/2023, intradermal was the preferred route of administration; vaccine effectiveness data
indicates this route has been equally effective
virusACAM2000
Live, replication competent vaccinia Live, replication deficient vaccinia JYNNEOS
Contraindications for ACAM2000 and JYNNEOS
2022/2023 U.S. mpox outbreak: JYNNEOS
recommended
▪
▪Fewer contraindications and adverse events with JYNNEOS
Before this outbreak, no real -world experience with JYNNEOS
https://www.cdc.gov/poxvirus/mpox/vaccines/index.html
Short-term goal of the Work Group
▪
▪Currently no ACIP recommendation for use of JYNNEOS during mpox
outbreaks
Develop ACIP recommendations for use of JYNNEOS during mpox
outbreaks*
*Public health authorities determine whether there is an mpox outbreak; a single case may be
considered an mpox outbreak at the discretion of public health authorities. Other circumstances in
which a public health response may be indicated include ongoing risk of introduction of mpox into a
community due to disease activity in another geographic area.
February 2023 ACIP meeting: Vote passed for use of
JYNNEOS during outbreaks
ACIP recommends the 2-dose* JYNNEOS vaccine series for persons
aged 18years and older at risk of mpox during an mpox outbreak§
*Dose 2 administered one month after dose 1
§Public health authorities determine whether there is an mpox outbreak; a single case may be
considered an mpox outbreak at the discretion of public health authorities. Other circumstances
in which a public health response may be indicated include ongoing risk of introduction of mpox
into a community due to disease activity in another geographic area.
Timeline that was proposed during February 2023*
Mpox outbreaks: Use of 2-
dose JYNNEOS for persons
aged ≥ 18 years
February 2023 June 2023 October 2023-Mpox outbreaks: Use of 2-dose JYNNEOS
for persons aged <18 years
-Updates about vaccine effectiveness and
safetyConsider need for longer term
vaccination strategy for 2-dose
JYNNEOS
*These votes do not impact existing recommendations for the current mpox outbreak.
§https://www.cdc.gov/poxvirus/monkeypox/interim -considerations/overview.html
Agenda for today’s meeting
▪Updates about epidemiology, vaccine safety, and vaccine effectiveness
during the ongoing outbreak: Faisal Minhaj
▪Clinical guidance about the use of 2 -dose JYNNEOS (subcutaneous) series
during mpox outbreaks: Agam Rao
▪Considerations for long -term protection against mpox : Discussion in the
context of the ongoing outbreak: Agam Rao
Tentative timeline for ACIP discussions and votes
ACIP meeting: Clinical
guidance about use of
JYNNEOS during outbrea
June 2023kPublication of MMWR
about use of JYNNEOS
during mpox outbreaks
August/September 2023ACIP meeting: Consider need
for longer term vaccination
strategy for 2-dose JYNNEOS
October 2023 Current US mpox vaccination strategy remains active: Populations at high
Current U.S. risk mposhox vaculd cinacontiontinue t strategy o be v remains accina in etedffect*
*MMWR publication will not change the clinical guidance posted for the ongoing outbreak:
https://www.cdc.gov/poxvirus/monkeypox/interim -considerations/overview.html
WG members
ACIP Member
Pablo Sánchez
Beth Bell
Ex Officio and Liaison Members
CSTE: Chris Hahn / Paul Cieslak
ASTHO: Ericka McGowan
NACHO: Philip Huang
FDA: Sixun Yang, Clement
Meseda & Alonzo García
ACOG: Howard Minkoff
AAP: Jim CampbellAIM: Rob Schechter / Jane Zucker
APHL: Jafar Razeq
NIH: Janet Lathey / Kimberly Taylor
IHS: Matthew Clark
NACI: Nicole Forbes / Oliver Baclic
IDSA: Shireesha Dhanireddy / Rajesh Gandhi
Invited Consultants
Subject matter experts: Inger Damon, Stuart
Isaacs, Mike Merchlinsky & Amanda
Zarrabian (HHS/BARDA)
Clinician experts in STIs, HIV, pediatrics,
maternal vaccination, vaccine safety, health
equity, smallpox vaccination strategies,
occupational health
Clinician experts
STIs, HIV, and mpox
(adult and peds):
Jason Zucker
Jeanne Marrazzo
Pablo Tebas
Vince Marconi
Kim Workowski
Bonnie Maldonado
Immunizations (including for special
populations) and vaccine safety:
Ruth Karron
Flor Munoz -Rivas
Kathy EdwardsHealth equity, vaccination strategies
including for smallpox:
Joel Breman
Gerard Vong
Occupational Medicine and worker safety:
Mark Russi
CDC contributors
Mpox epi, lab, and vaccine experts
Brett Petersen
Andrea McCollum
Christy Hutson
Laboratory Response Network:
Julie Villanueva
Infection control, worker safety:
Marie de Perio
David Kuhar
Special populations (e.g., Persons
experiencing homelessness)
Emily MositesVaccine safety
Michael McNeil
Jonathan Duffy
Regulatory Affairs
Yon Yu
STIs and HIV
Laura Bachmann
Leandro Mena
John Brooks
Alexa OsterDrug Services
Julian Jolly
Vaccine
implementation
Liz Velasquez
James Lee
DoD Liaison to CDC
Alan Lam
Work group lead
Agam Rao
For more information, contact CDC
1-800-CDC-INFO (232 -4636)
TTY: 1 -888-232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the
official position of the Centers for Disease Control and Prevention.Thank you!