New guidance on offering the Imvanex vaccine to men considered to be at higher risk of exposure.
A strategy published today by the UK Health Security Agency (UKHSA) recommends that some gay and bisexual men at higher risk of exposure to monkeypox should be offered vaccines to help control the recent outbreak of the virus.
Although anyone can contract monkeypox, data from the latest outbreak shows higher levels of transmission within – but not exclusive to – the sexual networks of gay, bisexual and other men who have sex with men.
The virus is not currently defined as a sexually transmitted infection, but it can be passed on by close and intimate contact that occurs during sex.
In response, the UK Health Security Agency’s (UKHSA) vaccination strategy recommends offering the smallpox vaccine Imvanex (licensed in the U.S. at JYNNEOS), which is shown to be effective against monkeypox, to men considered to be at higher risk of exposure.
As of 20 June there were 793 laboratory confirmed cases in the UK, up from 574 on 16 June reporting from the UKHSA.
The strategy is endorsed by the Joint Committee on Vaccination and Immunisation (JCVI), which was consulted on the eligibility criteria for the vaccine.
While we know anyone can catch monkeypox, we welcome the vaccine being offered to those gay and bi men who are eligible and currently at a higher risk of getting the virus. It is important that gay and bi men get the vaccine when offered to protect themselves and others. Let’s help get the outbreak under control so we can all have a safe and happy pride season.Robbie de Santos, Director of Communications and External Affairs at Stonewall
An individual’s eligibility would depend on a number of factors but would be similar to the criteria used to assess those eligible for HIV pre-exposure prophylaxis (PrEP) – but applied regardless of HIV status.
The strategy states that a clinician may advise vaccination for someone who, for example, has multiple partners, participates in group sex or attends ‘sex on premises’ venues.
“Our extensive contact tracing work has helped to limit the spread of the monkeypox virus, but we are continuing to see a notable proportion of cases in gay, bisexual and other men who have sex with men. By expanding the vaccine offer to those at higher risk, we hope to break chains of transmission and help contain the outbreak,” noted Dr Mary Ramsay, Head of Immunisation at UKHSA. “Although most cases are mild, severe illness can occur in some people, so it is important we use the available vaccine to target groups where spread is ongoing.”
NHS England is due to set out details on how eligible people can get vaccinated shortly and is asking for patience as they finalize these logistics.
The health authority encourages everyone, regardless of their sexuality, to be vigilant about new abnormalities on their skin.
“In the meantime, everyone should continue to be alert to any new spots, ulcers or blisters on any part of their body, particularly if they’ve had close contact with a new partner,” said Ramsay. “If you think you have these symptoms, avoid close contact with others and call NHS 111 or your local sexual health centre, though please phone ahead before attending.”
“In most point source outbreaks (outbreaks associated with a particular event) with secondary person to person spread you see the second wave generally being lower than the first. However, what we have seen with Monkeypox is a significant and continuing increase of the second wave despite control measures having been in place for a few weeks,” said Prof Paul Hunter, Professor in Medicine, The Norwich School of Medicine, University of East Anglia. “So, it is certainly looking like the current strategy of ring vaccination is not working. This is probably down to difficulties in identifying cases and their contacts rapidly enough, possibly due to stigma.
Hunter agreed with the UKHSA’s new vaccination strategy but also noted the importance of considering other potentially at-risk populations in which contact tracing may be challenging.
“The report today about offering vaccine to MSM at high risk of exposure is the right thing to do. I would just add that monkeypox is spreading because of frequent multiple close and intimate contacts,” said Hunter. “Even though we are not seeing much spread outside of MSM, Monkeypox doesn’t care whether those contacts are same sex or mixed sex and so I think we should be ready to start offering the vaccine to female sex workers as well.”
Source: UK Health Security Agency