Clinical Scorecard: Evaluating Vaccine Dose Prioritization Approaches During the 2022 Mpox Outbreak

At a Glance

Key Highlights

• NYC prioritized widespread single-dose vaccination due to limited JYNNEOS vaccine supply during 2022 mpox outbreak.
• Modeling estimated that NYC’s first-dose priority strategy averted 66% of potential mpox cases compared to no vaccination.
• Preallocating full 2-dose courses to a smaller population would have increased outbreak size compared to first-dose priority.

Guideline-Based Recommendations

Diagnosis

• Diagnosis based on symptom onset and mpox testing among symptomatic individuals in at-risk populations.
• Individuals seeking treatment for mpox symptoms should be tested and reported as diagnosed cases.

Management

• Administer JYNNEOS vaccine with priority on first-dose coverage during vaccine shortages.
• Symptomatic individuals should abstain from sexual activity until recovery.
• Symptom onset reduces sexual contact rates by 50% and lowers sexual activity level.

Monitoring & Follow-up

• Monitor incident mpox cases to calibrate transmission models and guide vaccination strategies.
• Track vaccine administration data and case reports to evaluate outbreak control.

Risks

• Limited vaccine supply may necessitate prioritization strategies impacting outbreak size.
• Delaying second doses in favor of widespread first-dose coverage may be more effective in outbreak control.

Patient & Prescribing Data

GBMSM population in New York City at increased risk for mpox infection.

Single-dose vaccination strategy averted more cases than prioritizing full 2-dose vaccination in a smaller group during vaccine shortages.

Clinical Best Practices

• Prioritize first-dose vaccination widely during outbreaks with limited vaccine supply to maximize cases averted.
• Use dynamic network modeling to inform vaccination strategies tailored to sexual behavior patterns in GBMSM.
• Encourage symptomatic individuals to reduce sexual contacts and seek testing promptly.

References

• CDC mpox vaccination guidance
• FDA approval of JYNNEOS vaccine
• WHO declaration on Clade I Monkeypox Virus outbreak