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Introduction

JYNNEOS is a live, non-replicating vaccine that is FDA licensed for prevention of smallpox and monkeypox in people ≥18 years. It has FDA Emergency Use Authorization for people <18 years. JYNNEOS can be considered for monkeypox vaccine in people who have had a high- or intermediate-risk exposure to monkeypox (see CDC guidance), to prevent or reduce severity of disease. Monkeypox vaccine should be given, if possible, within 4 days of exposure to prevent disease but may still reduce severity of disease if given up to 14 days after exposure.

Administration by subcutaneous injection is FDA approved for people ages ≥18 and FDA authorized for people ages <18 years. In addition, intradermal vaccination is FDA authorized for people ages ≥18 who do not have a history of keloid formation and is the preferred route of administration for all eligible individuals at this time. It is a 2-dose series, with the doses given 28 days apart.

The groups currently eligible for vaccination (see below) were selected based on the epidemiology of the current outbreak and will be adjusted based on emerging data and increasing vaccine supply. Los Angeles County Department of Public Health (LAC DPH) is partnering with community clinics to provide access to monkeypox vaccine across public and community sites in the County and, to the extent possible, integrate vaccination into routine clinical services for patients at high risk for monkeypox virus.

Current Groups Eligible for Vaccination

Due to limited vaccine supply, LAC DPH is offering JYNNEOS vaccine in phases. Eligibility for JYNNEOS vaccine will expand as vaccine supply increases or the epidemiology of the outbreak changes.

Current Groups Eligible for JYNNEOS vaccine

  1. Gay or bisexual men and transgender persons who:
    • Had multiple or anonymous sex partners in the last 14 days including engaging in survival and/or transactional sex (e.g., sex in exchange for shelter, food and other goods and needs).
      • Note: eligible persons who are immunocompromised, including those with advanced or uncontrolled HIV may be at high risk for severe disease and should be prioritized for vaccination. In addition, individuals meeting the prior eligibility criteria (i.e., had a diagnosis of gonorrhea and/or early syphilis within the past 12 months; or are on HIV pre-exposure prophylaxis (PrEP); OR attended or worked at a commercial sex venue or other venue where they had anonymous sex or sex with multiple partners within past 21 days) are still eligible for vaccination.
  2. Persons confirmed by LAC DPH to have high- or intermediate-risk contact with a confirmed monkeypox case (as defined by CDC and confirmed by LAC DPH).
  3. Persons who attended an event/venue where there was high risk of exposure to an individual(s) with confirmed monkeypox through skin-to-skin or sexual contact. (Public Health will work with event/venue organizers to identify persons who may have been present and at risk of exposure).
  4. Persons experiencing homelessness (PEH) with high-risk behaviors.
  5. High risk cohorts identified by clinical staff in the LA County Jail system.

Note: LAC DPH is directly communicating with groups 2-5 to provide vaccination.

 

For Patients Under 18 years old

The Food and Drug Administration has issued an Emergency Use Authorization and the Centers for Disease Control has released interim clinical guidance including continued use of subcutaneous dosing (0.5ml given 28 days apart) for eligible pediatric populations. Please see the interim clinical guidance for pediatric use of JYNNEOS or contact Department of Public Health (monkeypoxvaccine@ph.lacounty.gov).

Referring Eligible Patients for Monkeypox Vaccine

Providers with JYNNEOS vaccine from the Public Health Department should vaccinate their own patients meeting eligibility criteria #1 (above) for monkeypox vaccine. Eligible persons who are immunocompromised, including those with advanced or uncontrolled HIV may be at high risk for severe disease and should be prioritized for vaccination.

Providers that do not have JYNNEOS vaccine should instruct persons meeting eligibility criteria #1 to read the information on the public monkeypox webpage ph.lacounty.gov/monkeypox and sign-up on-line to be put on the list for vaccination. Note that at DPH sites, a consent form is required for people <18 years at each visit and children <16 years must be accompanied by their parent, legal guardian, or a responsible adult. See webpage for details. Individuals without access to internet should be instructed to call the DPH Call Center at 1-833-540-0473.

Please actively encourage eligible patients that are immunocompromised, including those with advanced or uncontrolled HIV, to sign up for monkeypox vaccination. They will be prioritized for vaccine appointments.

JYNNEOS Vaccine Administration

The information below is to support healthcare providers that are currently providing JYNNEOS vaccination.

Due to the limited vaccine supply, LAC DPH is aligning with CDC to allow an alternative regimen  (under FDA EUA) to administer JYNNEOS intradermally as a 2-dose series, with an injection volume of 0.1mL, for eligible individuals ≥18 years of age. Public Health expects providers to administer JYNNEOS intradermally to eligible individuals who do not have contradictions to this route of administration (as noted in the table below). Training resources for intradermal administration, including a video and images are available here. Providers can also contact monkeypoxvaccine@ph.lacounty.gov for assistance.

Eligible individuals under the age of 18, and individuals of any age who have a history of keloid formation, should receive subcutaneous dosing as a two-dose series with an injection volume of 0.5mL.

Vaccination Schedule and Dosing Regimens for JYNNEOS Vaccine
Regimen Route of administration  Injection volume Recommended number of doses  Recommended interval between 1st and 2nd dose 
Alternative regimen
People age ≥18 years Intradermal  0.1 mL  28 days 
Standard regimen
People age <18 years Subcutaneous  0.5 mL  28 days 
People of any age with history of developing keloid formation  Subcutaneous  0.5 mL 28 days 

It is important to note that neither one nor two doses of vaccine is 100% effective at prevention of infection and vaccination should be part of a multi-prong approach to decrease the risk of infection. See CDC Monkeypox Prevention for more information.

Please refer to the CDC’s interim clinical guidance for additional information, including vaccination schedule, recommended dosing intervals, interchangeability of dosing regimens, and co-administration of JYNNEOS vaccine with other vaccines.

Requirements for Becoming a Monkeypox Vaccine Provider

Registration

If you are interested in becoming a Monkeypox Vaccine provider, please send an email to monkeypoxvaccine@ph.lacounty.gov with the subject “Interested in becoming Monkeypox Vaccine Provider” and include the name of your organization and the approximate number of patients you serve who are eligible for the Monkeypox vaccine.

Providers who DO NOT have a CAIR account will need to be enrolled in CAIR as soon as possible. VPDC can assist your site with obtaining a CAIR ID upon receiving your registration form.

Other Requirements

  • Submit data for every vaccine administered through our REDCap OR MyTurn portal.
  • Report vaccine inventory weekly through REDCap. Training will be provided on this form as well.
  • Store vaccine in a Vaccine For Children compliant storage unit (refrigerator or freezer)
  • Monitor storage unit temperatures (current, minimum, and maximum) via Digital Data Logger and document temperatures using VFC Temperature logs (Refrigerator Temp Logs: Fahrenheit | Celsius Freezer Temp Logs: Fahrenheit | Celsius)
  • Bring appropriate equipment to pick—up vaccine from the LAC DPH Pharmacy (please see Instructions to Pick Up Vaccine below)
  • Commit to administering primary series (2 doses) for eligible clients seeking vaccination
  • Provide patients with a copy of their vaccine record and vaccine information statement (VIS)

Monkeypox Vaccination Resources

CDC Clinical Resources

JYNNEOSTM Vaccine Information

Vaccine Administration, Storage, and Reporting Resources