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EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health


November 15, 2022


TO:
California Local Health Jurisdictions

SUBJECT:
Considerations for Mpox Vaccination in California



Updated as of November 15, 2022:

  • Expanded vaccination recommendations for those seeking protection from mpox infection

Summary

The California Department of Public Health (CDPH) recommends that those who may be at risk for, or seek additional protection from mpox infection, as defined within this guidance, be vaccinated against mpox. 

While there is currently adequate vaccine supply, there are no longer "eligibility" criteria, and vaccine providers can offer vaccine to any patients who MAY be at risk, and persons who request vaccination should receive it without having to attest to specific risk factors.

Vaccination for Post-Exposure Prophylaxis

When expanding vaccination activities for at-risk populations, local health jurisdictions (LHJs) and vaccine providers should continue post-exposure prophylaxis (PEP) for patients known to have been exposed to mpox.

Vaccination for Occupational Groups

Continue vaccination for occupational groups recommended for vaccination by Advisory Committee on Immunization Practices (ACIP).

Continue vaccination for healthcare workers (HCWs) who are likely to collect laboratory specimens from patients with mpox (e.g., persons working in sexual health clinics or clinical settings that serve at-risk populations).

Vaccination Prioritization Considerations 

While specific eligibility criteria have been removed, prioritizing the education and vaccination of populations at highest risk is encouraged to decrease infections, serious illness, and prevent fatalities.

Vaccination efforts should be prioritized for:

  • Anyone living with human immunodeficiency virus (HIV).  It is recommended that additional efforts be made to reach those with a CD4 count <350/mm3, an unsuppressed HIV viral load, or an opportunistic infection, due to increased risk for complications of mpox
  • Any man or trans person who has sex with men or trans persons
  • People who use or are eligible for HIV PrEP
  • Sex workers
  • Sexual partners of the above groups 
  • People who have had direct skin-to-skin contact with one or more people AND who know others in their community that have had mpox infection
  • People who have been diagnosed with a bacterial sexually transmitted disease (e.g., chlamydia, gonorrhea, syphilis) in the past 3 months
  • People who anticipate experiencing the above risks

Each LHJ should assess local circumstances and needs for mpox vaccination based on local morbidity, infection rate, and populations at risk.

LHJs and vaccine providers are strongly recommended to  consider vaccine equity when planning vaccination activities.

  • Vaccines should be shared with medical providers and/or CBOs that can reach diverse populations at risk of mpox exposure.           
  • Priority should be given to making vaccines accessible to populations who have been disproportionately affected by mpox and populations who have lower vaccination rates such as Black and Latino individuals. See the CDPH Mpox Health Equity page for more information.
  • Priority should also be given to persons at risk for mpox exposure who are:
    • Incarcerated
    • Currently experiencing homelessness or intermittent homelessness
    • Living in residential substance use treatment centers or participating in substance use treatment programs

Venues to Consider for Vaccine Administration

Consideration should be given to locations that are preferred, accessible, and familiar to community members when determining how and where to offer vaccinations. Focused outreach and health education can ensure prioritized populations are more effectively reached. In non-urbanized areas, sites should be in discreet locations, whenever feasible. Suggested venues include:

  • STD and/or sexual health clinic sites
  • LGBTQ+ health clinics or community organizations
  • Sex-on-premises sites (e.g., saunas, bathhouses, sex clubs), in locations that are discreet yet distanced from primary areas of activity
  • Large events or venues, including Pride events, where sexual activity may be more likely
  • Medical practices that focus on HIV care
  • Providers and/or medical practices that offer HIV PrEP
  • Local health jurisdiction clinics
  • Gyms, bars, or clubs that cater to communities at high risk
  • Other locations, as deemed appropriate by LHJs

 

This guidance is subject to change to reflect the current status of the response, vaccine supply, and other guidance from the CDC.