The Centers for Disease Control and the California Department of Public Health (CDPH) recommends those that are highest risk for monkeypox as defined within the guidance get vaccinated as supply allows. This will help protect vaccinated persons against monkeypox illness and slow down the spread of disease. CDPH is coordinating with local health jurisdictions (LHJs) in distributing vaccines to vulnerable communities.
Additional supplies of JYNNEOS monkeypox vaccine under the next phases will reduce but not eliminate vaccine scarcity. Vaccination should expand to reach as many individuals at highest risk of monkeypox as possible to the extent permitted by limited supply.
During these vaccine phases, local health jurisdictions should:
Populations to Prioritize for Vaccination Efforts
Each local health jurisdiction should assess the unique circumstances within its respective jurisdiction. According to the PEP++ framework, individuals with risk factors that increase their likelihood for exposure in areas where monkeypox is spreading may be considered for vaccination, even if they have not had known exposure to someone with a confirmed or probable monkeypox infection. The following populations should be considered for prioritization.
Tier I Priority Groups:
Gay, bisexual, and other men (including cisgender and transgender men) who have sex with men (MSM) or transgender women who meet at least one of the following criteria:
Among this group, individuals who are living with HIV (particularly those with CD4 count < 200/mm3 or an opportunistic infection) or other conditions that cause immunocompromise should be prioritized for vaccination, including second doses.
Efforts should be made to reach Tier 1 populations that have barriers in accessing care, for example, engaging community organizations and trusted messengers for outreach and offering vaccines at non-clinical venues where individuals already attend (e.g., bathhouses, bars, clubs, Pride events). Tier II Priority Groups:
Gay, bisexual, and other men (including cisgender and transgender men) who have sex with men (MSM) or transgender women who do not meet Tier I criteria but meet one of the following criteria:
Additional Priority Groups:
LHJs should consider PEP++ efforts depending on local epidemiologic analyses and the detection of cases and/or risk of transmission in these groups. CDPH is available for consultation regarding implementation of PEP++ efforts.
Other groups to consider include:
Venues to Consider for PEP/PEP++ Administration
When determining how and where to offer vaccinations, consideration should be provided to locations that are acceptable and familiar to community members. Focused outreach, as opposed to open access, may ensure prioritized populations are more effectively reached. In non-urbanized areas, sites should be in discreet locations, whenever feasible.
Suggested venues include:
Health Education Considerations
Vaccination sites and/or health education informational material, such as flyers or QR codes linking to monkeypox vaccine information, should be prioritized in the following settings.
This guidance is subject to change to reflect the current status of the response, future allocations of additional vaccine doses, and other guidance from the CDC.
MSM: Men who have sex with men. PEP: Postexposure prophylaxis. Administration of vaccine to persons who have been exposed to a disease in order to prevent or lessen the severity of disease. PEP++: Postexposure prophylaxis (also called expanded PEP) with an emphasis on vaccinating persons at high risk of exposure in the absence of a known exposure. JYNNEOS: Smallpox and monkeypox vaccine; Live, Nonreplicating.