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Orthopoxvirus Vaccine Guidance for Persons at Risk for Occupational Exposure

On November 3, 2021, the CDC Advisory Committee and Immunization Practices (ACIP) voted to recommend vaccination for select persons at risk for occupational exposure to orthopoxviruses. Such persons include:

  • Research laboratory personnel, clinical laboratory personnel performing diagnostic testing for orthopoxviruses, and for designated response team members at risk for occupational exposure to orthopoxviruses.
  • Healthcare personnel who administer ACAM2000 or care for patients infected with replication competent orthopoxviruses based on shared clinical decision-making.
    • For example, those caring for patients enrolled in clinical trials for replication-competent orthopoxvirus vaccines and those caring for persons with suspected or confirmed orthopoxvirus infections (e.g., clinicians and environmental services personnel).
  • For information on persons who are at continued risk for occupational exposure see additional information on CDC Guidance on Orthopoxvirus Vaccine Guidance for Persons at Risk of Occupational Exposure.
  • Additional ACIP recommendations are available here.

Two orthopoxvirus vaccines are available from CDC Drug Service for persons at risk for occupational exposure.

  • JYNNEO is a live, non-replicating vaccine licensed by the U.S. Federal Drug Administration (FDA) for prevention of smallpox and monkeypox disease in adults 18 years of age and older determined to be at high risk for smallpox or monkeypox infection.
  • ACAM2000 is a live vaccine for active immunization against smallpox disease licensed by the U.S. FDA for persons determined to be at high risk for smallpox infection.

Requests for vaccine, including the reason for the request, should be referred to the CDC Emergency Operations Center at 770-488-7100.

Pre-exposure prophylaxis to prevent monkeypox

The CDC ACIP recommends that people whose jobs may expose them to orthopoxviruses, such as monkeypox, get vaccinated with either ACAM2000 or JYNNEOS to protect them if they are exposed to an orthopoxvirus, i.e. pre-exposure prophylaxis (PrEP). 

People who should get PrEP include:

  • Clinical laboratory personnel who perform testing to diagnose orthopoxviruses, including those who use PCR assays for diagnosis of orthopoxviruses, including Monkeypox virus
  • Research laboratory workers who directly handle cultures or animals contaminated or infected with orthopoxviruses that infect humans, including Monkeypox virus, replication-competent Vaccinia virus, or recombinant Vaccinia viruses derived from replication-competent Vaccinia virus strains
  • Certain healthcare and public health response team members designated by public health authorities to be vaccinated for preparedness purposes
    • People who can get PrEP if they want to receive it include healthcare personnel who administer ACAM2000 or anticipate caring for many patients with monkeypox.

Please note: At this time, most clinicians in the US and laboratorians not performing the orthopoxvirus generic test to diagnose orthopoxviruses, including monkeypox, are not advised to receive orthopoxvirus PrEP. Laboratorians should consult with laboratory biosafety officers and supervisors to identify risks and precautions, depending on the type of work they are doing. 

Additional information can be found in the CDC Monkeypox and Smallpox Vaccine Guidance.

Additional information:

The American College of Emergency Physicians Guide to Monkey Pox.

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