Minister confirms revised monkeypox strategy due to worldwide vaccine shortage

Wales’ Health Minister Eluned Morgan has announced the adoption of a new monkeypox vaccination strategy due to a worldwide vaccine shortage.

Following advice given by the Joint Committee for Vaccination and Immunisation (JCVI) to the UK Health Security Agency (UKHSA), the Welsh Government has confirmed the adoption of a fractional dosing approach to vaccinating those most at risk of contracting monkeypox.

This approach, which will operate initially as a pilot, will commence shortly and eligible individuals will begin to be invited for their jab in the coming days.

Fractional dosing is a clinically approved approach, which has been commonly used in other worldwide outbreaks when vaccine supplies are limited and has recently been authorised in the US by the Food and Drug Administration for its own monkeypox response.

The European Medicines Agency Emergency Task Force has also approved the approach.

Five-fold increase

The change in dosing will mean all those eligible for pre-exposure vaccination aged 18 and over will be offered a 0.1ml dose of the Jynneos vaccine, instead of the 0.5ml dose that is generally used.

This will result in a five-fold increase in the number of people that can be offered the vaccine in Wales and across the UK.

In a statement, the minister wrote: “This approach will maximise the number of doses that can be administered without compromising protection, with clinical study results showing it provides a near-identical immune response in patients.”

“In addition to a review of the available evidence by the JCVI and UKHSA, the change in approach has been considered and endorsed by clinical experts here in Wales and preparations are now underway within NHS Wales to commence the pilot.”

Under this revised approach, the vaccine will be administered via an injection given into the upper layer of the skin, rather than the more common approach of injecting either below the skin (subcutaneous) or into the muscle of the upper arm (intramuscular).

It may take a few seconds longer and should produce a “bleb” (a small blister) that disappears within a minute.

This method is commonly used for skin testing and vaccination against tuberculosis.

Immune response

Clinical trials demonstrate the protection offered through intradermal vaccination is similar to subcutaneous and intramuscular jabs and the vaccine takes the same length of time (around 10 days) to produce a protective immune response.

Those eligible for pre-exposure vaccination include healthcare workers at risk of exposure including those working in sexual health services and High Consequence Infectious Disease (HCID) units and Gay and bisexual men, specifically those receiving PrEP or that have recently contracted a STI.

The JCVI has also recommended that during periods of supply constraint, post exposure vaccination offers should be prioritised.

Post exposure vaccination for contacts will be prioritised for those at greater risk of severe disease, including children under the age of five, pregnant women and people who are severely immunosuppressed.

In addition, people eligible for pre-exposure vaccination, for example high risk Gay and Bisexual men, may be offered post-exposure vaccination.