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Posted on: October 25, 2022

Health Advisory: Updated Monkeypox Guidance for Use of JYNNEOS Vaccine

 Health Advisory: Updated Monkeypox Guidance for Use of JYNNEOS Vaccine

October 25, 2022 

Action Requested 

• Be aware of updated Guidelines for JYNNEOS Vaccine Use from the Washington State Department of Health.

• Report all cases of monkeypox immediately to Snohomish Health District at the time of suspicion and/or testing (425-339-3503).

Post-Exposure Prophylaxis (PEP) Guidance  

CDC recommends that the vaccine be given within 4 days from the date of exposure for the best chance to prevent onset of the disease.

If given between 4 and 14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease. However, when coupled with self-isolation and other prevention measures when symptoms first occur, PEP is important for controlling outbreaks and preventing further transmission of MPV. Link for additional information: Considerations for Monkeypox Vaccination | Monkeypox | Poxvirus | CDC

Medical Providers

Offer vaccine to the following persons based on current post exposure criteria:

  1. Known contacts who are identified by public health via case investigation, contact tracing, and risk exposure assessments 
    1. Persons who report high-risk exposure to a person with diagnosed MPV infection. This will include people who had sexual contact with a person with MPV or significant skin-to-skin or mucous membrane contact with a person with MPV*. 
    2. Persons who report exposure to a person identified as exposed to diagnosed MPV infection (second level contact).
  2. Presumed contacts who may meet the following criteria: 
    1. Know that a sex partner in the past 14 days was diagnosed with MPV 
    2. Had multiple sex partners in the past 14 days in a jurisdiction with known MPV 
    3. Persons who know that a sex partner or close social contact was exposed to a person diagnosed with MPV
  3. Medical providers are not required to verify that patients had contact with a person with known MPV infection.

Outbreak Response Pre-Exposure Vaccination

To more accurately reflect MPV vaccination strategy, we transitioned from utilizing the term expanded PEP or as previously identified PEP++ to instead identify those who remain at high risk of exposure. The goal remains to reach additional persons with risk factors that might have recently exposed them to MPV even if they have not had a documented exposure to someone with a confirmed diagnosis and to reach people with risk factors for infection before they are exposed. This allows the addition of criteria that expand the population of people eligible for vaccination, while still focusing on those at high risk of MPV exposure. Outreach to and vaccination of individuals who meet the categories below should be prioritized with vaccine supply limitations. 

1. The following populations should be offered vaccination:

a. Gay and bisexual men and transgender individuals who have had multiple or anonymous 

gay, male bisexual, or transgender sex partners in the last 6 months

b. People who have used methamphetamine in the last 6 months

c. People who have exchanged sex for money, drugs, or other purposes in the past 6 months

d. People who have been sexually assaulted, regardless of gender or sexual orientation

e. People who have had sexual contact or prolonged skin-to-skin exposure with people who 

were exposed to MPV

f. A new diagnosis in the last 12 months of one or more nationally reportable sexually 

transmitted diseases (i.e., acute HIV, chancroid, chlamydia, gonorrhea, or syphilis).

2. The following populations (among those who meet the above criteria) should be prioritized for outreach and for vaccination: 

a. Black, Hispanic/Latinx, Native Hawaiian and Other Pacific Islanders, Asian, Indigenous, or American Indian/Alaska Native who are GBMSM

b. Individuals who have attended a bathhouse or public sex venue, or participated in group sex (sex including >3 people at the same time) in the last 6 months 

c. Individuals who have experienced homelessness/unstable housing (including living in a shelter, car, or congregate setting; living with friends or relatives; couch surfing; agricultural workers and seafood workers) in the last 6 months 

d. Individuals who are currently or in the past 6 months have been incarcerated

e. Individuals who are currently taking PrEP to prevent HIV infection

3. If there is a surplus of vaccine, the following populations should be included:

a. All individuals who have had multiple or anonymous sex partners in the last 6 months.

b. Healthcare and public health workers who provide direct care to individuals with syphilis or other STIs.

*Examples include (but not limited to) sexual intercourse, intimate skin-to-skin contact (such as club dancing, cuddling, hugging, etc.)

**Incubation period is up to 21 days; use of 6 months is to expand identification of individuals at risk

Read the full Guidelines document for more information.

Background 

Monkeypox virus is a DNA virus in the Orthopox genus and is acquired through close contact with an infected person or animal. In the 2022 global outbreak of monkeypox, contact with infected animals has not been established as a means of transmission. After infection, there can be an incubation period of roughly 1-2 weeks. The virus may be transmitted through direct contact or close contact with an infected person, through contact with objects contaminated with the monkeypox virus, and may be transmitted by a pregnant person to their fetus transplacentally. Although in this current outbreak men who have sex with men are overrepresented, anyone who is in close contact with an infected person or objects contaminated with monkeypox is at risk of developing monkeypox. Most infections in this outbreak resolve within 2-4 weeks of onset, even without treatment but severe outcomes are possible. Immunocompromised persons, persons who are pregnant or breastfeeding, and children and adolescents may be at higher risk of severe disease. 

Local Case Counts

As of October 21, a total of 35 cases of monkeypox have been identified in Snohomish County

Additional Resources

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