The goal of the global outbreak response for monkeypox is to control the outbreak, and to effectively use strong public health measures to prevent onward spread of the disease. Judicious use of vaccines can support this response. This interim guidance, developed with the advice and support of the Strategic Advisory Group of Experts (SAGE) Ad-hoc Working Group on smallpox and monkeypox vaccines, provides the first WHO recommendations on vaccines and immunization for monkeypox. Key points follow.
- Mass vaccination is not required nor recommended for monkeypox at this time.
- For contacts of cases, post-exposure prophylaxis (PEP) is recommended with an appropriate second- or third-generation vaccine, ideally within four days of first exposure to prevent onset of disease.
- Pre-exposure prophylaxis (PrEP) is recommended for health workers at risk, laboratory personnel working with orthopoxviruses, clinical laboratory staff performing diagnostic testing for monkeypox, and others who may be at risk as per national policy.
- Vaccination programmes must be backed by thorough surveillance and contact-tracing, and accompanied by a strong information campaign, robust pharmacovigilance, ideally in the context of collaborative vaccine effectiveness studies with standardized protocols and data collection tools.
- Decisions on use of smallpox or monkeypox vaccines should be based on a full assessment of risks and benefits on a case-by-case basis.
Most interim recommendations provided here concern off-label use of vaccines. The guidance will be updated as more information becomes available.