New York continues mpox vaccine and health awareness campaign

• 73% (188) were not vaccinated or had received only one dose.
• 94% were among men who have sex with men.
• Most were Black or Hispanic and between the ages of 25-44.
• Most were mild; ten (3.9%) people were hospitalised.

Clade I outbreak in the Democratic Republic of the Congo

There is an outbreak of concern of Clade I MPXV in the Democratic Republic of the Congo. There have been no reported cases of Clade I in the U.S. and no evidence of transmission outside of endemic countries of Central Africa.

However, it is possible that Clade I could be introduced into the U.S. by a traveler to the Democratic Republic of the Congo or other endemic countries, or with epidemiological links to those regions. Clade I appears to be more transmissible and cause more severe disease. Isolation vaccination (JYNNEOS, ACAM2000), and treatment (e.g., tecovirimat, brincidofovir, vaccinia immune globulin intravenous) strategies used for Clade II infections are expected to be effective for Clade I infections.

Vaccination update

People with potential risk of exposure to mpox should receive two doses of the JYNNEOS vaccine to be fully vaccinated. It is estimated that only one in four people recommended to receive the vaccine in the U.S. are fully vaccinated. Increasing vaccine uptake is essential to preventing infections and severe disease.

On April 1, 2024, the JYNNEOS vaccine began transition to the commercial market, though no- cost federal supplies are available until early summer 2024. JYNNEOS vaccine will be made available through the Vaccines for Children (VFC) Program (for eligible adolescents), likely within a few months of commercialization.

Recommendations for health providers

1. Testing

• Given mild signs and symptoms reported by most cases since the 2022 outbreak, maintain a low threshold for mpox testing to reduce the potential for missed cases. Testing should be provided to any individual who requests it and has a sore or skin lesion that can be swabbed.
• Refer to the GOALS Framework for Sexual History Taking in Primary Care to assess testing needs and facilitate the patient-provider relationship by normalizing discussions about sexual health and behavior as a routine part of health care.
• Submit mpox specimens to a commercial or facility-based laboratory that has been approved to conduct mpox testing by New York State. If testing is not feasible, call the NYC Department of Health and Mental Hygiene (Health Department) Provider Access Line at 866-692-3641 to arrange for testing, following the NYC Public Health Laboratory specimen collection guidelines.
• Be alert to the possibility of Clade I MPXV and need for specimen collection for people with symptoms and a history of travel or epidemiological links to a region of endemicity, including the Democratic Republic of the Congo, within 21 days of symptom onset.
• If Clade I MPXV is suspected, call the Provider Access Line at 866-692-3641 for immediate consultation and to arrange for testing by the Centers for Disease Control and Prevention (CDC) (currently, only CDC can test for Clade I).

2. Vaccination

• Continue to encourage vaccination for individuals for whom it is recommended and especially those with a higher risk of mpox complications (e.g., people with advanced HIV or other severe immunocompromise).
• Advise those who have not yet received a second vaccine dose to do so as soon as possible, regardless of how much time has passed since their first dose.
• Start to identify processes and funds for ordering JYNNEOS on the commercial market.
• Order no-cost vaccine by emailing poxvax@health.nyc.gov. The NYC Health Department anticipates being able to fulfill requests until early summer 2024.
• If you do not offer vaccination, refer to vaccinefinder.nyc.gov to find a vaccination site.3) Patient care
• Determine clinical management based on an individual’s clinical status (e.g., vaccination history, underlying health conditions), severity of illness, and risk factors, regardless of MPXV clade.
• Share guidance on symptom relief (e.g., over-the-counter medication, cooling lotions and jelly, sitz baths) and how to prevent transmission.
• For immediate consultation regarding hospitalized people with or who are at risk for severe manifestations, call the CDC Clinical Escalations team at 770-488-7100.
• Offer treatment (e.g., tecovirimat [TPOXX], brincidofovir) in accordance with CDC guidance, including CDC’s Guidance for Tecovirimat Use. TPOXX can only be accessed through the Study of Tecovirimat for Mpox (STOMP) clinical trial (mild to moderate illness), or the Expanded Access-Investigational New Drug (EA-IND) protocol if someone has severe illness or does not want to participate in STOMP. STOMP has a remote enrollment option that enables people to continue to receive care from their regular provider. Refer to instructions for prescribing TPOXX for local delivery through Pharmex Pharmacy.
• Although the risk of occupational transmission of MPXV remains low, ensure health care staff who may be caring for people with suspected or confirmed infections are trained on infection prevention control, including appropriate personal protective equipment.Thank you for your continued support in protecting the sexual health of New Yorkers.