Receipt of First and Second Doses of JYNNEOS Vaccine for Prevention of Monkeypox — United States, Could 22–October 10, 2022
Jennifer L. Kriss, PhD1; Peter M. Boersma, MPH1; Emalee Martin, MPH1; Kirsten Reed, MPH1; Jennifer Adjemian, PhD1; Nathaniel Smith, MD1; Rosalind J. Carter, PhD1; Kathrine R. Tan, MD1; Arunkumar Srinivasan, PhD2; Sunanda McGarvey3; Jennifer McGehee, MS2; Danielle Henderson, MPH2; Noah Aleshire1; Adi V. Gundlapalli, MD1 (View creator affiliations)
What’s already recognized about this subject?
In the US, JYNNEOS vaccine is beneficial for individuals uncovered to or at excessive danger for publicity to Monkeypox virus.
What’s added by this report?
By October 10, 2022, a complete of 931,155 JYNNEOS vaccine doses have been administered in the US. Amongst individuals who acquired ≥1 vaccine dose, 51.4% have been non-Hispanic White, 12.6% have been non-Hispanic Black or African American (Black), and 22.5% have been Hispanic individuals. The chances of vaccine recipients who have been Black (5.6%) and Hispanic (15.5%) throughout Could 22–June 25 elevated to 13.3% and 22.7%, respectively, throughout July 31–October 10.
What are the implications for public well being apply?
Monitoring and addressing disparities in vaccination can scale back inequities and assist be certain that disproportionately affected populations are protected.
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Vaccination with JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) to forestall monkeypox commenced shortly after affirmation of the primary monkeypox case within the present outbreak in the US on Could 17, 2022 (1). Thus far, greater than 27,000 instances have been reported throughout all 50 states, the District of Columbia (DC), and Puerto Rico.* JYNNEOS vaccine is licensed by the Meals and Drug Administration (FDA) as a 0.5-mL 2-dose collection administered subcutaneously 28 days aside to forestall smallpox and monkeypox infections (2) and has been discovered to offer safety in opposition to monkeypox an infection throughout the present outbreak (3). The U.S. Division of Well being and Human Providers (HHS) allotted 1.1 million vials of JYNNEOS vaccine from the Strategic Nationwide Stockpile, with doses allotted to jurisdictions based mostly on case counts and estimated dimension of inhabitants in danger (4). Nonetheless, preliminary vaccine provides have been severely constrained relative to vaccine demand throughout the increasing outbreak. Some jurisdictions with highest incidence responded by prioritizing first dose administration throughout Could–July (5,6). The FDA emergency use authorization (EUA) of 0.1 mL dosing for intradermal administration of JYNNEOS for individuals aged ≥18 years on August 9, 2022, considerably expanded accessible vaccine provide† (7). The U.S. vaccination technique focuses totally on individuals with recognized or presumed exposures to monkeypox (8) or these at excessive danger for occupational publicity (9). Information on monkeypox vaccine doses administered and reported to CDC by U.S. jurisdictions have been analyzed to evaluate vaccine administration and completion of the 2-dose collection. A complete of 931,155 doses of JYNNEOS vaccine have been administered and reported to the CDC by 55 U.S. jurisdictions throughout Could 22–October 10, 2022. Amongst individuals who acquired ≥1 dose, 51.4% have been non-Hispanic White (White), 22.5% have been Hispanic or Latino (Hispanic), and 12.6% have been non-Hispanic Black or African American (Black). The chances of vaccine recipients who have been Black (5.6%) and Hispanic (15.5%) throughout Could 22–June 25 elevated to 13.3% and 22.7%, respectively, throughout July 31–October 10. Amongst 496,888 individuals who acquired a primary dose and have been eligible for a second dose throughout the research interval, 57.6% acquired their second dose. Second dose receipt was highest amongst older adults, White individuals, and people residing within the South U.S. Census Bureau Area. Monitoring and addressing disparities in vaccination can scale back inequities, and equitable entry to and acceptance of vaccine needs to be an important think about planning vaccination packages, occasions, and techniques. Receipt of each first and second doses is critical for optimum safety in opposition to Monkeypox virus an infection.
The system for reporting monkeypox vaccination information was tailored from present infrastructure and information stream buildings developed for reporting COVID-19 vaccine administration information.§ Suppliers submitted monkeypox vaccination information to their jurisdiction’s immunization info techniques (IIS); state, native, and territorial jurisdictions reported vaccine administration information to CDC. Monkeypox vaccine doses administered to individuals in 49 states, New York Metropolis, Philadelphia, DC, Puerto Rico, the U.S. Virgin Islands, and the Northern Mariana Islands throughout Could 22–October 10, 2022, and reported to CDC as of October 12, 2022, have been analyzed to evaluate vaccination by intercourse, age group, race and ethnicity, U.S. Census Bureau area, and urbanicity.¶
The proportion of individuals who acquired a second JYNNEOS vaccine dose was calculated from amongst all individuals who acquired a primary dose and have been due for his or her second dose throughout the research interval.** First and second doses have been linked by CDC based mostly on a recipient identifier assigned by the reporting entity and the three-digit reporting entity code.†† The interval in days between first and second doses was calculated utilizing date of administration for every dose. Analyses have been carried out utilizing SQL Server Administration Studio (model 18; Microsoft) and SAS software program (model 9.4; SAS Institute). This exercise was reviewed by CDC and was carried out in step with relevant federal legislation and CDC coverage.§§
Throughout Could 22–October 10, 2022, a complete of 931,155 JYNNEOS vaccine doses have been administered and reported to CDC by U.S. jurisdictions, together with 628,610 (67.5%) first doses, 301,770 (32.4%) second doses, and 775 (0.1%) third, fourth, or fifth doses.¶¶ Weekly first dose administration peaked at 102,262 throughout the week August 7–13 (Supplementary Determine, https://stacks.cdc.gov/view/cdc/121818). The vast majority of vaccine doses (63%) have been administered within the six states reporting the best monkeypox case counts (California, Florida, Georgia, Illinois, New York, and Texas).***
Amongst 628,610 individuals who acquired ≥1 dose of vaccine, 91.9% have been male, and 65.4% have been aged 25–49 years (Desk 1). Most vaccine recipients have been residents of city counties (82.5%); 15.9% and 1.6% lived in suburban and rural counties, respectively. Race and ethnicity have been reported for 91.0% of vaccinated individuals; amongst these, 51.4% have been White, 22.5% have been Hispanic, 12.6% have been Black, and seven.6% have been Asian individuals. The chances of vaccine recipients who have been Black (5.6%) and Hispanic (15.5%) throughout Could 22–June 25, elevated to 9.4% and 21.9%, respectively, throughout June 26–July 30, and to 13.3% and 22.7%, respectively, throughout July 31–October 10 (Determine) (Supplementary Desk 1, https://stacks.cdc.gov/view/cdc/121816). The commonest supplier websites the place individuals acquired vaccines have been public well being clinics (41.5%), industrial vaccination service suppliers (13.6%), medical practices (9.3%), and hospitals (9.1%) (Desk 1).
Amongst 496,888 first-dose vaccine recipients who have been eligible to obtain a second dose throughout the research interval, 285,964 (57.6%) had acquired the second dose as of October 10 (Desk 2). Receipt of a second dose was highest within the South (70.0%) and lowest within the Northeast (51.8%). The proportion of individuals who acquired a second dose diverse throughout jurisdictions (vary = 22.4%–82.5%) (Supplementary Desk 2, https://stacks.cdc.gov/view/cdc/121817). In New York Metropolis and Philadelphia, the place administration of second doses was delayed due to prioritization of first doses (5,6), fewer than one half of first-dose recipients had acquired a second dose. Second dose receipt was decrease amongst females (39.4%) than amongst males (59.3%), was highest amongst White individuals (61.4%), was lowest amongst individuals of Hispanic (53.9%) or unknown race or ethnicity (51.2%), and elevated with growing age. A couple of half of eligible Black, Asian, American Indian or Alaska Native, and Native Hawaiian or different Pacific Islander individuals acquired a second dose. Amongst individuals who acquired a second dose, 68.7% acquired the dose inside the beneficial interval of 24–35 days after the primary dose (median = 31 days; IQR = 28–38 days) (Desk 2).
This report paperwork the primary large-scale effort to offer JYNNEOS vaccine to individuals at increased danger for publicity to Monkeypox virus in the US. Greater than 900,000 doses of JYNNEOS vaccine have been administered throughout the first 5 months of the vaccination effort, with roughly 628,000 individuals receiving ≥1 dose, and 302,000 individuals receiving the entire 2-dose collection. Though a peak in first dose administration occurred in mid-August, administration of first and second vaccine doses is continuous. A couple of half of individuals who initiated the vaccination collection and have been eligible for a second dose throughout the research interval have acquired their second dose; completion of the second dose is critical for optimum safety in opposition to Monkeypox virus an infection. Importantly, there was substantial progress in growing the proportion of Black and Hispanic individuals vaccinated throughout the newer interval. Rising the supply of vaccine at group occasions, together with a deal with well being fairness, has contributed to those enhancements.
The findings on this report are topic to at the very least 4 limitations. First, it was not potential to evaluate vaccination based mostly on gender identification as a result of this info just isn’t routinely collected throughout vaccine administration, and present IIS techniques don’t embody this variable. Second, race or ethnicity was unknown for 9.0% of individuals who acquired JYNNEOS vaccine, which may restrict capacity to interpret variations by race and ethnicity. Third, linkage of a person particular person’s first and second doses depends upon the accuracy of recipient identifiers in a jurisdiction’s IIS. Individuals who acquired their second dose in a special jurisdiction than the place they acquired their first dose won’t be capable to be linked to their first dose, leading to an underestimation of second dose receipt. Lastly, second-dose standing was unknown for 23,264 (3.7%) first-dose recipients who lived in a jurisdiction that didn’t submit person-level vaccination information; vaccine recipients from this jurisdiction weren’t included within the evaluation of second dose receipt.
HHS allotted and distributed vaccine doses to prioritize individuals at highest danger for publicity to Monkeypox virus and in jurisdictions with the best case counts and dimension of precedence inhabitants. The multiphase allocation and distribution of vaccines was needed due to preliminary provide limitations throughout the interval of most fast epidemic development. Jurisdictions developed vaccination methods based mostly on native epidemiology and availability of assets. Early constraints might need restricted vaccine entry for populations who couldn’t journey lengthy distances, had rigid work schedules, or couldn’t entry on-line appointment scheduling. Over time, jurisdictions have labored to enhance vaccine entry, together with growing the variety of vaccine occasions and suppliers. Many individuals with elevated danger components throughout the present monkeypox outbreak have acquired ≥1 dose of monkeypox vaccine. Nonetheless, evaluation of the demographic traits of individuals who’ve acquired vaccine signifies that there are particular demographic teams who have been much less prone to be vaccinated, together with Hispanic and Black individuals, regardless of being disproportionately affected by the monkeypox outbreak (10). Monitoring and addressing disparities in vaccine administration can scale back well being inequities. CDC’s monkeypox vaccine fairness pilot program supplies a possibility to implement and consider novel methods to succeed in populations most affected by the monkeypox outbreak however who may face limitations to getting vaccinated.††† Equitable entry to and acceptance of vaccine needs to be an important think about planning vaccination packages, occasions, and techniques. Receipt of each first and second doses is critical for optimum safety in opposition to Monkeypox virus an infection. Bettering fairness in vaccination for each first and second doses is essential to guard individuals who’re most in danger and to finish the present monkeypox outbreak.
Immunization program managers, immunization info system managers, and different employees members of the immunization packages within the jurisdictions who offered these information.
- Minhaj FS, Ogale YP, Whitehill F, et al.; Monkeypox Response Crew 2022. Monkeypox outbreak—9 states, Could 2022. MMWR Morb Mortal Wkly Rep 2022;71:764–9. https://doi.org/10.15585/mmwr.mm7123e1 PMID:35679181
- Meals and Drug Administration. JYNNEOS [package insert, revised June 2021]. Silver Spring, MD: US Division of Well being and Human Providers, Meals and Drug Administration; 2021. https://www.fda.gov/media/131078/obtain
- Payne AB, Ray LC, Kugeler KJ, et al. Incidence of monkeypox amongst unvaccinated individuals in contrast with individuals receiving ≥1 JYNNEOS vaccine dose—32 U.S. jurisdictions, July 31–September 3, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1278–82. https://doi.org/10.15585/mmwr.mm7140e3 PMID:36201401
- Administration for Strategic Preparedness and Response. JYNNEOS vaccine distribution by jurisdiction. Washington, DC: US Division of Well being and Human Providers, Administration for Strategic Preparedness and Response; 2022. Accessed September 30, 2022. https://aspr.hhs.gov/SNS/Pages/JYNNEOS-Distribution.aspx
- Metropolis of Philadelphia Division of Well being. Monkeypox vaccine replace: expanded eligibility & second doses. Philadelphia, PA: Metropolis of Philadelphia Division of Well being; 2022. https://vax.phila.gov/index.php/notices/monkeypox-vaccine-update-expanded-eligibility-second-doses/
- New York Metropolis Division of Well being. NYC Well being Division on monkeypox vaccination technique and prioritization of first doses. New York, NY: New York Metropolis Division of Well being; 2022. https://www1.nyc.gov/website/doh/about/press/pr2022/monkeypox-vaccination-prioritization-first-doses.web page
- Meals and Drug Administration. Emergency use authorization for the emergency use of JYNNEOS. Silver Spring, MD: US Division of Well being and Human Providers, Meals and Drug Administration; 2022. https://www.fda.gov/media/160774/obtain
- CDC. JYNNEOS vaccine interim steerage. Atlanta, GA: US Division of Well being and Human Providers, CDC; 2022. https://www.cdc.gov/poxvirus/monkeypox/interim-considerations/jynneos-vaccine.html
- Rao AK, Petersen BW, Whitehill F, et al. Use of JYNNEOS (smallpox and monkeypox vaccine, stay, nonreplicating) for preexposure vaccination of individuals in danger for occupational publicity to orthopoxviruses: suggestions of the Advisory Committee on Immunization Practices—United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:734–42. https://doi.org/10.15585/mmwr.mm7122e1 PMID:35653347
- Philpott D, Hughes CM, Alroy KA, et al.; CDC Multinational Monkeypox Response Crew. Epidemiologic and scientific traits of monkeypox instances—United States, Could 17–July 22, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1018–22. https://doi.org/10.15585/mmwr.mm7132e3 PMID:35951487
FIGURE. Race and ethnicity*,† of individuals who acquired ≥1 dose of JYNNEOS vaccine, by week of administration — United States, Could 22–October 8, 2022
* Race and ethnicity have been lacking for 56,460 (9.0%) vaccinated individuals.
† Individuals with Hispanic or Latino (Hispanic) ethnicity have been categorized as Hispanic and is perhaps of any race; individuals with non-Hispanic ethnicity have been categorized as non-Hispanic American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or different Pacific Islander, White, multiracial (multiple race class chosen), or different. Individuals with lacking information for both race or ethnicity have been categorized as unknown race and ethnicity.
Advised quotation for this text: Kriss JL, Boersma PM, Martin E, et al. Receipt of First and Second Doses of JYNNEOS Vaccine for Prevention of Monkeypox — United States, Could 22–October 10, 2022. MMWR Morb Mortal Wkly Rep. ePub: 21 October 2022. DOI: http://dx.doi.org/10.15585/mmwr.mm7143e2.
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