Monkeypox (Mpox) Guidelines

Updated: Nov 29, 2022
  • Author: Mary Beth Graham, MD, FIDSA, FACP; Chief Editor: William D James, MD  more...
  • Print

Guidelines Summary

Clinical guidance on monkeypox (mpox) and smallpox vaccination was updated in June 2022 by the US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP). [48]

ACIP recommends that individuals with occupations that may expose them to orthopoxvirus diseases receive pre-exposure prophylaxis with either Jynneos or ACAM2000. Examples of such occupations include healthcare workers as designated by public health authorities, clinical laboratory personnel directly involved with orthopoxvirus testing, and research laboratory personnel handling orthopoxvirus cultures.

If a person is exposed to monkeypox virus and has not received smallpox vaccination within the last 3 years, the CDC recommends administration of Jynneos within 4 days of exposure. Vaccination may mitigate symptoms without preventing the disease if received within 4-14 days of exposure.

Persons with HIV Infection 

CDC has developed clinical considerations for prevention and treatment of monkeypox in persons with HIV infection, including pre-exposure and postexposure prophylaxis with Jynneos vaccine, treatment with tecovirimat, and infection control. The 2022 outbreak has disproportionately affected gay, bisexual, and other men who have sex with men. [7]   

Antiretroviral treatment and opportunistic infection prophylaxis should be continued in all persons with HIV infection who acquire monkeypox. The safety and immunogenicity of Jynneos have been specifically evaluated in persons with HIV infection. Clinical trials demonstrate that Jynneos is well-tolerated with similar immunogenicity and rates of adverse events in persons with HIV infection with CD4 cell counts of 200-750/μL and persons without HIV infection. [51]  

Because ACAM2000 contains a replication-competent, attenuated strain of vaccinia virus, severe localized or systemic complications of ACAM2000 (e.g., progressive vaccinia) can occur in persons with weakened immune systems, including from HIV infection. [52]  

Tecovirimat is the first-line medication recommended for treatment of monkeypox, including among persons with HIV infection. [7]