Updated Monkeypox Vaccination Guidance

Advisory Alert

October 13, 2022

*Cette information est seulement disponible en anglais.

To: Local Health System Partners

FOR IMMEDIATE ATTENTION

Stay up to date with Monkeypox vaccination guidance by visiting the Ministry of Health website.

Imvamune® is a live, attenuated, non-replicating vaccine that is approved in Canada for protection against monkeypox. Imvamune® should be considered for the following:

• Pre-exposure vaccination
• Post-exposure vaccination

Current Ontario guidelines recommend offering Imvamune® as a two-dose primary series, with a least 28 days between first and second doses for individuals currently eligible for pre-exposure or post-exposure vaccination. A full dose, 0.5ml of Imvamune®, should be given via the subcutaneous route for each dose. The Ministry of Health  continues to evaluate this approach with any changes in the epidemiology and evidence surrounding the vaccine.

Eligibility criteria for the use of Imvamune® for pre-exposure vaccination has been updated to include the following:

1. Two-spirit, non-binary, transgender cisgender, intersex, or gender-queer individuals who self-identify or have sexual partners who self-identify as belonging to the gay, bisexual, pansexual and men who have sex with men (gbMSM) community AND at least one of the following:
   • Had a confirmed sexually transmitted infection within the last year
   • Have or are planning to have two or more sexual partners or are in a relationship where at least one of the partners may have other sexual partners,
   • Have attended venues for sexual contact (i.e., bath houses, sex clubs) recently or may be planning to, or who work/volunteer in these settings; or
   • Have had anonymous sex (e.g., using hookup apps) recently or may be planning to; and/or
   • Are a sexual contact of an individual who engages in sex work.
2. Individuals who self-identify as engaging in sex work or are planning to, regardless of self-identified sex or gender.

Household and/or sexual contacts of those identified for pre-exposure vaccination eligibility in parts (a) and (b) above AND who are moderately to severely immunocompromised (see Appendix A) or pregnant may be at higher risk for severe illness from a monkeypox infection may be considered for pre-exposure vaccine and should contact their healthcare provider (or their local public health unit) for more information.

For population-specific information regarding Imvamune® eligibility, please refer to the “Special Populations” section in the Ministry of Health’s Monkeypox Vaccine (Imvamune^®) Guidance for Health Care Providers document.

Further information on the use of Imvamune® for post-exposure vaccination has been provided:

• The provision of Imvamune® for post-exposure vaccination requires an assessment of the risk of exposure by the public health unit.
• If the risk of exposure continues beyond or is expected to continue beyond 28 days following the first 0.5mL subcutaneous dose, a second dose, 0.5mL subcutaneous, should be offered.
• The second dose should be offered at least 28 days after the first dose.

Individuals who are moderately to severely immunocomprimised and are currently eligible for pre-exposure vaccination should receive two doses of the Imvamune® vaccine administered at the recommended interval. Please refer to:

• Appendix A for the definition of moderately to severely immunocompromised individuals; and
• Appendix B on how to verify eligibility in this population.

Information on the use of Imvamune® in children and youth has been provided:

• Appendix C has been added to include a process map for pediatric infectious disease consultations for monkeypox post-exposure vaccination for individuals under the age of 18, as well as roles and responsibilities of the following:
  • Public Health Units
  • Ministry of Health
  • Public Health Ontario
  • Pediatric specialist(s)

Eligible individuals seeking pre-exposure vaccination should be directed to call Public Health at 705.522.9200, ext. 482 (toll-free 1.866.522.9200) or Réseau ACCESS Network at 705.688.0500. Individuals can also call Public Health at ext. 772 if they are seeking post-exposure vaccination.

Additional Resources

For guidance on preventing monkeypox transmission in health care settings, please see Public Health Ontario’s (PHO) Infection Prevention and Control (IPAC) Recommendations for Monkeypox in Health Care Settings. Additional monkeypox resources can be found on PHO’s website.

For case and contact management information, please contact Public Health’s Control of Infectious Diseases program at 705.522.9200, ext. 772 (toll-free 1.866.522.9200).

Sincerely,

Original Signed By

Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer

NOTE: All Advisory Alerts are found on our website.

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This item was last modified on April 22, 2024