Mpox (Monkeypox) immunisation

Clinical guidance

• Vaccine routes:
• Subcutaneous (preferred): a standard primary vaccination course of mpox vaccine requires 2x 0.5 mL subcutaneous doses, given 4 weeks apart. Subcutaneous injection is the preferred route of administration, including as the first dose of post-exposure prophylaxis (PEP).
• Intradermal (dose sparing): an alternative route is by 2x 0.1 mL intradermal doses, given 4 weeks apart. Subcutaneous and intradermal routes are interchangeable for the 2-dose primary vaccination. However, due to sufficient dosages for subcutaneous injections, it is not recommended to offer an intradermal injection route.
• Vaccination before exposure to mpox:
• Those who are at-risk and planning to attend festivals, events, or to travel to a country experiencing a significant mpox outbreak, should aim to start the 2-dose vaccination series 4 to 6 weeks prior
• Vaccination after exposure to mpox: post-exposure prophylaxis (PEP):
• Assess risk levels associated with client health when vaccinating for PEP.
• If indicated, PEP with mpox vaccine should be given as soon as possible after the first exposure to a confirmed mpox case. Vaccination within 4 days of first exposure to an infectious case will provide the highest likelihood of disease prevention.
• Where a decision is made to provide PEP, a single dose of mpox vaccine should be given via the subcutaneous route. If mpox has not occurred and there is an ongoing exposure risk, the second dose of mpox vaccine should be given as close to (but not before) 28 days after the first dose, to complete a primary course for long-term protection.
• Mpox vaccine effectiveness
• Current data from the Australian Immunisation Handbook estimates vaccine effectiveness ranges from 36 per cent to 86 per cent after a single dose, and 66 per cent to 86 per cent for a complete 2-dose course in people considered at high risk of mpox.
• Effectiveness of post- exposure prophylaxis is estimated at 73 per cent to 89 per cent. Vaccination within 4 days of first exposure to an infectious case will provide the highest likelihood of disease prevention. 
• Vaccine effectiveness for intradermal administration (80.3 per cent) appears to be comparable to subcutaneous administration (88.9 per cent).
• Refer to Mpox for further information, including disease epidemiology, testing, notification and contact tracing.
• Detailed clinical guidance is available in the mpox chapter of the online Australian Immunisation Handbook (external site) and the ATAGI interim statement on the use of vaccines for prevention of mpox in 2024 (external site).
• Sign up to Vaccine Updates for important announcements

Education requirements

Education requirements for WA Health professionals are set by the Communicable Disease Control Directorate (CDCD) and support to understand the immunisation education needed for their role.

All immunisation providers must work within their scope of practice and, where relevant, comply with the Structured Administration and Supply Arrangements requirements. Registered nurses should refer to the specific SASA on ‘immunisation against monkeypox.’

Reporting to the Australian Immunisation Register (AIR)

Immunisation providers should report all vaccines administered to the Australian Immunisation Register (AIR). For more information, refer to Immunisation provider information and resources (health.wa.gov.au).

Reporting an adverse event following immunisation (AEFI)

The WA Vaccine Safety Surveillance (WAVSS) system is the central reporting service in WA for significant adverse events following immunisation (AEFI) or vaccine administration errors (VAEs). Providers should report any severe or potentially significant AEFI and VAE via the WAVSS reporting system as soon as possible, at SAFEVAC

For more information refer to Adverse event following immunisation (AEFI) (health.wa.gov.au). 

All clinical incidents (including VAEs) requiring treatment occurring within a WA Health HSP must be reported via WAVSS and in accordance with Clinical Incident Management Policy MP 0122/19.

JYNNEOS® is the mpox vaccine used in Australia. This vaccine is available to order on the Onelink ordering platform (external site).

Please be aware that the vaccine has a short expiry, so order limits have been put in place to prevent over ordering and subsequent wastage.

Providers or services that see high numbers of vaccine-eligible individuals are exempt from this order limit. Whole cartons (boxes of 20 vials) are labelled with the vaccine manufacture’s expiry date which is based on frozen storage. Vaccines are thawed to +2 to +8C in batches, to fulfil order requests. The date and time of thawing will be placed on a label adjacent to the frozen expiry and batch details. Vaccine is thawed in batches (not on order demand), and thawed expiry shelf life is up to 24 weeks.

Do not refreeze the vaccine once thawed.

Orders of less than 20 vials will be repackaged by Onelink and relabelled with the original details (including batch number and manufacturer expiry date), along with the revised expiry date and time of the thawed product. If you receive an order without these relevant details, please contact vaccineorders@health.wa.gov.au.

Cold chain management

For information and advice regarding cold chain management of the vaccine, refer to the National vaccine storage guidelines: Strive for 5 (external site) and Cold chain management.

Recording and reporting disposal

Wastage must be recorded as soon as practicable. If a vaccine expires before administration, complete the vaccine expiry form. For other cold chain breaches, immediately quarantine the vaccines in the fridge and seek advice by completing the Cold chain breach and vaccine wastage form (PDF 280KB) and submitting it to your local public health unit. For metropolitan sites, use Cold chain breach and vaccine wastage form (RedCap) (external site).

If you have any questions or concerns about vaccine ordering, please email vaccineorders@health.wa.gov.au.